Agency Staff on the Agenda –

Training the Hidden Workforce in

eMMs

Austin Health Major tertiary health provider in northeast

Melbourne

Three campuses

– The Austin Hospital

– Heidelberg Repatriation Hospital

– Royal Talbot Rehabilitation Centre

Major services

– Liver & Gastro-intestinal transplantation

– Spinal Cord Injuries

– Oncology

– Vic Respiratory Services

– ONJ Centre

– MH – External sites

– Dialysis – external sites

2011

Radiology orders Pathology orders e-Prescribing Discharge Summaries Results & Results Endorsement

2012-13

Inpatient medications MAR Fluid balance chart 724 Access

2014

Clinical Documentation First Net ? Oncology system ? Surgi Net

The Austin Health EMR Journey

Clinical System Chosen:

Organisational Statistics

Measure 2011 – 2012 Year

Staff (EFT)

Medical 647

Nursing 2,098

Allied 471

IT / Informatics 50

Total 5184

June 2011

• ‘Big Bang’ implementation of

some Cerner modules

across 3 campuses.

• Had more effect on the

workflows of medical staff.

Implementation Comprised of:

• Alerts & Allergy recording

• Diagnosis, problem and past history recording

• Results Review

• Pathology and radiology ordering

• Ordering Discharge Prescriptions

• Discharge Summaries

Training

• All staff to be trained as per job role

• EFT differs from actual numbers of staff =

large numbers

• Some specialities wanted to be trained

separately

• Nurse Bank staff contacted and offered

training – minimal uptake

Training

The Cerner training team trained 6 days a

week from 0800 to 2200 Monday –

Saturday for 4 months

Training Stats

•Nursing staff – 2344

•Bank Nurses – 291

•Medical – 892

•Clerical – 354

•Allied Health - 423

Grand

Total:

4304

Austin Health Nurses trained in:

- Documenting Allergies

- Recording Patient weights

- Checking results

- Documenting when they had

successfully collected a pathology

specimen

Superuser Training

•160 SuperUsers were trained

across the 3 campuses.

•2 x 8 hour training sessions

•Regular updates on any changes

made pre implementation

•Post Implementation support 24/7

Decisions for Agency Nurses

• Meetings with Senior Nursing staff and

Nursing Workforce Administrators

• Decision made – Agency nurses not required

to be trained in the use of Cerner

WHY??

Decisions re Agency Nurses

The changes to nursing workflows were

not significant enough to warrant the

training of numerous agency staff

Austin nurses were satisfied with this

decision

Planning for eMM Implementation

After a very successful go live of phase 1,

plans were being made for the introduction of

a fully electronic medication chart on Cerner.

The medication component would be rolled out

in a phased approach. As paper medication

charts would no longer be available at the

bedside, all nurses would be required to be

trained in administering medications from an

electronic chart.

Planning for eMM Implementation in

Rehabilitation/Continuing Care Wards– June 2012

• Electronic Drug charts to be

implemented in 4

Rehabilitation/Continuing Care

Wards(Repatriation Campus)

• 2 weeks 24/7 support from Clinical

Informatics Team

• ‘On the job’ training given to agency

staff

Planning for eMM Implementation in

Rehabilitation/Continuing Care Wards– June 2012

• 30 Superusers trained for the 4 wards.

• 2 X 8 hour training sessions

• Superusers would cover 3 shifts (morning,

evening and night) for a 2 week period

• 24/7 support from the Clinical Informatics

Team would be given for a period of 2 weeks –

reduced after 1 week due to confidence in

using the system

EMM: Electronic Medication Management Systems

‘A Guide To Safe Implementation’ 2nd Edition 2012

Australian sites that have already implemented

EMM systems found that it is not always

possible to fully train agency and locum staff

before they use the EMM system. Recognising

that these staff may only work on a single

occasion at the hospital, shortened training

should be tailored to reflect their needs and

access to EMM experts on the ward should be

made available.

Post Sub Acute Implementation

After extended support ended – training of

agency staff was given by a nominated

Superuser from the ward.

2nd Rehabilitation/Continuing Care

Implementation - August 2012

• Electronic Medication Charts

implemented in another 2

Rehabilitation/Continuing Care

Implementation wards (Talbot campus)

• Same training/support model used for

Talbot

Acute Care Implementation – Nov 12

•11 acute wards

•Did not include:

- ICU

- ED

- Mental Health

Training for the Implementation of an Electronic

Drug Chart in Acute Care

•All nursing, medical and clerical staff

trained (classroom) 6 days per week until

10pm over a 4 week period

•719 nurses

•45 doctors

•31 clerks

•130 superusers (plus 2 medical superusers)

Concerns

As Austin Health utilises Agency Nurses

to cover any shortfalls in the clinical

areas, many nursing staff voiced their

concerns that there was a need to train

agency nurses, especially prior to a shift

within the hospital.

Concerns re Agency Staff

• ? Compromise patient safety

• ? Increase workload for permanent nursing

staff

Concerns re Bank Staff

•Many Bank nurses did not regard

training as a priority so refused to attend.

•Wanted trained at a time suitable to

them, not what we could offer.

Required Agency Information

• Meetings with Director of Nursing, Nursing

Work Admin Personnel and Nurse Unit

Managers

• How many agencies?

• How many agency nurses?

Common Agreement

•Agreement that Superusers would not

train Agency nurses on the job as this

was a strain on resources and there was

no guarantee that a Superuser would be

available on each shift

•Agreement that agency administration

staff would need to be involved in the

planning and continuation of training

Initial Agency Meetings

• 23 agencies utilised by Austin Health were

invited.

• 19 responded

• 14 accepted, 5 declined

• 10 attended

The agencies who failed to attend, no longer have a contract with

Austin Health

Agency Admin Meeting

• An overview of the system was shown and its

complexities

• An explanation of the necessity for training

• The concerns of Austin Health nursing staff

raised

• The need to maintain a good relationship with

hospital and agency

Agreements • 2 hour training session offered to agency

nurses by the Clinical Informatics training team

onsite at Austin Health

• Austin Health would not be responsible for the

payment of these 2 hours

• Responsibility of the agency nurse to attend in

their own time

• A short term measure – more planning

required

15 x 2 hour training sessions booked

Capacity to train 245 agency nurses

87 nurses attended

Bank Staff

•At the same time, numerous sessions for

Bank staff were created.

•463 staff were booked in

•357 attended

•106 failed to attend = 77.11%

attendance rate

Bank Staff were paid to attend

Continuity Plan

• Throughout this time it was recognised that

this model could not continue

• Another form of training had to be made

available

• Contact with Education Manager in Peninsula

Health, Victoria re Learning Management

System (LMS)

• Close relationship between 2 Health Services

Continuity Plan

•Austin Health and Peninsula Health

share the same usernames for Cerner

due to a shared domain (Statewide

domain)

•Austin Health and Peninsula Health also

use some same agencies

•Access given to view Peninsula Health’s

LMS

Continuity Plan

• Business plan drawn up

• Budget agreed

• Presentations given by 4 companies

• Quotes requested and received

Decision…

…

Where would the LMS be Hosted?

•Would the LMS be hosted on the Intranet

or the Internet?

• If it was hosted internally, how would the

external staff access it?

• If it was hosted externally, how would it

be kept out of view?

Overcoming Obstacles

• Agency staff are not employees of Austin

Health therefore cannot log on externally to

the Clinical Portal

• ? Administrators becoming honouree

employees – NO!!

Discussion with legal department and IT…

Solutions…

• No patient identifiers on LMS – no

patient confidentiality compromised

• LMS could be hosted (but hidden) on

Austin Health’s website

• Password protected

• Instructions on accessing the

programme would be given to the

agencies

Roadblocks – Account Creation

Account Creation Process

• Nurse applies for job

• Nurse gets job

• Nurse receives paperwork from HR

• Nurse fills in paperwork

Account Creation • Nurse makes appointment with HR

• Nurse visits HR and completes ‘sign on’

process

• Nurses details entered onto the HR

system

• Nurses details are sent to Department of

Health

• Cerner account is created

Agency Nurses are not Austin Health

Employees!!!

Initial Agency Account Creation Process

• Agencies were sending through their nurses

details to me and accounts were being created

manually by me – time consuming and

laborious

• Not sustainable

Pre Go Live

•Most agencies wanted all their

nurses to have Cerner

accounts…just in case = huge

numbers

•Prior to go live, approx 400

accounts were created manually as

requested by agencies.

•Not sustainable

Requested IT Input

• IT expertise sought.

• IT created a template which requested specific

information regarding the agency nurse.

• 1st trail failed

• 2nd trial failed

• 3rd trial successful!!!

Bulk Upload Template

•This allowed the creation of multiple

accounts.

•Same template can be used by multiple

departments throughout the hospital

•Template used for new medical and

nursing staff in February rotations and

for university students

Process Change • Template completed by agencies with required

information

• Emailed through to Austin Health IT Service Desk

• Bulk upload occurred.

• Accounts created

• Details emailed back to agencies

• Logon details given to agency nurses on completion of

online training

The Creation of an LMS

• The screen captures were taken over a 2 day

period.

• 2 week turnaround period for review, recapture

and publication.

The Creation of an LMS

•20 lessons for nursing staff

•13 compulsory for agency nurses

Why only 13???

Training for first implementation not

compulsory for agency staff therefore those

modules made optional for agency nurses.

Agency nurses only had to complete

medication related modules.

Agencies Invited Back to Austin

•Agencies were shown the LMS and how

to access it

•Explanation of compulsory vs optional

modules

Agency Responsibilities and

Agreements

• Each agency responsible for ensuring and

checking their nurses were trained online prior

to accepting a shift at Austin.

• Each agency is responsible for ensuring a

Cerner account has been created prior to

commencing a shift at Austin Health

Accessing the LMS

www.austin.org.au

Reports

• Each agency has their own unique code

• Each agency has named administrators with

Reporting access

• Agencies given instructions on creating reports

detailing who has completed training and

which modules they completed

• Agencies can only access their own reports

Account Details • If an agency nurse cannot get their log in

details from their agency, they can either

contact Austin Health Service desk

during office hours or the Clinical

Informatics Unit Oncall person if it is out

of hours.

•Austin Health’s After Hours Site

Managers have also been trained in

searching for account details

Account Details

Austin Health’s IT Service Desk team,

the entire Clinical Informatics Unit and all

the After Hours Site Managers also have

Reports Access on the LMS so they can

check training records prior to giving out

passwords

Policy

No training = No access = No

shifts at Austin Health

Lessons are separated as per job

title:

• Nurse

• Agency Nurse

• Medical Officer

• Clerk

• Medical Student

• Allied Health

Stats

•The LMS first became available on 7th

November 2012

•To date, there have been 20152 ‘hits’ on

it

No of Nurses Who Have Completed their

Training per Agency

0

100

200

300

400

500

600

700

800

900

1000

1

Belmore

C4U

Collins & Brown

HCI

Malvern

Mediserve

Origin

Swingshift

VNS

Workpac

YNA

Post Go Live

•Due to budget restraints, many agency

staff have opted to join Nurse Bank as

they receive more regular shifts at Austin

Health.

•Since the acute go live in November

2012 a further 187 Bank nurses have

received training

Questions?