Thanks to Kelly Aldrich DNP, MS, RN-BC, Informatics Nurse Specialist, Chief Clinical Transformation Officer at Center for Medical Interoperability for this resource!
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Nursing Informatics in Times of COVID 19: Achievements, Challenges, and New Ideas
April 14, 202012:00PM- 1:00PM,EDT
In collaboration with AMIA’s Nursing Informatics Working Group and the Alliance for Nursing Informatics, the AMIA COVID-19 Webinar Series continues with a presentation highlighting the contributions of nursing informatics.
A team at EBSCO Information Services has created COVID-19 Information and Updates, an online information portal with valuable resources for healthcare professionals, librarians and medical researchers related to the evolving pandemic.
It has been my pleasure to interview nursing informatics leaders this week to help share their learnings and experiences around the COVID-19 pandemic. It has been so informative to hear the creative solutions are being implemented in the field! Please check out the videos at ANIA’s YouTube channel or you can download the podcasts. More interviews coming this week and next! Cheryl
April 14 at 12PM Eastern – In collaboration with AMIA’s Nursing Informatics Working Group and the Alliance for Nursing Informatics, the AMIA COVID-19 Webinar Series continues with a presentation highlighting the contributions of nursing informatics.
The lack of a national or global unified response to the COVID-19 pandemic presents health care professionals with the greatest challenge of their careers. As informaticians create systematic responses to a host of issues – eg, creating terminologies, tracking and predicting outbreaks, ensuring practitioners’ personal safety, establishing telemedicine systems, and using AI to develop new diagnostics and treatments – it is critical to exchange information in real time to determine best practices in uncharted territory. During this webinar, nurse informaticians share information about how they are “building the airplane while flying” and using nursing informatics to respond to this global crisis. The live webinar is being planned as a certified continuing nursing education activity.
This international effort has been developed by stakeholders from 8 countries and 26 states, and represents 70 interventions for 15 roles across the care continuum. To participate, contact Karen Monsen at the University of MInnesota Center for Nursing Informatics, firstname.lastname@example.org
“So first in Michigan (Detroit and Southeast Michigan) – we are not gearing up we are in the midst of a big surge so these are more of our actual actions. The first day that Michigan declared a state of ER and The Federal Government as well – we came together as an IT team (Epic, Infrastructure, Analytics, Clinical Informatics) and discussed our response. We immediately initiated what we call our “go-live command center.” This was a well-established process from our Epic go-lives that all of our teams are familiar with the process. We have delivered on every request in the time needed so far. We also canceled our April Upgrade and training.” Donna Summer, MSN RN-BC CNIO HFHS
The following are notes from the field sent from the CNIO on how they have met the need so far. (Date: April 1, 2020) Here is what Henry Ford Health System did:
Activated what we call our go live command center
Stopped all other work
Identified the top priorities and put efforts only toward those items
Documented and provided owners operational and Epic IT team to track work
Put Redeployed PM’s1 on two MACC2 groups (build new depts)
Twice daily meetings to check in and reprioritize work
Embed nursing informatics in site incident command centers to anticipate needs (leaders are too busy to reach out)
Daily team meetings to provide system and Helios updates to teams
Ability to quickly change current practice in order to expedite work. Examples:
1 PM=project managers 2 Healthcare MultiAgency Coordination Center (H-MACC)
Giving Epic access prior to training and then quickly creating elearnings and webinars. Because these areas are part of our teams we could move fast.
Clinical informatics people who can guide clinical build instead of waiting for others to direct.
Identifying change management and education needs.
10. Look at dashboard and capacity and make the decisions for the system to respond to.
Here is just some of the work HFHS has done since emergency declared – and Nursing Informatics has been instrumental
Average creating one to two more departments per day to increase both ICU and Med- Surg capacity (this is a multidisciplinary team that has now been working 19 days straight) and this is not slowing down.
Today (April 1, 2020) we are creating a Medical units in two ambulatory sites and two field hospitals to house in patients who are stable but can’t be transferred to SNIF’s because either the SNIF’s don’t have the ability to care for them or we are waiting for subsequent negative COVID tests.
Amazing Pathology Informatics people who were one of the first in the country to come up with a test so we were fortunate to have internal testing nearly from the beginning
Cancelled all nonemergent procedures/surgeries
Closed multiple clinics
Increased capacity for televisits and added using Haiku for televisits – we are averaging about 300 concurrent sessions now
Developed a Nursing Disaster Navigator with reduced documentation/policy – implemented this within 1 week of the disaster and so much needed (NIS, CNS). We copied Vanderbilt’s design and policy3. Used Epic’s idea but had to build ourselves using our content (Elsevier)
Asked to participate in a regional COVID strategy sharing meeting – we had implemented all of the recommendations but most of the participating hospitals had not. (We shared with Chicago hospitals what we built in our disaster navigator).
Started today on a RT disaster documentation – anticipating standalone vents in unusual places without device integration – need to shorten Vent documentation
Device integration and central monitoring is a big need as we go into unusual areas for patient care – they are as busy as our build teams
We have given as many as 3 Epic documentation roles to redeployed staff
Redeployed many people and nurses – created expedited access and on the fly eLearning training. (Thank God for the disaster navigator because we are just now training nurses to this.)
Screening tents, clinics were deployed in the first days
But it took us about >1 week to set up pools for results for notification
Employee plans for exposure, testing and back to work always evolving – biggest issue with surges is nursing staff. But also EVS, providers. (At one of our sites we have >100 staff awaiting results or recovery to come back to work.)
Updating Body disposition policies and documentation
Added a screening bot for patients
Used MyChart to send messages to patients
3 Tie to Vanderbilt’s Nursing Documentation recommendations—see additional resources
Developed dot phrases that have discharge instructions centrally and can be updated when changing
Worked with Healthwise to get basic discharge instructions, patient videos. Put in English and Spanish, but paid to get Bengali and Arabic too (large populations in our areas).
Really hard to help redeployed staff: AMB RN to IP, CRNA’s to ICU/ED or APP role, Techs, Aides, IP RN to ICU RN, – no end to the different combinations – so lots of access/training with elearnings and webinars by nursing informaticists
Stopped all onsite classroom training last week (not ideal in helping our RN’s who are redeployed). Even new hire nurses – webinars (not a best practice but only option right now)
Lots of NI support for CRNA’s in new roles – want to use their Anesthesia tools for an IP encounter – same with their perioperative nurse counterparts.
In general a lot of scared redeployed nurses both of COVID but also of their lack of experience in these specialties. Started this week with some alternate nursing models
Analytics, Analytics – everybody and their brother external to the health system wants data – one letter from VP Pence had approximately 72 data elements in it.
We were able to get basic dashboards going quickly – COVID admitted patients, pending tests, patients in isolation. Recently added our discharged alive and deaths. Doing our own predictive models related to our data only.
Employee testing dashboards, transfer data – now working on hand off preparation if we send patients to the newly planned FEMA field hospital.
Analytic challenge tracking capacity – we have to continually update as we change units to COVID, NON-COVID, ICU, GPU, Mixed acuity etc. . . .
Some absolutely phenomenal build done by our Epic team that fortunately has NI’s on it and our NIS. And thank goodness we have nurses – because operations can’t spare anyone to help us with order sets, bpa’s and triage build
Triage system with auto-calculation of SOFA/mSOFA (amazing) and color codes. (Hoping we don’t have to do this but ready.)
Order sets for terminal weans
Comfort Hospice care orders – the protocols are really hard to follow and we anticipate some might happen outside our ICU’s. Influenced the decision to use an assessment score to determine actions. NIS developed a Visio and education. We go live with that tomorrow.
Amazing pharmacist informatics people for complex order sets
COVID order sets
Constant movement of providers and clinics and then schedules too
“I am sure I missed at least 50 things because the pace is crazy. Glad to share with anyone who needs help. They should have a plan!”
Notes on staffing challenges:
“Frequent thanks and reminders that our clinicians have it worse than us (many have worked 14 days straight). Not good at thinking long term on staff and their ability to keep this pace. We have people that do not have back up. Good at short term; we have to figure out how we maintain this pace.”