Factors Disrupting the Preference Card Management Process: A Root Cause Analysis.

Preference cards, the nexus of an efficient OR, help ensure that OR personnel have what they need to safely and efficiently care for surgical patients. In June 2013, a new electronic health record (EHR) was implemented in the ORs of the Duke University Health System, Durham, North Carolina. Although it was an integrated system, the EHR disrupted supply management in the OR, which affected the availability of correct resources. The project team performed a process-improvement project using root cause analysis (RCA) to identify the factors that led to the disruption in the preference card management process for orthopedic surgical procedures. Team members identified that a chief cause of resource disruption was the mistiming of interface messages that created the pick lists and requisition forms. Based on the results of the RCA, the project team developed and implemented recommendations for process improvement.

Clinical Decision Support for Nurses: A Fall Risk and Prevention Example.

Clinical decision support tools in electronic health records have demonstrated improvement with process measures and clinician performance, predominantly for providers. Clinical decision support tools could improve patient fall risk identification and prevention plans, a common concern for nursing. This quality-improvement project used clinical decision support to improve the rate of nurse compliance with documented fall risk assessments and, for patients at high risk, fall prevention plans of care in 16 adult inpatient units. Preintervention and postintervention data were compared using quarterly audits, retrospective chart review, safety reports, and falls and falls-with-injury rates. Documentation of fall risk assessments on the 16 units improved significantly according to quarterly audit data (P = .05), whereas documentation of the plans of care did not. Retrospective chart review on two units indicated improvement for admission fall risk assessment (P = .05) and a decrease in the documentation of the shift plan of care (P = .01); one unit had a statistically significant decrease in documentation of plans of care on admission (P = .00). Examination of safety reports for patients who fell showed all patients before and after clinical decision support had fall risk assessments documented. Falls and falls with injury did not change significantly before and after clinical decision support intervention.