Abington Memorial Hospital located in the Philadelphia suburb of Abington, has implemented evidence-based clinical practice guidelines for clinicians at the point of care. Barbara Wadsworth, Abington’s chief nursing officer, says the results have reduced care variance, improved interdisciplinary collaboration and increased accountability among caregivers.

“It’s very reassuring to know that nurses and others have access to the data they need to make confident, informed decisions,” Wadsworth says. “We had some guidelines before, but the difference in terms of the quality of the CPM information and its ease of use is like night and day. We feel like we’ve fundamentally transformed the way we provide care.”

Beyond boosting quality, the clinical practice guidelines — along with the interdisciplinary practice framework (CPM Framework) and clinical documentation system that accompanies them — have played a central role in helping Abington achieve coveted Magnet Status under the Magnet Recognition Program, an initiative designed to recognize quality of care, professionalism and best practices in nursing.

Today, the CPM Framework, evidence-based guidelines and clinical documentation system combined with the hospital’s EHR technology — are utilized throughout the hospital’s medical/surgical, pediatric and critical care units. The applications also are being rolled out in the neonatal intensive care and psychiatry departments.

With workstations strategically placed on each unit, the practical benefits of the guidelines and documentation have been immediate, Wadsworth says.

“It gives the novice nurse immediate information that he or she needs to care for the patient,” she says. “At the same time, it provides more experienced clinicians with a reference point for a disease that they perhaps haven’t seen in a while, or one they’ve never cared for before. Now, signs and symptoms of complications, nursing interventions and patient education — everything they need to be doing for that patient — is clearly articulated and just a mouse-click away.”

North Shore-Long Island Jewish Medical Center, (North Shore-LIJ) is partnering with CPM to add evidence-based content to its EHR system and to facilitate the system’s transition to an integrated, enterprise-wide, evidence-based model of practice. Since 2007, North Shore and CPM have zeroed in on interdisciplinary clinical documentation by integrating data previously entered separately by disciplines as diverse as physical, occupational, speech and respiratory therapy, nursing, dietitians, social work, case management, child life and pastoral care.

“Because providers typically completed documentation within their own ‘siloed,’ paper-based documents, redundancy was a severe problem,” says Cathy Halloran, North Shore-LIJ’s Assistant Vice President for Clinical Systems. “Providers often asked patients the same series of questions over and over again, wasting valuable staff time and sometimes annoying patients and family members.”

Implementing a professional practice framework and care model has allowed North Shore-LIJ to move forward with evidence-based practice guidelines across nine institutions. Prior to the system’s involvement with CPM, each hospital had its own screens for patients at risk for pressure ulcers or falls. Using its EHR system, North Shore-LIJ was able to combine best practices for nine hospitals while allowing hospital clinics to develop their own post-anesthesia scoring systems and full-risk assessment programs.

“Our patients can be confident that wherever they go within this system, they will benefit from providers’ use of a single, consistent scale,” Halloran said. “Hospitals also benefit by using the evidence to determine how effectively they achieve outcomes, as well as the impact of the full-risk program on patients.”

While Halloran is pleased that North Shore-LIJ’s work now meets or surpasses the emerging meaningful use criteria, she sees the system’s real drivers as the patient, families and evidence-based care. “We‘re turning Northshore-LIJ into the best place to receive care and to give care,” she said. “No matter where a patient with heart failure goes within our system, we’re confident that he or she will receive the same high level of care.”

Fairview Health Services, based in Minneapolis, in 1999 began developing a strategy to bring clinical documentation to the next level and unite disciplines around interdisciplinary, evidence-based content.

Addressing the problem of discontinuity was a key objective in the effort. Nurses often face what Thomas R. Clancy, Ph.D., RN, Clinical Professor in the School of Nursing at the University of Minnesota, calls “compression complexity”, or the need to respond to anticipated events while handling multiple responsibilities — all within a highly condensed time frame.

Such multi-tasking is often the cause of medical errors, inefficiency and waste, according to Dr. Clancy, who documented his findings in “Improving Patient Safety, Increasing Nursing Efficiency and Reducing Cost through Technology Supported Pull Systems,” published in 2010.

After discovering that the time required to complete inter-shift or professional exchange reports (PER) varied greatly among nursing units (from 40 minutes to more than an hour), Fairview nursing leaders launched a program to reduce end-of-shift compression complexity. To understand the working of the PER process on nursing units, nurse leaders entered into a collaborative study with the University of Minnesota School of Nursing and CPM. The CPM Framework brought with it a process and format for PER that has evolved through the years by leveraging key patient information from the clinical documentation system.

Survey results revealed that nurses completing a PER focused on patient assessment, signs and symptoms, and impending orders, but limited discussion of progress toward goals, integration with interdisciplinary team members and nursing orders, and discharge needs.

From this study, a new process emerged that incorporated an understanding of the patient story and included documentation throughout the day, the “pulling forward” of meaningful patient information, updates by each disciplines and information transmittal to a new shift. It also revealed that nurses who leverage a framework for coordinating and documenting care produced a professional exchange report (PER) cycle time that was 62 percent more efficient than a typical medical/surgical unit. In addition, the nurses enjoyed a 29 percent improvement in PER effectiveness survey scores.