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Championing Evidence-Based Interdisciplinary Plans of Care for the Neonate: Where Do You Begin?
Title: Championing Evidence-Based Interdisciplinary Plans of Care for the Neonate: Where Do You Begin?
- Describe the process used to develop, implement, and evaluate interdisciplinary, evidence-based plan of care within the electronic health record (EHR) for the neonatal population.
- Describe innovative strategies to assist in the adoption of interdisciplinary, evidence-based plan of care.
- Identify challenges and opportunities for interdisciplinary care coordination for the neonatal population using interdisciplinary, evidence based plans of care.
To describe the main strategies used by a multi-site hospital system to develop and adopt interdisciplinary, evidence-based plans of care (IPOC) within an electronic health record (EHR) for the neonatal population.
Proposed change:
The EHR project vision at this organization was to provide a fully integrated, enterprise-wide, single patient EHR based on current science that supports and enhances patient safety, patient experience, patient- and family-centered care, interdisciplinary practice and collaboration, and capacity/revenue management. The EHR project was to replace several computer systems/paper and move from a fragmented discipline-specific approach to an interdisciplinary model of care.
Implementation, outcomes and evaluation:
To fully realize this vision from beginning to adoption, a cultural transformation needed to occur and was defined in the Clinical Documentation Philosophy and Guiding Principles. These principles provided the foundation to support the project’s vision. The vigorous selection process for an EHR system and IPOC content that incorporated this philosophy was crucial.
A project management team with evidence-practice expertise was employed to collaborate with an interdisciplinary team of subject matter experts. The first step was to prioritize needed IPOC content for all populations. This team then developed the general IPOC content.
A second interdisciplinary team was assembled to develop content specific to the neonatal population. This team first identified the need for gestationally-based IPOCs (pre-term, late-preterm, and term newborn). Specialty content addressing additional neonatal medical conditions and procedures was identified with an emphasis on prevention of nosocomial complications/infections, family-centered care, breastfeeding, and neurodevelopmental promotion. This was challenging, yet exciting to hear all of the disciplines speak to their own expertise about providing care for neonates. This team developed the IPOC content using a third-party content vendor of evidence-based IPOC templates and an on-line blogging technology to seek feedback from clinicians.
Innovative strategies were used to facilitate interdisciplinary use and adoption. Preparatory education and training strategies included: on-line learning modules, lectures, simulation labs, access to practice learning environments, and real-time on-line information. Post go-live strategies included real-time updates on the organization’s Intranet to communicate system status/problems, daily hot topics, tip sheets as well as end-user bedside support and chart audits.
A total of 187 IPOCs were developed over a 24-month period of which 18 were neonatal-specific and 24 were neonatal/pediatric-specific.
Implications for nursing practice: Include future opportunities to evaluate of the impact of the IPOCs on clinical outcomes.
Keywords: plans of care, neonatal, electronic health record, interdisciplinary, evidence-based practice