Barbara J. Zarowitz, PharmD, BCPS, BCGP, FCCP, FASCP

This guest blog is part two in a series on quality improvement in long-term care. To read part one, click here.

How often have you said, if only I had that when I needed it? In healthcare, as in so many other fields, the “expert next door”is frequently not available when most needed.  But through technology, that expert can be available to nurses, physicians and others taking care of the nation’s older adults in long-term care homes whether they are next door or in another part of the country.

Quality outcomes improve when clinical tools are embedded into workflow and electronic health records (EHR).1 These tools and information, referred to as clinical decision support or CDS, can make the difference between nursing homes that achieve their quality goals and those that don’t. CDS can take the form of prescribing alerts, algorithms to streamline care processes, order sets that align with clinical evidence, triggers for care plans, or suggested interventions for members of the interprofessional care team. CDS, consistent with organization clinical guidelines and standards of care, provides clinicians with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.2 In other words, …the “expert next door”. CDS is most beneficial when it provides the best knowledge at the time it is needed, it fits into the health team’s workflow so there is high adoption and effective use, and it is updated continuously thus providing only current and timely recommendations. CDS is the artificial intelligence that provides just the right guidance at the bedside at the time of care delivery.  

It has been stated that a barrier to achieving high quality clinical outcomes in older adults in nursing homes is a lack of confidence in one’s own clinical skills and judgment.3 Through telehealth technology, the “expert next door”can be consulted to verify a diagnosis, recommend alternative treatment options, guide monitoring, and potentially prevent an avoidable hospital admission.4   A tenet of providing high quality health care is to have the best-informed evidence base to guide treatment decisions and interventions. Telehealth is an effective method of delivering evidence-based information and processes of care to the care team or providing a skilled clinician to assess the patient and confer with the nursing staff remotely.

Slow adoption of technology that can enhance care quality hampers long-term care (LTC) facilities from consistently delivering excellent care. Most LTC electronic health records (EHRs) lack CDS tools that can be used easily in everyday practice. Many LTC clinicians do not utilize the EHR.  Failure to adopt technology with embedded CDS can leave LTC facilities constantly clawing up the quality chasm. 

References

  1. Mor V. Defining and measuring quality outcomes in long-term care. JAMDA 2007;8:E.129-E.137 DOI:10.1016/j/jamda.2006.12.014 
  2. Osheroff JA, Teich JM, Middleton B, et al. A roadmap for national action on clinical decision support. J Am Med Inform Assoc 2007;14:141-5. DOI:10.1197/jamia.M2334.
  3. Laging B, Ford R, Bauer M and Nau R. A meta-synthesis of factors influencing nursing home staff decisions to transfer residents to hospital. J Adv Nurs 2015;71:2224-36. Doi:10.1111/jan.12652 
  4. Edirippulige S, Martin-Khan M, Beattie E, et al. A systematic review of telemedicine services for residents in long term care facilities. J Telemed Telecare 2013;19:127-132. DOI:10.1177/1357633X13483256