The challenges of creating a system from five individual hospitals are many, but some seem more daunting than others. One good example: reviewing some 1,700 clinical procedures and standardizing them for thousands of clinical staff.
That’s the task facing UCHealth, which has been working on many fronts to reduce variations in care that are the residue of its hospitals practicing for many years as standalone entities. The result was multiple policies – and lots of duplication – for the same procedures.
But the situation also presented a classic opportunity to improve efficiencies and ensure that patients receive the same evidence-based care at UCHealth’s Metro Denver, Northern Colorado and Colorado Springs facilities.
Single source of truth
After much discussion and effort, leaders from UCHealth settled on a solution last July: Lippincott Procedures, an online resource that provides step-by-step guidelines for procedures performed by nurses, respiratory therapists and physical therapists. The resource is now available across UCHealth on The Source and through links in the Epic electronic health record, said Kari Waterman, MS, CNS, RN-BC, manager of clinical education and professional development at UCHealth Metro Denver.
The move to Lippincott resulted from meetings of the Clinical Practice Governance Group, which includes representatives from across UCHealth, Waterman said. Their task was to align policy and practice at the various hospitals. One possible solution was to assign teams to review procedures, ensure their accordance with evidence-based practice, vet proposed changes, and post new, standardized versions on the Source.
Waterman described that approach as “very labor-intensive.”
A better way was already available. Memorial Hospital has been using Lippincott for five years. The company does the heavy lifting that standardization requires. Its subject matter experts (SMEs) review the literature and evidence-based research for procedures. Lippincott publishes exhaustive information about each one, including guidelines, illustrations, video, and supporting references, and updates the information annually, Waterman said.
Divide and conquer
In May, some 150 clinical subject-matter experts (SMEs) from UCHealth gathered for a full-day workshop to divvy up, review, and vet all the procedures published by Lippincott. They decided on the company as the procedural “source of truth” for clinicians to follow. With that, the Clinical Practice Governance Group reps could devote their energies to reviewing existing UCHealth policies, removing duplications, and linking procedure-related content to the Lippincott website.
Policies will be reviewed as they come up for revision, Waterman said. Some will be reduced in length; some will be eliminated altogether.
“Clinics and units that want to know how to do a procedure can go to Lippincott,” she said. “Our policies can then address what we should do when something happens, like a patient fall.”
By the book
Cortney Lupo, MSN, RN, clinical nurse educator at UCHealth Colorado Springs, said Lippincott has been well-received by nurses and providers and is now an established procedural reference.
“It’s helped to slim down our documentation and streamline our policies,” she said. “Everyone is on the same page.”
UCHealth has adopted a “Why not Lippincott?” motto when reviewing procedures, but Lupo and Waterman both emphasized that the content is not written in stone. UCHealth providers can insert additional directions or information specific to a facility as “critical notes” for procedures. The notes appear in red at the top of each procedure page.
In one recent review, for example, perinatal educators and clinical nurse specialists recommended evidence-based changes to fetal heart monitoring procedures and included them as a critical note, Lupo said.
“There is an avenue for staff to have input,” she said. A system-wide Lippincott Utilization Committee composed of SMEs from various clinical areas conducts quarterly reviews of Lippincott content, she added. Changes that are supported by more current health care or nursing literature, as well as research, are sent to the company, which reviews them for insertion in the next annual version of its procedures.
While Lippincott is entrenched at UCHealth Colorado Springs, Professional Development is working to raise awareness of it among staff at Metro Denver and Northern Colorado, Waterman said. Meanwhile, the process of reviewing, revising, and standardizing all UCHealth clinical policies continues, with Lippincott serving as the guiding light.
“When a policy is up for revision at any site, we are reaching out to SMEs at other facilities to see if we can develop a new system policy,” Waterman said. “It will be a rare situation when a procedure we all use to care for patients should not be standardized. We want to get a leg up on that work.”