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Running head: PREPARING FOR THE INFORMATICS NURSE SPECIALIST ROLE 1

Practicum Proposal: Preparing for the Informatics Nurse Specialist Role

Jennifer Dilly

Ferris State University

April 26, 2012

PREPARING FOR THE ROLE OF AN INFORMATICS NURSE SPECIALIST 2

Abstract

Informatics Nurse Specialists (INS) must adhere to certain professional performance standards as

outlined by the American Nurses Association (ANA). Opportunities to practice these

professional performance standards can be obtained through participation in formal practicum

settings during graduate level educational preparation. The following proposal outlines one such

opportunity and begins with an explanation of the role of an INS including the preparedness

needed to practice within the role. The setting in which the practicum will take place is

described followed by a description of the goals and objectives to be obtained. Descriptions of

certain activities, including a specific Clinical Project, designed to facilitate the accomplishment

of each objective and their timelines are provided as is the background of the preceptor of the

practicum. An explanation of why the preceptor’s qualifications and current practice lends her to

being a fitting preceptor for the practicum is included. An evaluation tool is provided so the

preceptor and student can evaluate the work accomplished and determine whether the student has

met the outlined objectives.

Keywords: Informatics Nurse Specialist, practicum, professional standards


Practicum Proposal: Preparing for the Informatics Nurse Specialist Role

The American Nurses Association (ANA) defines Nursing Informatics as a combination

of nursing, computer, and information science (ANA, 2008). There are different levels of nurses

practicing informatics, with the main differences including educational preparedness and

competency level. Many nurses working in informatics have built their knowledge and skills

based on experience working in the field (Bowman-Hayes, 2009). Some may have even taken a

certification course for informatics, but with increasing technologies and demand for information

management skills; there is a growing expectation for graduate preparedness. An Informatics

Nurse Specialist (INS) is Masters prepared and is expected to adhere to a higher level of

competency and standards. While the ANA (2008) outlines professional performance standards

for all nurses working in informatics, INSs must adhere to these standards as well as an

additional set of standards. The additional standards are learned through Master’s level

educational preparedness. For example, all nurses in informatics would be expected to have the

ability to evaluate and analyze data. The INS, however, would also be expected to know how to

design data collection software or databases that enable end users to obtain useful and

meaningful information.

The purpose and focus of this practicum will closely follow many of the standards for an

INS outlined by the ANA. The practicum will serve as an opportunity not only to view how the

preceptor, an INS performing within the role at a Mental Health services facility, but also

participate in some of the work the preceptor would be responsible for. As McBride (2005)

notes, nurses are one of the largest groups of healthcare providers to use information technology

systems, yet are most likely not be involved with the decision making for those systems. An INS

who, through graduate level preparation, understands the science of nursing as well as computer


and information science, is poised to be that liaison nurses can use to voice their needs within

such systems.

The opportunity to practice knowledge I have gained through the graduate level

preparation will occur through a clinical project. The clinical project includes an analysis of the

medication reconciliation process within the facility’s electronic documentation system and

caregiver workflow surrounding that process. Nursing research and theory coursework has

enabled me to dig deeper for research helpful in formulating new questions and new solutions as

well as how to apply solutions using an applicable theoretical framework. Project management

coursework has facilitated how I have planned the scope and time management portion of the

project and may help me deal with any sudden changes the project may entail. Information

management coursework, including business intelligence and database, information and data

analysis management, has given me knowledge to build pertinent data systems as well as a vision

of how data can be managed using specific systems and software. My past work experience in

quality improvement and regulatory compliance will also add another dimension to the work

within the project. Knowledge of quality improvement includes the ability to data mine, compile

data into meaningful information, and use the information to drive change in practice. Many of

the changes involve aligning care with national standards outlined by regulatory agencies. The

ability to obtain the information to drive change includes the use of electronic data sources.

Literature supports the use of an Electronic Health Record (EHR) in providing accurate

continuity of care for patients (Graetz et al., 2009). Discharge planning, including medication

reconciliation, is a process that should be started at patient admission and on-going throughout a

patients stay (Archie and Boren, 2009). The use of informatics in discharge planning is essential

as the information that is shared between caregivers helps to ensure continuity of care.


Conducting the clinical project will be an opportunity to apply this evidence and practice for the

role of an INS.

The purpose of this paper is to present a proposal for a practicum that will aid in the

preparation for the role of an Informatics Nurse Specialist. An overview of the setting where the

practicum and clinical project will take place will be included. The goals and objectives of the

practicum will be discussed and will include an explanation of how the clinical project will

propel active learning of the role. Information from past specialty concentration coursework as

well as nursing research and theory will be contained in the explanation of the goals and

objectives. The preceptor for the practicum will be identified; her qualifications for assisting

with the practicum and project will be discussed as will her current practice. Activities that drive

the active participation will be outlined giving the reader an idea of the role I will take during the

practicum. A Planning Guide will be included outlining all goals, objectives, activities and the

timelines for accomplishment. Agency approval will be confirmed through the inclusion of an

agency agreement, and an evaluation tool will provide measurement of accomplishments for the

competencies. Finally, a literature resource list will be included showing the information used to

guide the practicum.

Setting

The practicum and clinical project will take place at Pine Rest Christian Mental Health

Services, a facility that serves both inpatients and outpatients including children, adolescents,

adults and older adults. The facility is part of a nationwide health system, Trinity Health. The

setting will include working with a preceptor from the Hospital Based Services (HBS) division.

The HBS consists of 170 inpatient beds in seven units. The units are mostly contained at the

Pine Rest main campus on 68th street in Grand Rapids, MI. The main campus has four adult


units, one older adult unit and one Child and Adolescent unit. There is also an additional

Psychiatric Medical Unit within Saint Mary’s Hospital in downtown Grand Rapids. HBS

provides a wide variety of psychiatric services across all ages.

There are three employees providing Informatics services for Pine Rest’s HBS division.

The preceptor for the practicum covers the nursing informatics aspect of the division, while

another co-worker covers informatics related to physician services. The two work closely

together for a multi-disciplinary approach and are able to cover for one another when necessary.

The third employee is the departments’ Director of Operations in whom the other two employees

report to. The department is not only responsible for development and implementation of

documentation systems, acting as liaisons and technology support between caregivers and the

Information Technology (IT) department, but also to seek out information for the development of

evidence-based policies and procedures.

The facility uses the Cerner product, Powerchart, for their EHR. The preceptor

acknowledges that due to the facility being part of a nationwide health system, a consensus

across the system needs to be reached prior to changes being made. There is also local limited

control over finances that can be used for data systems. Regardless of this, the preceptor and her

co-worker continue to suggest improvements based on their expertise and knowledge of new

evidence and needs for regulatory compliance. The facility is accredited by The Joint

Commission (2012) and so must follow appropriate standards, including the National Patient

Safety Goals (NPSG), recommended by the accrediting body. The preceptor has identified a

need for standardization of documentation in regards to where the documentation is entered and

what documentation nurses provide within the EHR. Without the standardization, the preceptor

has noticed an inability to obtain concise data from the EHR. The setting will therefore provide


an ideal place to learn how nursing, computer, and information science are used by an

Informatics Nurse Specialist.

Goal and Objectives

The goal for the practicum is to advance my learning of the role of an INS using guidance

from the ANA Nursing Informatics Scope and Standards (2008). The INS role is an evolving

one so, through the eyes of my preceptor, I will also be learning what the role means to her and

the mental health services facility where she is employed. There are three particular ANA

standards I hope to follow, (a) Standard 2: Issue Identification, (b) Standard 3: Outcome

Identification, and (c) Standard 15: Advocacy.

Standard 2 has specific objectives including an analysis of caregiver workflow and

documentation processes to identify issues (ANA, 2008). The literature supports that incorrect

usage of technology by caregivers, including electronic documentation, can negatively affect

patient outcomes (Huckvale et al., 2010). Incomplete or inaccurate documentation can decrease

patient safety immediately or in the long term. For example, not adequately following a process

to gather admission information correctly can cause incorrect information to be passed to other

caregivers over and over again, either during the admission or during follow up care after the

admission. The incorrect information can cause errors in patient care, errors that could have

been prevented had issues within the process of documentation been identified and corrected.

Conducting an analysis of caregiver workflow and documentation processes will help identify

issues and get to the root cause of any issues related to technology use. The analysis will allow

future re-designs of workflows that encompass correct usage of technology in practice (McLane

& Turley, 2011).


The objective for Standard 3 includes identifying specific, expected outcomes and the

relation of those outcomes to improved patient care (ANA, 2008). The ability to search

applicable clinical practice guidelines for use in reaching those outcomes is essential. An INS is

expected to search for these guidelines and apply them to practice within clinical systems (ANA,

2008). Systematic reviews of literature are helpful in identifying applicable research and the

most recent evidence. For example, the intent of the review conducted by McGowan et al.

(2010) was to identify the impact caregivers’ electronic access to health information had on the

improvement of practice and patient care. The most recent evidence contained in the review can

be used to help caregivers know what should be expected when improvements have been

implemented. Furthermore, improving patient outcomes is important to the financial stability of

hospitals. Nurses’ provision of care needs to be evidence-based as disparity in care can lead to

decreases in monetary reimbursements (Sanford, 2010). Payers such as The Center for Medicare

and Medicaid Services (CMS) (2012) will not reimburse for certain conditions caused by

healthcare facilities. An INS’s knowledge must include the ability to identify outcomes not only

related to safer, more efficient care, but also to link the outcomes to more cost conscious care

(Sanford, 2010).

The objective for Standard 15 includes advocacy for patients and caregivers through the

promotion of complete and accurate information collection and management (ANA, 2009).

Throughout the practicum the preceptor and I will be looking at the documentation caregivers

provide. I will be advocating for patients by analyzing and standardizing how information is

correctly and privately managed. The clinical project will specifically provide practice for

obtaining competency in advocacy. The project will include improving compliance with The

Joint Commission’s (TJC) (2012) National Patient Safety Goal (NPSG) for Medication


Reconciliation. The NPSG intends to address discrepancies in patient medication lists upon

admission and discharge as to promote better patient outcomes. According to the preceptor for

the practicum, the facility already has electronic medication reconciliation in the documentation

system; however, there is a complex and ill-defined workflow affecting the accuracy of the

process. Advocacy for patients will be obtained if a well-defined workflow is identified.

Following a well-defined workflow will allow caregivers to deliver appropriate and accurate

service that will continue to positively affect care long after the patient has been discharged.

Archie and Boren (2009) conducted a systematic review of literature investigating the impact of

accurate discharge planning, including medication reconciliation, on patient outcomes. Many

poor outcomes were seen in those patients who did not have accurate exchange of information

between caregivers. Some examples of poor outcomes include lack of patient preparedness to

transition to home, vagueness in follow-up care, lack of patient’s empowerment or even

awareness of role within own care, and a decrease in patient satisfaction.

I will be practicing advocacy for caregivers by standardizing how to collect and enter

information in systems so they have provided an accurate service for their patients, as well as

received their own professional benefit. Caregivers will reap rewards from a workflow that

increases team building between providers, increases efficiency in practice, and ultimately

increases job satisfaction (Archie and Boren, 2009). Caregivers will know that they have created

a truly effective transition of care for their patients. Advocacy for caregivers also involves

protection of their own license by providing accurate accounts of the care provided. EHRs need

to be built to guide accurate documentation that when retrieved, provides an accurate view of

care that was delivered. Measures have been taken by groups such as AHIMA to provide

guidelines to help EHR users prevent fraudulent documentation from inadvertently or


intentionally being entered or pulled from other systems (Arrowood et al., 2007). One such

guideline proposed is prohibiting previously entered documentation from being pulled through

and used as the next entry.

Preceptor

The preceptor for the practicum is Pamela (Pam) Hietbrink, a Nursing Informatics

Specialist (NIS) for Pine Rest Christian Mental Health Services at the main campus on 68th street

in Grand Rapids, MI. Pam’s career as a nurse began in behavioral health; however, she quickly

changed her focus to surgery (personal communication, January 9, 2012). She practiced in

surgery at the same hospital for 25 years at it was during that timeframe that she began to show

interest in the technology side of healthcare. She began by working with others in the

organization to computerize the surgical inventory process. Eventually she became the

supervisor over the operating room and started to work on various department improvements

such as managing the surgical patient scheduling system. The interest in making department

improvements led her to the next step in her career as a Quality Coordinator. This position was

eliminated three years after Pam began working in it. She then decided to take the opportunity to

pursue her Master’s in Nursing (MSN) with a focus on Informatics. Her MSN degree was

complete in July of 2009 and shortly after she was rewarded with an opportunity to practice her

degree in her current role at Pine Rest.

Pam chose not to become board certified even though the American Nurses Credentialing

Center (ANCC) (2010) offers a certification in nursing informatics. The certification is not

required, so Pam is relying on her graduate education and her past experience and education as

she practices (personal communication, January 9, 2012). Her current role requires the

development of evidence-based policies and procedures, facilitating the development and


implementation of nursing documentation systems, and service as a liaison between the

information technology department and direct caregivers. Pam’s experience in quality

improvement has added to her ability to search for information to develop the evidence-based

policies and procedures as well as understand how and what data is required to improve patient

care. She is able to translate her knowledge to nurses so they too can understand the importance

of evidence-based care through usage of technology. Pam has experience in advocating for

caregivers and the organization’s needs for improvements to the documentation systems. She

does point out that although her career started in behavioral health, her knowledge of behavioral

health was lacking when she started her role because her experience was over 30 years ago. She

has had to learn her position as she worked in the role especially because she is responsible for

the development of behavioral health policies and procedures.

The American Nurses Association (ANA) (2008) admits that the role of a Nursing

Informatics Specialist (NIS) is not well defined and is still evolving. Someone within this role

may perform somewhat different duties than another with the same title. Pam has met the

competency level required for an NIS through her practice with nursing, computer, and

information science at Pine Rest. She is well beyond a beginning level of nursing informatics

due to her educational background and now her experience within the role, qualifications that

lend her to being an ideal preceptor for this practicum.

Role and Activity Timeline

The role I will take within the practicum will be defined by the activities I will

accomplish for the practicum and the clinical project outlined in the Project Planning Guide

located in Appendix A. The activities for the first objective will take place throughout the fall

semester from August to December 2012. The activities to advance my learning of the role will


first include a review of literature related to the role of an INS. While the role is not yet well

defined, there is still a fair amount of literature to review surrounding its evolution.

Carter-Templeton, Patterson and Russell’s (2009) literature search of required competencies for

informatics nurses revealed that professional nursing organizations are still trying to determine

what competencies are needed for INSs. As of 2009, the ANA also recognized that this role is

not well defined. Newer literature regarding scope of practice and salaries for current INSs as

well as the identification of how they can help organizations is emerging (Anderson &

Sensmeier, 2011; McLane & Turley, 2011).

I will also be meeting periodically throughout the semester with my preceptor and

engaging in weekly or bi-weekly calls which will enable my learning of how she is practicing

within the role. Meeting with her will also allow me to discuss observations I may have about

her practice. I will be attending applicable professional meetings with my preceptor as well as

actively participating in her work towards evidence-based standardization of documentation.

The next activities will be in relation to achieving the objective of meeting the ANA

standard for issue identification. These activities will take place over September and October

2012 and will begin with learning the Cerner Electronic Health Record (EHR) specific to

behavioral healthcare. The documentation requirements for quality initiatives and standards of

care the facility participates in or are required to follow will be reviewed. Data surrounding

patient care will need to be reviewed as trends in data can reveal improvement needs (Roberts &

Sewell, 2011). The data trends may help identify what caregiver workflows and documentation

processes need to be improved. After reviewing, a gap analysis can be performed. The gap

analysis will involve comparing the current workflow with the expected or future state workflow

including what content is required to be documented. Issues and their root causes will be


identified through the analysis so any identified gaps can be addressed (Rueckert, Krenzischek,

& Poe, 2011).

The Outcome Identification objective will be met through a few different activities

conducted from September through October 2012. A review of the literature related to quality

initiatives and standards of care for the facility will already have been conducted for the Issue

Identification objective. The specific expected outcomes for the initiatives and standards will be

outlined for comparison. A review of current patient outcomes for the facility related to quality

initiatives and standards will be completed and used to compare to the already outlined expected

outcomes. The comparison will provide a view of any needed opportunities for improvement in

patient care as reviewing and analyzing data provides an understanding of needed improvements

Roberts & Sewell, 2011).

The final objective, advocacy for caregivers and students, will be achieved through

various activities including a clinical project. The activities will be accomplished throughout the

semester from August through December 2012. The first activity will include obtaining

literature and information surrounding The Joint Commission’s (2012) Medication

Reconciliation NPSG. Knowing what is required for compliance with the goal is important prior

to any analysis. The second activity will be learning what the facility’s current process or

workflow is for performing medication reconciliation. This activity is equally important as

knowing what is required for compliance because it leads to the next activity of identifying the

gaps between current processes and necessary compliance with the NPSG. The next activity

involves clearly identifying the workflow for performing medication reconciliation. The

workflow will need to reach across other disciplines in order to produce accurate outcomes for


patients. Finally, any suggestions for improvements to the documentation system will be

identified.

Preceptor and Agency Agreements

Appendix B contains Student-Preceptor and Student-Agency Agreements. The

agreements summarize the goals, objectives and planned activities that will be completed during

the Practicum and Clinical Project. I have signed both agreements and have obtained signatures

from both the preceptor and a representative of the agency.

Evaluation Tool

Appendix C contains the tool that will be used to determine whether objectives for the

Practicum and Clinical Project have been reached. I will evaluate myself and will obtain

feedback from the preceptor as well. The evaluation will include the determination of whether

the work conducted in the Practicum has exceeded or met each objective or whether more

practice is needed to obtain competency in the role of an Informatics Nurse Specialist (INS).

The evaluation tool is set up to provide tangible examples of how the specific, measureable,

attainable, relevant and timely (SMART) goals have been met (Bovend’Eerdt, Botell, & Wade,

2009). The tool is exclusively qualitative as to allow for the preceptor’s perceptions of the

student’s involvement and especially in response to the nature of a role that continues to be

defined differently by many and ever-evolving (ANA, 2008).

The first objective of obtaining a clear understanding of the preceptor’s role and growing

into the role as an INS will be evaluated through reflections and observations I make as the

student. The preceptor will be able to evaluate my understanding of (a) the literature I have

reviewed, (b) the discussions during any professional meetings I attend, and (c) the work we do

together to standardize various documentation points of care. The bi-weekly and weekly phone


meetings and face-to-face discussions will allow me to share my reflections and observations of

her role and will allow her to obtain a clear sense of how well I understand the role of an INS

and how she functions within that role.

The second objective, meeting the ANA standard for Issue Identification, will include

identifying issues in caregiver workflow and documentation processes. The ANA (2008)

measurement criteria for an INS include the ability to assess current practice and workflow, and

identify any issues through systematic methodologies such as a gap analysis. Issues identified

could include gaps in nursing practice knowledge or usage of technology in applying nursing

knowledge. Part of a INSs role is to identify what helps nurses provide care according to best

practice and includes assessing for their needs related to technology (Hunter, McGonigle, &

Hebda, 2011). The evaluation for this objective will include whether I clearly understand the use

of the electronic health record (EHR) in relation to documentation of care for behavioral health

patients. Knowledge includes documentation requirements for quality initiatives, standards of

care, caregiver workflow, and processes for documentation. The knowledge will become evident

by identification of issues through data review as well as the performance of the gap analysis

between current and expected caregiver workflow.

The third objective includes meeting the ANA standard for Outcomes Identification by

identifying expected outcomes and their relation to improved patient care. The ANA (2008)

measurement criteria for an INS include the ability to identify expected outcomes through use of

current evidence and guidelines and the alignment with quality and cost initiatives. Hunter,

McGonigle and Hebda (2011) support this criteria and feel that INSs, through their knowledge of

nursing practice and various system capabilities, are crucial to identification and translation of

how technology and nursing practice combined provide better outcomes for patients. The


preceptor’s evaluation of my competency in this standard will indicate whether, through

literature review of quality initiatives and standards of care required of the facility, I have

effectively outlined specific expected outcomes as well as current facility outcomes. The

preceptor will also evaluate how I have provided suggestions for improvement related to

documentation of patient care and the desired outcomes.

The last objective, meeting the ANA standard for Advocacy, will include comments

regarding the Clinical Project and will indicate whether I have effectively advocated for patients

and caregivers. The evaluation will include whether the gap analysis of the caregiver’s

workflow related to The Joint Commission’s National Patient Safety Goal for medication

reconciliation led to viable improvement suggestions, including electronic documentation

solutions, and ultimately a clearer workflow. The new workflow would help caregivers be more

efficient and lead to patient advocacy through effective medication reconciliation. Literature

supports that an action, such as providing accurate information to patients, is considered

advocating for patients as it allows patients to take better care of themselves (Degaspari, 2012).

Improving the workflow aligns with the ANA (2008) Advocacy standard expectation for an INS

as the standard criteria includes facilitating caregiver’s usage of information and knowledge in

improving patient care.

Finally, the evaluation tool will be used to obtain information about any other related

comments or recommendations for continued learning. At the end of the tool a separate area is

provided to enable the preceptor to communicate further specific comments and

recommendations related to the Clinical Project within the Practicum. One more area is

provided for comments related to further SMART goal identification. The objectives outlined in


this proposal do not encompass all competencies expected of an INS, therefore, any further goals

the preceptor perceives as necessary to continue my growth into the role can be recommended.

Conclusion

The American Nurses Association (ANA) outlines specific competencies required of an

Informatics Nurse Specialist (INS). This practicum proposal outlines how the practicum will

provide an opportunity to practice some of the specific competencies required by the ANA as

well as how the preceptor, currently practicing as an INS, performs within this evolving role.

The preceptor’s background lends her to be an ideal preceptor for this practicum. Through use

of the provided evaluation tool, the preceptor and student will have the opportunity to evaluate

the obtainment of objectives pertaining to; (1) the understanding and growth into the role of an

INS, (2) meeting the ANA standard for Issue Identification, (3) meeting the ANA standard for

Outcomes Identification, and (4) meeting the ANA standard for Advocacy through a Clinical

Project related to The Joint Commission’s National Patient Safety Goal for medication

reconciliation. Activities and their timelines for completion are clearly outlined giving the

preceptor and student specific, measureable, attainable, relevant, and timely examples to use in

the evaluation of whether each objective was accomplished. The evaluation tool also provides

for additional preceptor recommendations related to the student’s further development into the

role of an INS.


References

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practice. Washington, D.C.: Nursesbooks.org.

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APPENDIX ANURS 730 Practicum Planning Guide

Practicum: Preparing for the role of an Informatics Nurse Specialist Clinical Project: Compliance improvement surrounding the Medication Reconciliation NPSG

Goals Objectives Activities TimelineGoal 1:Advance my learning of the role of an Informatics Nurse Specialist (INS) using guidance from ANA Nursing Informatics Scope and Standards (2009) throughout Fall semester 2012. Three standards will be addressed including:

Standard 2:Issue Identification

Standard 3:Outcome Identification

Standard 15:Advocacy

1.1Enhance my understanding of the role of an INS and encourage my growth into the role.

1.2 Standard 2: Issue Identification.Analysis of caregiver workflow and documentation processes to identify issues (ANA, 2009).

1.1aReview literature related to the role of an INS.

1.1 bMeet with preceptor to review various aspects of her current role and responsibilities and student’s observations of the role.

1.1 cAttend applicable professional meetings with preceptor.

1.1dActively participate with preceptor’s (and co-worker when necessary) work to standardize the organization’s documentation and search for applicable evidence.

1.2aLearn Cerner EHR related to Behavioral Health care.

1.2bReview what quality initiatives or standards of care the facility is involved with and the documentation

1.1aAugust - September 2012

1.1 bAugust - December 2012

1.1 cAugust - December 2012

1.1dAugust - December 2012

1.2aSeptember 2012

1.2bSeptember 2012


1.3 Standard 3:Outcome IdentificationIdentifying specific expected outcomes and the relation to improved patient care (ANA, 2009).

requirements.

1.2cReview data surrounding quality initiatives and standards of care.

1.2dLearn current caregiver workflow and processes for documentation.

1.2ePerform gap analysis between current and expected workflow including documentation content.

1.3aReview literature about current initiatives and standards of care facility is required to comply with.

1.3bOutline specific outcomes expected for initiatives and standards.

1.3cReview current patient outcomes for the facility and examine need for improvements related to patient care.

1.2cOctober2012

1.2d October 2012

1.3aSeptember 2012

1.3bOctober 2012

1.3cOctober 2012


1.4 Standard 15:AdvocacyAdvocating for patients and caregivers through the promotion of complete and accurate information collection and management. The Advocacy standard will be practiced during the clinical project as compliance with The Joint Commission’s National Patient safety Goal for medication reconciliation will be improved (ANA, 2009).

1.4aReview literature related to accurate documentation capture to promote better outcomes.

1.4bReview of literature related to NPSG for medication reconciliation including requirements for documentation

1.4cReview current caregiver workflow related to medication reconciliation

1.4dPerform gap analysis by comparing current workflow with requirements for compliance with NPSG

1.4ePrioritize gaps according to need

1.4fSuggest improvements to caregiver workflow, create outline of future state of workflow

1.4gSuggest improvements to documentation system

1.4aSeptember 2012

1.4bSeptember 2012

1.4cOctober – November 2012

1.4dOctober – November 2012

1.4eNovember – December 2012

1.4fNovember – December 2012

1.4gNovember – December 2012


APPENDIX BPreceptor and Agency Agreements


APPENDIX C

Student-Preceptor Evaluation Tool

Student ____Jennifer Dilly______Preceptor ___Pamela Hietbrink___

For each objective, please provide comments or examples as to how objectives were exceeded, met, or not met.

Preceptor and Student Evaluation ToolObjective 1.1 Enhance the understanding of the role of an INS and encourage growth into the role.The student has actively participated in learning the role through literature review and discussions regarding the preceptor’s role. There has been active participation in discussions within applicable professional meetings as well as with the regular phone and face-to-face meetings. Through active participation with the preceptors’ work to standardize the organization’s documentation, there is evidence that the student understands what the role of an INS entails.Preceptor Comments/Examples

Objective Exceeded Objective Met Objective Not Met

Student Comments/ExamplesObjective Exceeded Objective Met Objective Not Met

Objective 1.2 Standard 2 - Issue Identification: Analysis of caregiver workflow and


documentation processes to identify issues (ANA, 2009).The student clearly understands the use of Cerner EHR in relation to documentation of care for behavioral health patients. Knowledge includes documentation requirements for quality initiatives, standards of care, caregiver workflow, and processes for documentation. The knowledge is evident by identification of issues through data review as well as performance of gap analysis between current and expected caregiver workflow.Preceptor Comments/Examples



Objective 1.3 Standard 3 - Outcome Identification: Identifying specific expected outcomes and the relation to improved patient care (ANA, 2009).Through literature review of quality initiatives and standards of care required of the facility, the student has effectively outlined specific expected outcomes as well as current facility outcomes, and has provided suggestions for improvement related to documentation of patient care. Preceptor Comments/Examples




Objective 1.4 Standard 15 – Advocacy: Advocating for patients and caregivers through the promotion of complete and accurate information collection and management. The Advocacy standard will be practiced during the clinical project as compliance with The Joint Commission’s National Patient Safety Goal for medication reconciliation will be improved (ANA, 2009).Through literature review, the student has gained an understanding of the relation of accurate documentation capture, including medication reconciliation, in the promotion of better outcomes. The evidence of this understanding is shown through the performance of a gap analysis of caregiver’s current workflow for medication reconciliation related to the requirements for compliance with The Joint Commission’s National Patient Safety Goal, and the ability to suggest viable improvements to the workflow and documentation system.Preceptor Comments/Examples




Clinical Project Specific:Please provide any comments or recommendations related to the deliverables (gap analysis, re-designed workflow, summary of improvement suggestions) for the Clinical Project.

The above objectives do not cover all competencies related to the role of an INS. To continue growth into the role beyond the obtainment of the above evaluated objectives, further SMART (specific, measureable, attainable, relevant, timed) goals recommended include:

Student Signature __________________________________ Date __________________

Preceptor Signature ________________________________ Date __________________


APPENDIX D

Bibliography/Literature Resource List

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(2011). HIMSS position statement on transforming nursing practice through technology

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American Nurses Association (ANA). (2008). Nursing informatics: Scope & standards of

practice. Washington, D.C.: Nursesbooks.org.

American Nurses Credentialing Center (ANCC). (2010). Informatics Nursing. Retrieved from

http://www.nursecredentialing.org/NurseSpecialties/Informatics.aspx

Anderson, C. & Sensmeier, J. (2011). Nursing informatics scope of practice expands, salaries

increase. CIN: Computer, Informatics, Nursing, 29(5), 319-320.

doi:10.1097/NCN.0b013e3182269d99

Archie, R. R. and Boren, S. A. (2009). Opportunities for informatics to improve discharge

planning: A systematic review of the literature. AMIA 2009 Symposium Proceedings.

Symposium conducted at the meeting of AMIA, San Francisco, CA.

Arrowood, D., Choate, E, Curtis, E., DeCathelineau, S., Drury, B., …and Williams, M. (2007).

Guidelines for EHR documentation to prevent fraud. Journal of AHIMA, 78(1), 65-68.


Bovend’Eerdt, T. J., Botell, R. E., and Wade, D. T. (2009). Writing SMART rehabilitation goals

and achieving goal attainment scaling: A practical guide. Clinical Rehabilitation, 23(4),

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Overview. Retrieved from http://www.cms.gov/hospitalacqcond/

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and electronic health records: Connecting clinicians. AMIA 2009 Symposium

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19(Suppl 2), i25-i33. doi:10.1136/qshc.2009.038497


Hunter, K., McGonigle, D., & Hebda, T. (2011). The importance of INSs. Health Management

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providers to improve practice and patient care. The Cochrane Database of Systematic Reviews,

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technologies on registered nurses' work. Clinical Nurse Specialist, 22(3), 132-140.

doi:10.1097/01.NUR.0000311693.92662.14

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