Making the Grade

EMRs can help improve long-term care report cards.

By Phyllis A. Rosenberger, RN

Several initiatives have evolved over the last few years aimed at improving care in skilled nursing facilities. CMS's Nursing Home Compare, the Advancing Excellence in America's Nursing Home Campaign and the 2008 Action Plan for (Further Improvement of) Nursing Home Quality have targeted quality in restraint reduction, prevalence of pressure ulcers and pain management, with much success.

EMR AS A QUALITY TOOL

But LTC facilities are looking for more ways to improve, and electronic medical records will prove to be an important tool in that quest. Since a large portion of the nursing home population has an extended length of stay and has become increasingly medically complex, facilities are realizing that they need EMRs to review and compile resident and facility information in real time. Access to this vital information on demand means that facilities can better analyze positive and negative trends and address their issues head on.

With an EMR, facilities can take a more interdisciplinary approach to resident care with the convenience of all disciplines having access to the chart from any location. Clinical information is easily shared and constantly updated, giving the entire care team the information they need for the best care.

CONSISTENT RECORDS

Surveyors routinely look for consistency in resident care information. Because of human error, turnover, training of staff and a nationwide shortage of nurses, information will be more effectively maintained by automatic one-time data updates in a full-function EMR. The benefits of automated workflow for accurate tracking, checklists, completion and prompting are numerous. Now facility managers, administrators and quality assurance personnel can view instant reports and promptly make changes to improve quality of care with measurable results.

For example, a CNA notices a reddened area on a resident's coccyx. Following incontinence care, she immediately sends a message alert to the nurse. In turn, the RN documents a skin assessment form. This automatically triggers a tracking sheet for weekly wound rounds. It can alert all disciplines from dietary to therapy to change the resident's chair cushion or initiate a back-to-bed schedule for the resident.

All of these changes are automatically made on the CNA care card and the care plan. Reports and visual graphs can track the progress of the resident's healing, and the data can be used to report on pressure ulcer statistics and facility-wide care. With an EMR in place, the care team is focused on care, not spending time compiling paper.

Documenting care and using reports can result in better resident outcomes. Risks can be identified and a comprehensive admission checklist and process will mean better knowledge of residents and more comprehensive care at the onset.

FULFILLING EMR'S POTENTIAL

An EMR is much more than a digital filing system. It should be an integral part of attaining the best practice standards for skilled nursing care. For this reason, it's important to look for an EMR software vendor who is focused on quality improvement processes as well as resident results. Ask potential vendors if they will give you a comprehensive system that can help you improve your quality process and ensure they can provide everything you need.

The benefits of EMRs have already been noted by surveyors, including time saved and spent with residents, centralized data management and legible forms that are easily identified by users. There will be -challenges to implementation, including staff training, conversion time, cost and the general fear of change. Yet there is no doubt that with well-organized implementation and solid staff education, a facility and a fully committed vendor can make the transition a good one.

Phyllis A. Rosenberger is director of nursing at Fulton County Residential Health Care Facility in Gloversville, N.Y., part time clinical project leader for Kingsway Arms Nursing Center, Schenectady, N.Y., and a certified nurse educator and clinical applications consultant for 6N Systems Inc., Wilton, N.Y. DISCLOSURE: 6N Systems develops EMR software.