NK8EOb

 

Innovation NK8EO

 

Using the required empirical outcomes (EO) presentation format, provide one example of an improved outcome in an ambulatory care setting associated with clinical nurse(s) involvement in the adoption of technology. 

 

 

Example b: Clinical Nurse Involvement in the Adoption of TeleHealth Increases Patient Experience Scores in the Emergency Department

Problem
The Emergency Department (ED) at Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) had lower than expected patient experience scores for the Press Ganey survey item, “Staff cared about you as a person.”

 

Pre-Intervention

Amy Elder, BSN, RN, ED Clinical Nurse, collaborated with Kayla Bullard, BSN, RN, ED Nurse Manager, to adopt telehealth technology for ED clinical nurses to provide care for sexual assault victims. Elder had cared for a sexual assault patient and believed she lacked the proper knowledge and training based on the current ED practice. Bullard, as the nurse manager of the ED, was aware of the opportunity to improve the patient experience in the ED.

 

In June 2022, the Press Ganey (PG) top box percentage for “Staff cared about you as a person” was 47.10%, which was lower than expected.

 

Goal Statement

To improve the PG top box percentage for “Staff cared about you as a person” in the ED at CHI SVHS.

 

Participants

 

 

SANE Telehealth Work Group

 

Name/Credentials

Discipline

Title/Role

Department

Amy Elder, BSN, RN

Nursing

Clinical Nurse

Emergency Department

Kayla Bullard, BSN,
RN

Nursing

Nurse Manager

Emergency
Department

Jaime Spencer, BSN, RN

Nursing

Stroke Coordinator

Emergency Department

Sherry Searcy-Lyle, BSN, RN, SANE-A

Nursing

Director University of Arkansas for Medical Sciences

University of Arkansas for Medical Sciences

Rhiannon Zerbe, BSN, RN, SANE-A,
SANE-P

Nursing

Forensic Nurse

University of Arkansas for
Medical Sciences

 

Description of the Intervention
July 2022

  • Elder met with Sherry Searcy-Lyle, BSN, RN, SANE-A, Director University of Arkansas for Medical Sciences (UAMS) Institute for Digital Health & Innovation (IDHI) TeleSANE program.
    • Searcy-Lyle explained the evidence-based practice (EBP) telehealth program and the onboarding process for CHI SVHS’s ED to adopt this technology, which included signing a contract to follow their policies and procedures of the program, getting the equipment, and training ED clinical nurses on the telehealth cart and the colposcope forensic camera. The services provided by UAMS would include CHI SVHS following the policies and procedures of the IDHI Digital Health Sexual Assault Assessment Program. The policies and procedures include reporting to law enforcement, completing medical records, understanding retention and release of information, evidence integrity, sexual assault forensic kits, understanding human trafficking, completing speculum exam, caring for adolescents, managing sexually transmitted infection prophylaxis, obtaining consent to treatment, and the role of victim advocate.
    • Technology used as part of the program included the TeleCart, colposcope camera, and speculum
    • Training would include policies and procedures, patient-centered care with a vulnerable population with an extremely sensitive examination, protecting the patient’s dignity, use of the TeleCart materials and storage, colposcope, sexual assault kit, how to document, and necessary forms to complete
  • Elder brought this information back to CHI SVHS and shared it with Teresa Lambert, MBA, BSN, RN, Vice President Patient Care Services, Assistant Chief Nursing Officer (role of CNO).
  • Lambert shared this information with Douglas Ross, MD, FACHE, President CHI SVHS, who agreed to adopt the UAMS TeleSANE program. The contract with UAMS was signed, and Elder immediately connected with IDHI to arrange dates for education.

 

August 2022

  1. Rhiannon Zerbe, BSN, RN, SANE-A, SANE-P, Forensic Nurse, UAMS, reached out to Bullard to schedule training dates for the clinical nurses for the UAMS TeleSANE program. The in-person training would be provided to all ED clinical nurses who might be involved in caring for sexual assault victims.

 

September 2022

  • Zerbe educated every ED clinical nurse available at the time of the scheduled training and then educated those who were not available at the time. The training incorporated the following:
    • Patient-centered care for vulnerable patients, ensuring their dignity during an extremely sensitive examination.
    • Initiation of exams through completion, which involved the adoption of technology. The ED nurse logs into TeleCart, and the SANE nurse connects within 10 minutes. The ED nurse clicks on the consult icon on the TeleCart to request a phone call or video consult. ED nurses have to connect the iPad to the cart, understand real-time streaming to the TeleSANE hub nurse, share the screen, use the touchscreen monitor, and seamlessly conduct an online meeting through Cisco Support. ED nurses must also understand data control through the TeleCart to ensure patient privacy and confidentiality.
    • SANE nurses then guide ED nurses through the exam. The ED nurse acts as the telehealth SANE nurse’s “hands.” The ED nurse completes the UAMS medical-forensic sexual assault examination form. At the conclusion of the exam, the telehealth SANE nurse provides the victim (patient) with follow-up appointments in the community and assistance with obtaining prophylactic medications if needed.
    • Use of the colposcope technology – Lutech SD-300 – forensic camera connected to the TeleCart via USB and HDMI ports. The colposcope includes a lens cap, LED group light, enclosure, mini LCD screen, foot pedal, and built-in camera. ED nurses learned how to share screens, store images, and perform forensic photography. Specifically, they were taught to bookend which is taking a picture of a patient identifier as the first picture in the series, the photos of the patients injuries, and then a picture of a patient identifier again as the last picture in the series. They then apply the rule of three’s, which is a distant orientation photo, an up close photo of the injury, and an up close photo of the injury with a ruler. This rule is used for every documented injury. The background used is a blank wall with no equipment, people, or pictures in the photo. The ED nurses were taught to avoid taking pictures of the victim’s face unless there are injuries on their face.
    • Sexual assault kit instructions included information about kit security, meaning that once a kit is unsealed, one does not walk away from it. The kit contains multiple envelopes and an evidence bag, each labeled with suggestions of what to collect (blood, hair, oral swab, vaginal swab, etc.). Collections are completed by the ED nurse under the guidance and direction of the TeleSANE nurse and put in the kit. The associated paperwork is completed and put in the kit at the end of the examination and sealed with evidence tape. The kit is then placed in locked storage and picked up by law enforcement within three days. A log is kept in the storage room for placing or picking up kits.
    • Documentation and the necessary forms to complete include the four-page consent that provides permission for the ED nurse to connect with a SANE nurse via the TeleCart and share information with the telehealth nurse.

 

The ED nurses appreciated the education they were provided and their ability to partner with the telehealth SANE nurse for the exams. The UAMS TeleSANE partnership greatly enhanced the confidence of the ED clinical nurses, which gave the ED nurses the ability to show patients that they cared about them as a person. After the ED clinical nurses completed the training, the UAMS TeleSANE program was activated, and they began using the TeleCart and the colposcope. The adoption of technology to better care for patients as people was communicated in daily huddles and on the CHI SVHS Facebook page.

 

The interventions were fully implemented by the end of September 2022.

 

The involvement of Clinical Nurse Elder and the rest of the ED nursing team in adopting telehealth technology in the CHI SVHS ED was associated with an improvement in the top box percent score for “Staff cared about you as a person.”

 

References

Eman, A., Kamel, M., Sobhy, A., El Rasheed, S., & Abdelkhalek, M. (2019). Sexual assault forensic examination in adult and child cases: Is Colposcopy really necessary? Instant Journal of Forensic Science, 45–58. https://doi.org/10.36811/ijfs.2019.110007

 

Meunier-Sham, J., Preiss, R., Petricone, R., Re, C., & Gillen, L. (2019). Laying the foundation for the National Telenursing Center: Integration of the quality-caring© model into Telesane Practice. (2019). Journal of Forensic Nursing, 15(3). https://doi.org/10.1097/jfn.0000000000000255

 

Outcome

(Evidence NK8EOb-1, CHI SVHS ED – PG Top Box Percent Staff Cared About You as a Person Graph)