Building the Evidence - Use of the Electronic Health Record in the Measurement of Nurse Practitioner Performance

Abstract

Background: Health care providers are required to demonstrate evidence of ongoing competence or performance. This is especially crucial for nurse practitioners working in critical care arenas, like the Neonatal Intensive Care Unit (NICU). Neonatal nurse practitioners (NNP) working in these settings must competently perform multiple high risk procedures, like the percutaneous insertion of central catheters (PICC), yet performance for these providers and outcomes for these procedures are often not visible. In addition few frameworks exist that adequately measure them. Purpose: The main purpose of the project was to determine if an evidence based electronic PICC line note could be utilized as a tool to evaluate NNP PICC line performance or outcomes in a Neonatal Intensive Care Nursery Setting. The objectives of the project were as follows: 1.) Determine what tools if any, are utilized by Baltimore-Washington area NICU’s to evaluate NNP PICC line insertion performance or competence 2.) Evaluate the perception of eight commonly used performance measurement tools. 3.) Build and implement an evidence based electronic PICC line note embedded within the electronic health record, for NNP providers to use in the NICU at Mercy Medical Center. 4.) Using data analysis software, analyze the PICC line note elements to determine the usability of the note as a tool to measure NNP PICC line performance. 5.) Evaluate the note implementation process and NNP satisfaction with the updated PICC line note format. Methods: Baltimore Washington area NICU’s were surveyed to determine what tools they use to measure NNP PICC line performance, and what their perceptions were of those tools as measures of NNP PICC line performance outcomes. Using GE Centricity Perinatal Software, an evidence based electronic NNP PICC line procedure note was developed and implemented. A post implementation survey was conducted using the Clinical Information Systems Evaluation Scale. SPSS was used to analyze both survey results as well as the outcomes of the PICC line note. Results: Out of 14 NICU’s surveyed, 78.6% (N=11) do not measure NNP PICC line outcomes or performance. Of the 21.4 % (N=3) that do measure NP PICC line performance, two used the electronic health record to do so, but felt that it was less than adequate to measure NNP PICC line performance (M = 1.7, SD = 0.6). Eighty one percent of note fields were completed in the insertion section of the note, 85% of fields were completed for the adjustment part of the note and 88% of the removal note fields were completed. The implementation was viewed as moderately to highly successful with a CISIES total score of 3.2. Conclusions: NNP PICC line performance is not routinely measured in local Baltimore Washington area NICU’s. The successful implementation of a clinical information system, in this case an evidence based electronic NNP PICC line procedure note, demonstrates the potential power of the electronic health record to serve as a tool in the evaluation of NNP performance, outcomes and competence.