The Robert Wood Johnson Foundation IOM Initiative on The Future of Nursing is significant in many ways (http://www.iom.edu/Activities/Workforce/Nursing.aspx) First, it comes during a unique and critical time, as our country’s leaders wrestle with healthcare reform and decisions are being made for funding through the American Recovery and Reinvestment Act. Next, it gives voice to nursing, which, as a profession, is key to making significant shifts in sustainable change. Three forums have been established for Acute Care, Community Health/Public Health/Primary Care/Long-Term Care, and Education.
Today, December 3, 2009, nurses are gathering in Philadelphia for the Forum on the Future of Nursing: Community Health, Public Health, Primary Care, and Long-Term Care. The forum dedicated to Education will be held on February 22. 2010 in Houston, TX
I had the privilege of testifying at the Acute Care Forum held on October 19th at Cedars-Sinai Medical Center. There was a cause for celebration as RWJF/IOM called for input on Quality/Safety, Technology, and Interdisciplinary Collaboration. It was great to hear nursing leaders around the country share their perspectives, as well as hear the testimonies provided by my dear colleagues Joyce Sensmeier for the Alliance for Nursing Informatics (ANI) and Dana Alexander on behalf of the Technology Informatics Guiding Education Reform (TIGER) – both of which I am proud to a part of and the contributions we are collectively making in supporting nurses throughout the country.
Among topics were innovative models used to improve quality and safety in acute-care settings. During this session, I discussed the Clinical Practice Model (CPM)™, which has been evolving since 1983 with the input of thousands of nurses and interdisciplinary clinicians via an international healthcare consortium.
The CPM Resource Center supports a professional practice framework that addresses the fundamental elements of creating healthy healing work cultures keeping patients and nurses safe. The CPM Framework™, innovative in its inception, is fundamental today as nurses continue to face many complexities in acute care environments to provide interdisciplinary care and successfully integrate intentionally designed technology to support quality care and outcomes.
The CPM Framework was created to address the primary barriers nurses face in maximizing quality and safety. Identified in a six-year, multi-site pilot, these barriers include a lack of shared purpose, clarity on scope of practice, evidence-based clinical tools and resources at the point of care, dialogue, healthy relationships and effective engagement processes and infrastructures. The CPM Framework partners with organizations to implement and sustain these foundational elements of care. As a result, CPM Consortium sites have demonstrated statistically significant improvement in care based on national quality/safety standards and sustained them over long periods of time.
The CPM Framework has developed innovative technologies by leading Intentionally Designed Automation (IDA)™ at the point of care in partnership with multiple HIT companies. IDA is intentionally designed by nurses to assure that the technology supports professional practice – the workflow and thought-flow of professional nurses providing care in acute-care settings. It includes components of the CPM point-of-care documentation that assure capturing the patient’s story, developing an evidence-based plan of care utilizing Clinical Practice Guidelines, individualizing the plan for a patient’s values/situation, providing assessments and interventions within the context of the patients diagnosis and situation, evaluating progress toward goals and education.
Having innovative technologies and a standardized common framework at the point of care for nurses and allied health clinicians to deliver their professional services is critical to practice interoperability and improvement measurements. There are more than 125 acute-care settings that have nurses and interdisciplinary teams using IDA today who use the CPM Framework. Outcome measurements include: reduced patient falls, reduced pressure ulcers, exceeding core measure national and regional benchmarks by 85-95%, increased nursing satisfaction and more. CPM Consortium sites have been national exemplars for the TIGER Initiative, Sigma Theta Tau International and ANCC Magnet Designated Hospitals.
Barriers to the adoption and use of innovative technology, however, remain. These barriers center on a lack of understanding of the need to do the fundamental work of embedding a professional practice framework inside technology and how to unitize an implementation science for effective and sustainable adoption.
Thus I proposed that, in the spirit of the IOM report “Knowing What Works in Healthcare: A Roadmap for the Nation (IOM -2008),” we focus on “what works” and stop recreating the wheel – looking to better understand and utilize the best practices and technologies at hand. This includes the CPM Framework™, which is grounded in complexity science and chaos theory and has been proven in many, many acute-care to work and be replicated.
Having innovative technologies and a standardized common framework at the point of care to deliver professional services is critical to practice interoperability and improvement measurements. They also are an integral part of the solution – not only to our current healthcare crisis but also the meaningful use of healthcare tools and funds going forward and sustainability.
Stay tuned for more on the Forums….and please speak up!
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