University of Wisconsin–Milwaukee

Kathy Quirk

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Aug 19, 2008 
The Knowledge Based Nursing Initiative goes 'live'
Knowledge-Based Nursing Initiative
One part of the KBNI is a nursing knowledge repository. Researchers on the project reviewed information from a variety of nursing and medical sources in building the repository.

Photo by Peter Jakubowsk

A collaborative project from UWM’s College of Nursing to improve nursing care through the use of informatics went “live” July 21 at two Aurora Health Care locations.

The Knowledge-Based Nursing Initiative (KBNI), launched in 2004, is a partnership involving the University of Wisconsin-Milwaukee College of Nursing, Cerner Corporation and Aurora Health Care.

For the past four years, researchers, computer engineers, staff nurses and information technology experts have been working together to better apply informatics to the work that nurses do. The goal, says Project Director Norma Lang of the College of Nursing, is to synthesize the best medical and nursing knowledge and get it to nurses at the point of care in a user-friendly format. Lang is a Wisconsin distinguished professor of nursing.   

“Nursing is knowledge work, but much of the work that nurses do isn’t captured in current patient records systems,” says Sally Lundeen, dean of UWM’s College of Nursing and co-principal investigator on the KBNI project. “By developing ways of better capturing information on what nurses are doing, researchers can make links between the work of nurses and the outcomes for patients.”

The project team has compiled an electronic “nursing knowledge repository” from scientific publications, research reports, national guidelines, professional organizations and other sources of nursing “best practices.” The designers then translate that information into “actionable knowledge,” information nurses can use to make decisions.

The data-gathering and interface software are now in use at two Aurora St. Luke’s Medical Center nursing units. The evidence-based protocols now in place focus on patient falls: assessing the possibility a patient may fall down and sustain an injury and how to prevent such injuries – considering such factors as a patient’s overall medical history, current illness or injury and treatment, age and other factors. The protocols also consider how well patients are doing in taking their medications and their tolerance for activity.

When a patient is admitted, nurses conduct a bedside assessment. That assessment, incorporated on a computer screen, helps guide care. For example, if patients use a cane or walk with a gait, they are at higher risk for falls. If they have brittle bones or use blood thinners, they run the risk of serious injury or excessive bleeding as a result of falls. The nurses can refer to the software for evidence-based practices that help prevent falls.

Getting critical information and decision-making support to nurses in a useful electronic format is vital to improving the overall quality of care and controlling avoidable health problems, says Lang.

“There is nothing like this project in the world,” notes Lang. “What we’re doing is bringing together the university, a premier health care system and a huge health information technology company to synthesize the best knowledge and get it to the nurse right at the point of care.”

Eventually, participants hope to learn enough to remove unnecessary, time-consuming steps in nursing workflows, according to a recent article in WTN News by Joe Vanden Plas. “Everybody knows in the quality world that if you do it right the first time, it's the most cost-effective way to do it,” Lang noted in the article. “So we're interested in putting in the right steps, the right processes of what we call nursing action.”

For more information about the Knowledge-Based Nursing Initiative, see the WTN article at and UWM’s 2008 Research Report at