Plenary Presentation: Patient-Centred Clinical Outcomes

Tuesday October 2nd, 2007

Nursing-sensitive Outcomes – Standardizing Nursing Language for Inclusion in EHRs

Dr. Kathryn Hannah, Executive Project Lead, Canadian Nurses Association
Peggy White, National Project Director, C-HOBIC initiative

On May 28, 2007 Canada Health Infoway announced that funding for the Canadian Nurses Association (CNA) to lead the project: Inclusion of Patient-Centred Clinical Outcomes In EHRs.

This project will:

• Normalize the nursing clinical care terminology used by three provinces to the national clinical terminology standards (i.e. SNOMED-CT),
• Capture nursing-sensitive, patient-centred, clinical outcomes information across four (4) sectors (acute care, complex continuing care, long-term care and home care) of the health system,
• Store the captured data in jurisdictional EHRs using a national standard for clinical terminology, and
• Lay the foundation for the addition of clinical outcomes from other disciplines and for other sectors.
• The partners with CNA in this project are: Ontario, Prince Edward Island and Saskatchewan.

This presentation will provide the background to this initiative with an overview of the evidence supporting the recommended outcomes. The proposed methodology for the electronic collection and abstraction of the nursing-sensitive outcomes in each province will be explored. The implications of including nursing information on provincial databases will be examined with a focus on patient safety, quality of care and accountability. Finally, this paper will describe how this project is providing a single approach for coding information that will support interoperability, consistency, and comparability of clinical information that is reflective of nursing practice across the health care system.

Representing Nursing Practice using ICNP®

Dr. Margaret Kennedy, Principal, Kennedy Health Informatics Association

The International Classification for Nursing Practice® is a terminology and classification system developed by the International Council of Nurses to communicate nursing practice. This tool represents three specific areas of nursing practice: nursing phenomena or diagnoses, nursing actions, and nursing outcomes. The Canadian Nurses Association has endorsed the use of the International Classification for Nursing Practice® to communicate nursing data in Canada.

Implementation of this assessment tool was a significant change in practice. For most clinicians this assessment was also the first introduction to an electronic client record and to charting at point of care. Numerous barriers exist which challenge the adoption of the tool into clinical practice. Capitalizing on our health authority’s ability to extract assessment data, an opportunity was created to initiate site-specific sharing of aggregate RAI-HC data and open dialogue regarding use and meaning of RAI outputs in clinical practice. This team approach supports integration and promotes data quality by empowering clinicians to use RAI data in clinical decision-making. The presentation will detail this innovative decision support strategy used to instill confidence in the tool by increasing relevance, utility and ownership of the information. Feedback received, lessons learned, processes developed, and next steps regarding ongoing support for integration will also be shared.

Introduction and Draw

CNIA President Robin Carriere

Dr. Kathryn Hannah

Peggy White, Dr. Margie Kennedy

Dr. Margie Kennedy

Dr. Margie Kennedy

About the Presenters

Dr. Kathryn J. Hannah is a nurse and a senior, health informatics consultant specializing in information management in health environments. With over 30 years of experience in academia, health care delivery, government and the private sector, Dr. Hannah has a rich depth of knowledge and experience in health care delivery organizations, the health system and in nursing. Currently, Dr. Hannah participates actively in the Canadian Delegation to the International Standards Organization Technical Committee 215 on Health Informatics. Dr. Hannah is a member of the Standards Collaborative Strategy Committee that is responsible for coordinating health information standards in Canada.

Peggy White has an extensive background as a health care leader in the acute care sector. Peggy has published numerous articles in healthcare journals on nursing-sensitive outcomes. She co-authored a chapter on Patient Safety in Nursing-Sensitive Outcomes: State of the Science and a chapter on Nursing Leadership in Quality Work Environments for Nurse and Patient Safety. Peggy is the Project Manager of the Health Outcomes for Better Information and Care at the Ministry of Health and Long-Term Care and the National Project Director on the C-HOBIC initiative.

Dr. Margie Kennedy, BScN MN PhD is an informatics educator, previously holding a faculty position at the School of Nursing, St. Francis Xavier University. She is currently the Director of Client Engagement for NS Logix, an innovative applied health informatics firm in Nova Scotia. Her research interests include the role of technology in improving health outcomes, with a particular interest in marginalized populations. She is an active contributor to informatics education, research, and development, and represents the Canadian Nurses’ Association on the Clinical Standards Sub-committee at the Canada Health Infoway.