Title : Leveraging nursing informatics to streamline IPOC workflows and improve clinical efficiency
Abstract:
The Interdisciplinary Plan of Care (IPOC) plays a pivotal role in delivering comprehensive and holistic patient care. Despite its importance, the current documentation process within Electronic Health Records (EHR) at Hamad Medical Corporation was found to be redundant and inefficient, leading to delays, increased nursing workload, and potential risk to patient safety. To address these issues, the Nursing Informatics (NI) team initiated a quality improvement project aimed at optimizing IPOC documentation by integrating associated documentation tasks (DTAs) and automating trigger-based IPOC activation. The project's primary scope included enhancing four high-priority IPOCs: Risk of Urinary Catheter Associated Urinary Tract Infection (CAUTI), Risk of Central Venous Catheter Associated Bloodstream Infection (CLABSI), Acute Pain (Adult), and Risk of Impaired Skin Integrity. Key interventions involved linking 50 relevant DTAs to their respective IPOCs and developing automated triggers to suggest the appropriate IPOC based on nursing documentation. These triggers such as catheter or central line insertion dates and detection of pain or skin abnormalities were designed to activate the IPOCs in real time, improving documentation accuracy and efficiency. Launched in August 2023 and concluded in September 2024, the project’s objectives included streamlining documentation, reducing redundancy, saving nursing time, and improving user satisfaction. Additionally, the integration allowed for real-time data capture from interactive view into the care plan, reducing the need for duplicative documentation and ensuring accurate date-time stamping. Quantitative outcomes demonstrated significant time savings across all four IPOCs, with documentation time reduced by an average of 32%, equating to 381 seconds saved per documentation cycle. For instance, the time required to document the CVC infection risk plan decreased from 5 minutes and 26 seconds to 3 minutes and 6 seconds (a 42% reduction), while the CAUTI risk plan saw a 35%-time savings. Nurses reported a 90% satisfaction rate with the improved workflow, indicating strong end-user support and perceived value. The project was executed in two phases: phase one involved mapping and proposal development, while phase two focused on implementation, testing in the CERT domain, training, go-live, and post- implementation evaluation. Challenges encountered included limited SME availability, approval delays, and technical build issues; these were effectively mitigated through proactive communication, flexible scheduling, and tight follow-up with stakeholders and the Health Information and Communication Technology (HICT) team. Key lessons emphasized the importance of realistic timelines, sequential focus on IPOCs, and early stakeholder engagement, especially with HICT and clinical leadership. Based on the successful outcome, the team recommends future review of existing IPOCs for further optimization and expanding similar integration strategies to additional clinical areas. This project exemplifies a model for operational excellence in nursing documentation and offers a replicable framework for other healthcare facilities aiming to enhance documentation quality, reduce the nursing workload, and ultimately improve patient outcomes through informatics-driven solutions.
