Streamlining Workflows and Infection Control In Senior Care Facilities

Sixteen years ago, I began my tenure at Parker Life, an organization that provides assisted living, long-term care, and memory care for New Jersey seniors. Over time, I came to work both sides of the healthcare equation: frontline and informatics.

Initially, I worked as a staff nurse at a 52-bed facility. In 2010, I switched to the management side of the business and helped walk our clinical staff through the deployment of an EHR enterprise system that reduced our reliance on paper. I made a third move in 2018, this time to our IT department, where I helped migrate Parker Life to a new software platform. 

As a former floor nurse, I understand the challenges my frontline colleagues face every day. As an informatics clinician, I saw how our initial EHR simplified some aspects of their work, but other processes remained cumbersome. One of those processes was infection control. 

Logging Infections the Hard Way 

When we suspected a resident had an infection, we applied the SBAR (Situation, Background, Appraisal, Recommendation) briefing model. It is a framework that allows a healthcare team to communicate a resident's condition and make critical decisions about situations that demand immediate attention and treatment. 

To make the best decisions, we gathered information like resident histories, lists of medications, allergies, lab and imaging results, most recent vital signs, and other supporting documents. We kept everything in a binder and manually logged information into Microsoft Excel for review by the infection control designee. The process was labor intensive and time consuming. It overburdened our nurse managers, and each manual input increased the likelihood of human error. 

Once collected, everything was filed away, which made it less visible and accessible to physicians and other staff members. Even the Excel files were stored on local machines and were inaccessible to colleagues at other locations. It made collaboration across sites impossible. On top of all this, our quality teams had to cross check and confirm all the information we compiled, which added a further layer of complexity. 

We eventually began to share the Excel documents via SharePoint but were stuck when it came to infection control. Our initial EHR had an infection control module, but it wasn’t intuitive or easy. Entering and retrieving data was almost as cumbersome as filing papers in binders. We had to customize everything to align the system with our internal processes, and that got messy. 

Moving to a More Modern Solution 

All that changed in 2018, when we moved to PointClickCare, a cloud-based healthcare software provider. One of our sites had already implemented the platform, and when it came time to standardize practices across our entire network, PointClickCare made the most sense. PointClickCare had a lot of out-of-the-box functionality and the fact that it was built specifically for long-term care facilities on a foundation of best practices eliminated the guesswork from our process decisions.

At that time, PointClickCare didn’t have an infection control module, but in April 2020, they launched their Infection Prevention and Control (IPC) solution. The IPC module works in three ways. First, it helps communicate important insights and evidence-based recommendations, from the Centers for Disease Control (CDC) standards, to clinical and non-clinical teams. Second, it analyzes patterns and trends in infection data and allows us to share information to facilitate infection reporting and make better decisions at individual sites and across our organization. Third, it incorporates best practices for antibiotic stewardship to ensure the best outcomes for our residents and more options for medications as needed. 

When IPC was released, we were a month into the COVID-19 crisis, and we had marshalled our human and clinical resources to protect our most vulnerable residents. Given the pandemic's severity, PointClickCare rolled out IPC to get it into the healthcare community's hands as quickly as possible to deal with the pressing need.

Getting Buy in and Rolling Out Fast 

We already used PointClickCare core clinical, but to implement IPC, I needed quick buy-in from our education team and nurse leaders, all of whom are part of our Clinical Steering Committee. I reached out to PointClickCare and arranged a successful demo of the IPC module. Once I had my peers on board, I got approval from our chief medical officer, and we rolled it out to all our sites.

We authored a workflow document and emailed it to nurse leaders and managers across the organization. Then, we followed with in-person demos and training for frontline staff, and workflow tutorials for their superiors. We ensured that everyone had the information they needed for how to use IPC, according to our internal processes, to hit the ground running. 

Streamlined Workflows that Save Lives 

PointClickCare's IPC module simplified the way we log infections. When a nurse identifies a potential infection, they are prompted to open a case in the IPC module diagnosis tab and tag it "suspected." They don't have to fill in all the details right away, but this flags the case for our Infection Preventionist. In this newly-created role, the Infection Preventionist then reviews the case, adds the necessary information from the resident's file—lab reports, medication lists, etc.—and changes the status to "confirmed” if necessary.

This workflow has streamlined our activities and made them more efficient. Regulations specify that we have a dedicated Infection Preventionist at each site. This staff member uses IPC to open and close cases as needed, it frees our nurses to provide more intensive frontline care. It also frees our nurse managers to ensure their teams have everything they need to meet our residents' needs. 

PointClickCare's IPC module has also transformed how we collect, view, and share data related to the detection and control of infectious diseases to protect and treat our residents. Everything is easier to access and more visible, leading to faster diagnoses and swift action to treat infections and contain their spread. It's a game-changer and a lifesaver. 

Incorporating New Features into Our Workflows 

Just as we expected, PointClickCare has been enhancing with additional features since they launched the IPC module. PointClickCare uses pendo in-app notifications and assistance and I've also created a rolling “cheat sheet” of the features. With each successive update, I review the new features and decide which ones fit our specific use case. I then add them to the cheat sheet and send it to all our sites and all our personnel before the latest version of the EHR is deployed. This way, our staff gets information and support on new features both internally and from PointClickCare.

One of my favorite new features is the IPC badge that appears on a resident's medical record. If one of our seniors is battling an active infection, the IPC badge will be displayed next to their photograph. This alerts staff to click on it for details about the type of infection, the transmission route, the treatment being administered, and any contact precautions required, like the need to wear PPE. 

An even more powerful tool is the Infection Screening Evaluation we use to document infections and trigger active IPC cases. We didn't have to custom code it, as would have been the case with our previous EHR. The Infection Screening Evaluation, based on McGeer’s and Loeb’s criteria, provides a management console and dashboards that track infections at the resident, site, and organizational levels. We don't have to hunt through binders, Excel spreadsheets, and hard drives to find the data to discuss a specific case or confirm a trend across our five sites. 

Tailor Made for Long-Term Care Facilities 

PointClickCare is tailor made for long-term care facilities like ours. It centralizes resident information in an electronic repository that eliminates the frustration of dealing with paper records. The IPC module is integrated with our primary EHR and therefore connects with all our systems. We can view residents' lab and medical imaging results by clicking on a tab without ever leaving the IPC module. This allows us to consolidate and contextualize residents' entire medical histories within the scope of their infection treatment regimen. 

We use the IPC module's antibiotic stewardship feature to track drug-resistant infections and residents' medical and prescription histories to reduce their susceptibility to these organisms. It's a powerful tool in our fight against antibiotic resistance.

Unsurprisingly, we also use IPC to track COVID-19 infections across all of Parker’s facilities. We have a dedicated COVID-19 monitoring dashboard that we can click into and see how many confirmed and suspected cases we have in real time. We can then allocate the appropriate resources to contain the spread and care for residents. 

Better Care Today and Tomorrow 

PointClickCare's IPC module has streamlined how we gather and view data related to the detection and control of infectious diseases. It has turbocharged our ability to share that information to protect and treat our residents. Everything is more accessible and visible, improving our ability to diagnose, treat, and contain the spread of infections. 

It is a powerful tool that has helped Parker Life weather the pandemic and will help us deliver the best possible outcomes and highest quality of life to the seniors in our care.