Mary Blankson DNP, APRN, FNP-C Chief Nursing Officer

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The Skys the Limit!

Promoting Team Based Care

DC Primary Care AssociationOctober 27, 2015Mary Blankson DNP, APRN, FNP-C Chief Nursing Officer

Our Vision: Since 1972, Community Health Center, Inc. has been building a world-class primary health care system committed to caring for underserved and uninsured populations and focused on improving health outcomes, as well as building healthy communities. CHC Inc. Profile:Founding Year - 1972Primary Care Hubs 13 ; 218 sitesOrganization Staff 650; active patients: 130kDisciplines: Medical, Behavioral Health, DentalSpecialties: CDE, Nutritionist, Podiatry, Chiropractic CareSpecialty access by eConsults

Top Chronic Diseases Cardiovascular DiseaseObesity/OverweightDiabetesChronic PainAsthmaDepression Three Foundational Pillars Clinical Excellence Research & Development Training the Next GenerationElements of Model

Integrated primary care teams/podsIntegrated medical, dental, BH EMRPCMH Level 3TJC Patient HomeSchool Based Health Centers across CTWherever You Are HCH program

InnovationsPostgraduate Training Programs Weitzman Institute Project ECHO CT (pain, opioid addiction, QI)Specialty access by eConsults

CHCs Educational, Technical & Innovation Projects

4Facilities and Physical Model

Interdisciplinary Pods that Promote Team-Based CareOpen office structureCollaboration throughout the workday

5Exam rooms and therapy roomsReducing stigma of seeing other disciplines Seamless transition between Disciplines

05/14/2014

6Facilities: One Corridor Care

6What does an Integrated Record Look Like?

00/00/008Data Driven: the Right Data at the Right Time

Extract, transform, load8 Additional on-site specialtiesNutritionDiabetes educationChiropracticPodiatryRetinal screeningCare that is Comprehensive: IPCP Team4 Clinical Chief positions:Chief Medical OfficerChief Nursing OfficerChief of Behavioral HealthChief Dental OfficerLeadership SupportExecutive MentoringInterdisciplinary Chief Meetings Leadership MeetingsCollaboration/Integration among departmentsQI Projects/Microsystem workClinical Initiatives/PoliciesMU2/PCMH/UDS

Interdisciplinary Leadership

A peer to the other chief roles, specifically working directly with the CMO on all policies guiding medical practice in our organization. 10Onsite Clinical DirectorsOSMDNursing ManagersOSBHDOSDDCollaboration/Integration among departmentsIntegrated MicrosystemsIntegrated Care MeetingsClinical/Pod HuddlesLeadership SupportLeadership Skills Training Leadership Meetings

Interdisciplinary LeadingA peer to the other chief roles, specifically working directly with the CMO on all policies guiding medical practice in our organization. 11

Interdisciplinary CareEvery CHC Patient has Team!

InitiativeBHMedicalNursingDentalIntegrated Care MeetingsrrrRecallsrrrrBH GroupsrrShared Medical VisitsrrrWarm Hand-OffsrrrPrenatal-Dental ProjectrrrShared Care PlansrrrComplex Care ManagementrrrTrauma Screening & TFCBTrrStanding OrdersrrFluoride VarnishrrrSBIRTrrrBH DashboardrrrrAppointment Allocationrrrr00/00/00Interdisciplinary Care InitiativesFigure 1. Diabetes Dashboard by Provider

Here is a screenshot of our diabetes dashboard. The information comes from clinical data warehouse that our business intelligence team created.Automatically feeds into our SharePoint page for agency-wide use.15Team-Based Care: Tele-Ophthalmology16Collaboration/Integration among departmentsTraining/CompetenciesProgram OversightDeveloping Standing OrdersChair of the Pharmacy & Therapeutics CommitteeMU2 ImplementationPCMH, UDS Reporting & TJCMA/RN recruitmentNursing InformaticsPromotion of Research & TranslationMentor/Coach to the Nurse ManagersRelationships with Professional Schools

Leadership for RNs and MAs: The Role of the CNO in Team-Based Care

A peer to the other chief roles, specifically working directly with the CMO on all policies guiding medical practice in our organization. 17POD design2 Medical Providers1 Registered Nurse2 Medical Assistants1 Behavioral Health ClinicianAdditional members: podiatrist, dietician, Pharm-D, chiropractor, CDEStudent/TraineesThe Interdisciplinary Team

Essential member of the primary care team and interprofessional activities(1) RN supports (2) primary care providers/panelsKey functional activities:Patient education and treatment within provider visitsIndependent Nurse Visits under standing ordersDelegated provider follow up visits using order sets Self management goal setting and care managementComplex Care Management; coordination and planningTelephonic Advice and Triage via dedicated triage lineQuality improvement leaders, coaches, and participantsLeaders and participants in research Clinical mentoring of RN students; Supervision and mentoring of Medical Assistants

Domains of RN Nursing Practice at CHC, Inc.Uncomplicated UTIVulvovaginal candidiasisComprehensive diabetes visit with retinal screeningPupil dilationTitration of basal insulinPedi & adult vaccinesTB DOTBronchodilator testing in spirometryTobacco cessationEmergency contraceptionPregnancy testingOrders for emergency situations

Nursing Standing OrdersIndependent Nursing Visits*By order of the CMO, but formulated through collaboration with the CMO & CNO positions to ensure intact nursing process/workflow and adequate training/competency on performing standing orders*or Depo Provera for contraception*smoking cessation to include prescription for nicotine patches, CO monitoring, and referral to BH for support in cessation21Chronic Illness CareNational Advisory Council on Nurse Education and Practice* BH visits for monitoring for medication adverse events, assessing progress in treatment, repeating depression screens, etc.22Competency FairsLeadership ConferencesFacilitation TrainingComprehensive didactics for Complex Care ManagementTransition CareMedication ReconciliationCHFDMAsthmaCOPDPsychMI/SMG

Training

4-day comprehensive didactics for Care CoordinationTransition Care, Medication Reconciliation, CHF, DM, Pediatric Asthma, COPD, Psych, Motivational Interviewing, Self Management Goal SettingSupervision Case Reviews via videoconferenceEHR TemplatesStructured Intakes/Follow upNursing Informatics/Outcome MeasuresDashboards (Population Management)Community EngagementOpen HouseData Sharing

RN Complex Care Management

*Nursing informatics to ensure that the fingerprint of nursing is well documented so that we can say without a doubt what the nurses impact is on health outcomes. This data will better inform the role definitions and workflow within the team, and promote IPE among all members of the team as each learns to trust in the model of care and the training & capabilities of each other team member*how to use data in their every day tasksand put it at their fingertips---and ensure it is actionable*hospitals, urgent care centers, housing, food banks and other community agencies

*We need to be careful as we design new workflows, and evaluate progress that we keep in mind every team member and ensure that nurses practice at the top of their license, so there should be focus on other team members and their roles in order to ensure that the nursing aspects of CC continue to be nursing practice by its full definition. As we expand their responsibilities evaluating staffing rolls and ratios to accomplish the work.24Reason for Complex Care Management

Consider Possible Data Sources

Customizing the Sort

27Additional Actionable Data

Complex Care Management Scorecard00/00/0029

Complex Care Management Scorecard00/00/0030

Planned CareDelegated OrderingPanel ManagementScanning/Faxing/handling of incoming faxesRetinal Camera OperationQI/Microsystem Participants Role of the Medical Assistant

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Planned Care Dashboard3200/00/0033PCDBirth Cohort HCV ScreeningAdded to the PCDBaseline Screening RatesFinal Data Collection CompletedNew Screening Rate33As initiatives/responsibilities are added, redefining ratios

Refining workflows with EHR limitations

Recruiting RNs with ambulatory care experience

Training to our model of care

Working toward full MA certificationChallenges 34Additional standing orders

Improve data driven performance appraisals for MA/RN teams

Improve structured data entry for team members (Informatics) to better document the impact of various care team members

Increasing the use of automated workflows

Continue to enhance front-line involvement and leading in initiativesFuture DirectionsContact InformationNational Advisory Council on Nurse Education and PracticeMary Blankson, DNP, APRN, FNP-C Chief Nursing Officer(860) 852-0851 office(860) 227-5432 cell Mary@chc1.com

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