Handoff Project Account Manager by olk11775


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									                    Project Requirements: Nursing Shift Handoff Data Set

                                 Baylor Healthcare System

                                   Department of Nursing

                                    Intensive Care Unit

                                Lauren Wiseman, RN, MSN(c)

                              Deborah Crownover, RN, MSN(c)

                               Cindy Sunderman, RN, MSN(c)

                            September 20 – November 26, 2008

Last update: 11/26/08                                                      1
Project Documentation - System Requirements

System Definition:

Development of the Nursing Shift Handoff Data Set (NSHDS) application will provide a
standardized approach to hand-off communication between clinical areas for adult ICU patients.
The medical environment creates a multitude of opportunities for patient hand-offs where critical
historic medical care information is necessary for the receiving unit to provide optimum safe,
patient-centric health care. This historical information must be accurate, concise, and include the
treatment, services, present condition, as well as recent or anticipated changes surrounding the
patient’s medical status. The information must be retrievable to decrease nurses’ cognitive load
during shift handoff and enable review during a 24 hour period. Quality data must be available
for the Joint Commission review to meet the mandated standardized requirements for handoff
reports. The NSHDS will accompany the implementation of the Eclipsys electronic health
documentation rollout in the Baylor Healthcare System.


The scope of the Nursing Shift Handoff Data Set (NSHDS) is limited to documentation of data
elements of adult ICU patients required in shift handoff report that will provide information on
patients, specify care needed for oncoming shift, provide evaluation of care, and promote
continuity of care and staff cohesion. Presently shift handoff report in the ICU is conducted
orally in person at the patient bedside and utilizes the situation, background, assessment, and
recommendation (SBAR) method.

Project Milestone Dates:

                                Contract Signed   Technical QA/Testing   User Training   Go-Live
CIO – Charlene Cink             9/26/08
IS Person – Deb Crownover                         11/14/08
Supervisor – Cindy Sunderman                                             11/17/08
Baylor Regional Medical                                                                  11/26/08
Center at Grapevine ICU Staff

Last update: 11/26/08                                                                       2
Key Players:

Role                    Name                  Title/Location   Phone(s)/Pager   Email Address
Project Leader          Lauren Wiseman        RN, MSN(c)       309.268.9569     lauren.wiseman@duke.edu
Project Sponsor         Charlene Cink         RN, MS           214.820.         charlenc@BaylorHealth.edu
Project Team            Deborah Crownover     RN, MSN(c)       919.477.7792     crown003@mc.duke.edu
Members                 Cindy Sunderman       RN, MSN(c)       972.375.7448     cindy.sunderman@duke.edu

Major                   MSN Students
Stakeholders            Linda Goodwin         RN, PhD                           linda.goodwin@duke.edu
                        Baylor Health Care
                        Baylor Information
                         System (IT)
                        ICU Nurses
                        ICU Nurse Manager
                        Nurse Administrator
                        ICU Patients &
                        Joint Commission
Effected User           ICU Nurses

Functional Description:

The following system requirements have been identified:
   Nursing shift handoff data set will meet standardization requirements of the Joint Commission’s
    2008 National Patient Safety Goal Requirement 2E.
   Data already entered into ICU patient records via Eclipsys should be captured through an interface
    and not require duplicate data entry by busy care providers.

   Reports are needed for nurses to document ICU patient shift handoff report. These are needed to
    enable complete and accurate transfer of patient information to oncoming nurses.

   Electronic data transfer within Baylor Health Care System (BHCS) and Baylor Information System
    (BIS) will meet the legal requirements of the state of Texas.

Last update: 11/26/08                                                                           3
Data Elements Diagram

                                                                  Nursing Shift
                                                                  Handoff Data

            Demographics            Assessment                      Treatment                         Action             Shift/Nurses

        Name                    Vital Signs                    Planned Surgery/               Plan of Care               Reporting RN
        Medical Record #        Oxygen Status                   Treatments                    Patient/Family Education   Date & Time
        Account #               Pain Level                     Invasive Lines                 Discharge Plan             Accepting RN
        Code Status             Pain Interventions             Therapy                        Physician Plan             Date & Time
        Emergency Contact       Nutritional Status             Wound Care/Dressing            Consults
        DPA                     Fall Risk                      Diagnostic Testing
        Advance Directive       ADL
        HIPPA Password          Abnormal Assessment           O2 Sats
        Isolation Status         Findings                     O2 Delivery
        Allergies               Lab Values                    O2 Rate
        Chief Complaint         Comments
        Significant PMH                                          Diet
                            T, BP, HR, RR                        Intake

                                   Pertinent normal & abnormal labs related to hospitalization
                                    (i.e. lactate level in sepsis patients, cardiac enzymes and
                                              potassium levels in cardiac patients, etc)

Last update: 11/26/08                                                                   4
Anticipated Risks

Development/Implementation Risks
Maintenance Risks
Use Risks

            User acceptance of the Nursing Shift Handoff Data Set is one risk. Frontline nurses and
             nurse managers will be required to enter data into the system. These users have multiple
             demands on their time and may not see data entry as a high priority. They may feel the
             use of verbal report or a paper form is simpler and less time consuming.

            Organizational politics and turf wars are potential risks since the database is being
             developed by nurses rather than by the Baylor Information System department. The
             project manager has discussed the database with BIS and also with the clinical
             documentation manager and both has verbally “signed off” on the database design;
             however, unanticipated issues may surface.

            Unanticipated developmental failures in the design of the database program and may
             encounter difficulties in the design process. Compatibility issues may exist between the
             Eclipsys system and the designed database.

            The database will house patient information and is subject to security and confidentiality
             risks. The database and the information contained therein must be secure and HIPAA

Last update: 11/26/08                                                                           5
High Level Use-Case Diagram and Definitions

                            Nursing Shift Handoff Data Set

                                    Enter Patient Data

       ICU Nurse                                             Eclipsys System (Phase II)
                                    Store Patient Data

                                       View Patient

                                      Perform Query

                                     Generate Report(s)

        External Customer              View Report(s)            Internal Customer

Last update: 11/26/08                                                                     6
Actor Definitions

ICU Nurse           The ICU Nurse includes both the ICU Staff Nurse and the ICU Charge Nurse.
                           The ICU Staff Nurse is any on-coming or off-going nurse who has, as part of
                            their job responsibility, the duty of collecting and documenting shift report
                            patient data and information. This actor has rights to enter, store, modify,
                            and display, (query, and report) data to self and other actors as required by
                            the nursing shift hand off report and patient care process.

                           ICU Charge Nurse is any on-coming or off-going nurse who has unit charge
                            nurse duties. This actor can enter, store, modify, and display data into the
                            nursing shift handoff report to self and other actors as required by the
                            nursing shift hand off report and patient care process including unit charge
                            nurse duties. This actor has rights to query, and report data to self and/or
                            other actors as required by the patient care process and charge nurse
Eclipsys            Eclipsys is a clinical information system used in acute care facilities to provide
System              electronic clinical documentation of patient data and patient care activities. This
                    actor will automatically populate (enter) patient data into the database during
                    Phase II of this project.

Internal            The Internal Customer includes the ICU Nurse Manager and the System
Customer            Administrator. These actors are not in direct patient care of ICU patients but do
                    have roles inside the ICU that affect the management and functioning of the unit.
                           ICU Nurse Manager is the nurse manager of the ICU. This actor can conduct
                            queries, generate, and view reports of the data in the NSHDS database as
                            required by the duties of the nurse manager.
                           The System Administrator is responsible for the functioning of the HIT
                            system and can conduct queries, generate, and view reports of the data in
                            the NSHDS database.
                    The External Customer is any actor that does not have direct responsibility in the
                    management or functioning of the ICU but has a need to review reports for
                    information, compliance and quality assurance purposes. This actor group includes
                    the Nurse Administrator, the Physician, and Joint Commission.

                           Nursing Administrator is any nurse functioning in the role of nursing house
                            supervisor. This actor can view generated reports as required by the duties
                            of nursing administration.

                           The Physician is any doctor providing care to ICU patients. This actor can
                            view generated reports specific to the patient(s) they are providing care to.

                           Joint Commission must view reports to ensure adherence to the 2008
                            National Patient Safety Goal requirement 2E.

Last update: 11/26/08                                                                             7
Use Case Definitions

Enter Data              The use case when an ICU Staff or Charge Nurse actor enters collected data
                        on an ICU patient into a newly created nursing shift handoff record.
                        A nurse collects, verifies, and enters (types/keys in) patient information and
                        data for a nursing shift report handoff patient log record into the Nursing
                        Shift Handoff Report Database.

Store Data              The nurse decides the data is ready for storage when entering data for a
                        nursing shift report handoff patient log record. The nurse indicates to the
                        system that they are ready for the system to store the data after they have
                        reviewed and verified the entered data as accurate.

Display Nursing Shift   View selected data from the nursing shift report handoff patient log.
Handoff Report Data
                        The Nursing Shift Handoff Data Set database generates a display of ICU
(Read Only)
                        patient data/information necessary for nursing shift handoff report.
                        Nursing Administrators and the System Administrator can view all entered
                        ICU nursing shift handoff report data. Internal customers can display
                        generated reports. External customers will not have display access to
                        nursing shift report handoff records but may request such from the ICU nurse
                        manager or nurse administrator.

Generate Report(s)      Written and electronic output of a query.
                         The Nurse Manager, Nurse Administrators, Physicians, and External
                        Customers receive data reported by the NSHDS patient log record system.
                        This system reports relevant, pre-determined data elements in aggregate
                        form to External Customers.

Last update: 11/26/08                                                                           8
                                  Use Case Description

               Use Case: Nurse shift handoff database
            Description: Data and information acquired during the delivery of care
                          to an ICU patient is entered into the NSHDB. This data is
                          compiled at the end of shift for handoff report. Data is
                          frequently stored (or saved) to prevent loss of important
                          data elements and duplicate entry of information. Data is
                          retrievable throughout the next shift to decrease cognitive
                          load of the ICU nurses. In the second phase of this project
                          the data will be populated from the electronic clinical
                          documentation system of Eclipsys.
                 Actors: ICU nurse, Eclipsys System (Phase II), External Customer and
                          Internal Customer (see definitions).
                   Goal: Data pertaining to the care of the ICU patient will be
                          entered and stored in real time.
                Trigger: Accepting or delivering nurse shift handoff report.
          Preconditions: ICU patient in the Baylor Health System
        Post conditions: Information as identified in the data elements diagram is
                          entered and stored into the Eclipsys electronic clinical
           Normal Path: See activity diagram and scenario
       Alternative Path: See activity diagram and scenario
             Exceptions: See activity diagram and scenario
                Priority: High – information must be entered and stored throughout
                          the shift in order to compile the handoff report.
      Frequency of Use: Data will be entered and stored frequently throughout the
                          shift as delivered in real time.
 Constraints and Special Downtime policies and forms will be available in the event
          Requirements: of a system outage. Help desk will be available in the event
                          of a login failure by any actor.
           Assumptions: The nurse shift handoff report will be populated with data
                          retrieved from the electronic clinical documentation.
       Notes and Issues: See issues log.

Last update: 11/26/08                                                               9


    Clara is a day shift ICU staff nurse. During the course of her shift and care of two patients
    Clara uses the NSHDB system to document the changes in the Nurse Shift Handoff Report
    Database she received from the night shift nurse. At the completion of her shift Clara
    reviews the data and completes the entries necessary for report to the oncoming shift.


    Florence, the oncoming night shift nurse, logs into the system and opens the Nurse Shift
    Handoff Report Database. Florence reviews the information about the patients whose care
    she will be assuming while Clara the day shift nurse continues to monitor and provide care
    for those patients. After reviewing the report, Florence speaks directly to Clara and
    clarifies any questions about the report. During her initial assessment of the patients,
    Florence notes a change in the condition of one of her patients. Florence retrieves the
    report information to confirm the change and notifies the physician of the change in


    The joint commission has arrived to complete an unannounced on-site survey. The
    surveyor asks Rhoda the charge nurse how the ICU meets the National Patient Safety Goal
    requirement 2E. Rhoda accesses the NSHDS and generates a shift report as an example.
    The ICU manager accesses the NSHDS and generates a report that demonstrates that each
    shift consistently uses the database to standardize shift handoff reports.

Last update: 11/26/08                                                                   10
Normal Path
                  Actor Action                      System Responsibility

Select login from the workstation.         System presents login screen.

Successful login.                          System displays main menu.

Selects NSHDS.                             System launches NSHDS.

User enters patient last name, first       System displays patient last name, first
name.                                      name.

User enters patient medical record         System displays patient medical record
number.                                    number.

User verifies patient medical record       System displays patient medical record
number.                                    number.

User manually enters verifies and stores   System stores data.
data (see page 4).

User exits NSHDS.                          System records user log off.

Alternative Path
              Actor Action                          System Responsibility

Unsuccessful login.                        System denies access.

User retries login.                        System denies access.

User contacts Help desk.                   System denies access.

                  Actor Action                      System Responsibility

User initiates downtime policy.            Downtime.

Last update: 11/26/08                                                               11
        Activity diagram:                          Start

                                        User logs into workstation

          Unsuccessful log in
                                                                                  Successful log in
             User retrys

                                                                                                                                  Application fails to
         Unsuccessful                                                                  Chooses
                                                                                                                                  open, user initiates
   User contacts IT Helpdesk                                                            NSHDS                Alternate   path
                                                                 Normal    path                                                  downtime procedure

                                                      Selects Icon from
                                                      computer screen
                                                         and opens
                                                           NSHDS                  NSHDS Launches successfully
              NSHDS Application fails
                    to open

                                                                                          Enters patient

                  User contacts                Patient Medical Record                    Verifies Medical                Patient Medical Record correct
              admissions for Medical         Number incorrect or absent                  Record Number
                 Record Number


                                                                                                                                        Phase I & II

                                                                              No                      Required Data available?
                                                 Phase II                                           Phase II-Patient demographics
                                                                                                 automatically entered from Eclipsys
                                        Notifies IT helpdesk                          Phase
                                          as information                                I
                                         should be drawn
                                          from Eclipsys
                                               system                     Manually Enters
                                                                          data (See Page 4)
                                                                           into NSHDS via
                                                                             user friendly                                         Verifies/Queries/
                                                                                 form                                           Generates Data in NSHDS
                                                                                                                                  via application icon

                                                                           Stores data in
                                                                          NSHDS via save
                                                                                icon                                            User receives data from

                                                                                                            Exit NSHDS


Last update: 11/26/08                                                                                                                                  12

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