Championing Evidence-Based Interdisciplinary Plans of Care for the Neonate: Where Do You Begin?


Paper Presentation

Purpose for the Program

To describe the main strategies used by a multisite hospital system to develop and adopt interdisciplinary, evidence-based plans of care (IPOC) within an electronic health record (EHR) for the neonatal population.

Proposed Change

The EHR project vision at this organization was to provide a fully integrated, enterprise-wide, single-patient EHR based on current science that supports and enhances patient safety, patient experience, patient- and family-centered care, interdisciplinary practice and collaboration, and capacity/revenue management. The EHR project was to replace several of the computer systems/paper-based systems and move from a fragmented discipline-specific approach to an interdisciplinary model of care.

Implementation, Outcomes, and Evaluation

To fully realize this vision from beginning to adoption, a cultural transformation needed to occur and was defined in the Clinical Documentation Philosophy and Guiding Principles. These principles provided the foundation to support the project's vision. The vigorous selection process for an EHR system and IPOC content that incorporated this philosophy was crucial.

A project management team with evidence-practice expertise was employed to collaborate with an interdisciplinary team of subject matter experts. The first step was to prioritize the needed IPOC content for all populations. This team then developed the general IPOC content.

A second interdisciplinary team was assembled to develop content that was specific to the neonatal population. This team first identified the need for gestationally based IPOCs (preterm, late preterm, and term newborn). Specialty content that addressed additional neonatal medical conditions and procedures was identified with an emphasis on prevention of nosocomial complications/infections, family-centered care, breastfeeding, and neurodevelopmental promotion. This was challenging, yet it was exciting to hear all of the disciplines speak to their own expertise about providing care for neonates. This team developed the IPOC content using a third-party content vendor of evidence-based IPOC templates and an online blogging technology to seek feedback from clinicians.

Innovative strategies were used to facilitate interdisciplinary use and adoption. Preparatory education and training strategies included online learning modules, lectures, simulation labs, access to practice learning environments, and real-time online information. Post go-live strategies included real-time updates on the organization's Intranet to communicate system status/problems, daily hot topics, tip sheets, as well as end-user bedside support and chart audits.

Implications for Nursing Practice

A total of 187 IPOCs were developed over a 24-month period of which 18 were neonatal-specific and 24 were neonatal/pediatric-specific.