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Carolinas HealthCare System

Carolinas HealthCare System optimizes solutions to save time, improve nurses’ workflows and patient care

When Carolinas HealthCare System decided to take on a massive optimization project, staff members learned every click counts. The three-year optimization project impacted 12 facilities, more than 8,000 nurses and nursing assistants, and eliminated millions of clicks which left clinicians, celebrating.

“We had Cerner in place for 10 years and needed to make a change,” said Becky Fox, MSN, RN-BC, assistant vice president and chief nursing informatics officer. “By simplifying, standardizing and optimizing documentation, it improved the workflow of our nurses.”

The optimization project focused on five key areas: task reduction, position alignment, medication improvements, migrating from PowerForms to iView, and interdisciplinary plan of care (IPOC) implementation

Task reduction identified and eliminated 66 routine patient care tasks, removing more than 18 million annual clicks.

“It really helped get rid of noise in the EMR,” Jason Mauney, nurse manager from pediatric progressive care.

“Small changes can really have a large impact,” said Fox. Staff saw a 15 percent improvement in on-time medication administration by aligning with Cerner recommendations and extending the medication administration timeframe window from 30 to 60 minutes. “This simple change eliminated another 400,000 clicks and extra steps by the nurse.”

The biggest impact occurred when clinicians migrated from PowerForms to iView, using Cerner model content, which provided a simpler, cleaner view when nurses logged in. The redesign included less visible content, larger fonts to make it easier to read, eliminated redundancies and organized information in a more user-friendly format. Ten additional assessment tools helped guide nurses and collectively, reduced the time to document a head-to-toe assessment by 20 percent, which returned more than 35,000 estimated hours back to nurses.

“When you give nurses back time, this translates to more time with their patients, and ultimately, better patient care,” Fox said.

While the optimization project focused predominantly on documentation, Carolinas HealthCare System took the opportunity to couple it with other important work, implementing two clinical decision support tools. The early detection alert (EDA), Cerner’s sepsis tool, monitors for deteriorating/sepsis; and the CHS-designed C. difficile Screen which monitors upon admission and daily for the contagious colon infection.

From May 2016 through March 2017, the EDA fired more than 14,800 alerts, 32 percent leading to additional patient evaluations and/or new orders. For the same time frame, the automatic screen identified 124 patients with C. difficile, 75 (60%) of which were considered community acquired infections – facilitating timelier isolation, treatment and protection of other patients and clinical staff.

Carolinas HeathCare System’s last phase of optimization went live May 2017 with the implementation of (IPOC). “The new IPOC tool is faster and easier for the whole care team to focus on the patient’s plan of care,” said Eugenia Ashwood, RN.

“Partnership was key to our project success, and using technology in the most efficient way, was key to helping our nurses be their best,” said Fox.

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.