NURSING IT INNOVATION AWARD
requirements are met. That removal might
happen within a few hours. Even if the
doctor skips the discontinue order, nurses
still go in and review the catheter insertion
against clinical guidelines. They will call the
physician if removal is warranted.
Some patients, says Batch, have legitimate
reasons for leaving a catheter in. “If you are
monitoring urine output, you need to leave it
in,” she says. Batch played a key role in recon-
figuring the order entry system to accommo-
date the discontinue-per-protocol order. She
led a group of four I. T. application builders,
who are also nurses. The task was exhaustive:
the group had to rewrite and test changes to
more than 1,600 order sets. That’s because a
catheter insertion order is usually embedded
in order sets tackling a much broader range
of procedures and conditions, such has open
heart surgery and pneumonia. “We identi-
fied the order sets which had ‘insert foley’
and replaced with a combined order/discon-
tinue protocol,” Batch says.
Terese Kornet, R.N., director, nursing systems; David Stabile, R.N., senior clinical analyst
and Mika Epps, R.N., lead clinical analyst (left to right) drove the Penn Medicine effort.
ber of catheter-line days fell to 1. 41—about
half of what it was prior to go-live. When
physicians ordered a catheter with no protocol, the line days still fell to 1. 88.
Batch says the group considered activat-
ing an alert feature in Epic to remind nurses
about doing a catheter removal assessment.
But when it began the project in early Feb.
2011, the alert feature was not fully devel-
oped in the EHR, so they held off. “Nurses
are compliant and doctors are using the
discontinue order without the alert,” says
Batch. “That will reduce alert fatigue.”
Mitchell, the CNIO, played a lead role in
gaining physician acceptance of the new
workflow. The medical executive commit-
tees at each of the 14 hospitals had to agree
to turn over the catheter removal decision
to the nurses. “It is a nurse-driven protocol,
but physician-initiated,” Batch says. “There
were a lot of moving parts.”
BRONZE PRIZE
UNIVERSITY OF
PENNSYLVANIA
HEALTH SYSTEM
Location: Philadelphia
Size: 1,700 beds across three hospitals
IT Project: Nurse-driven
vaccine protocol
U-Penn’sproject wasdrivenbyrecent regulations from CMS that call for all patients discharged from acute
inpatient facilities to be assessed for, and offered, vaccines for flu and pneumonia. The
new measures took effect Jan. 1, 2012, and
the academic medical center—also known
as Penn Medicine—sprang into action, forming in February a multi-disciplinary team to
tackle the problem. The new protocol was
activated in late August and resulted in a
more streamlined workflow. The project led
to both a reduction in inappropriate vaccine
orders being fired and ultimately, more vaccines being administered. Nearly 90 percent
of patients are now assessed, thanks to modifications in the order entry workflow.
Photo by Emile Wamsteker
