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Yang Q, Yang L, Yang C, Wu X, Xu Z, Wang X. How is work-family conflict linked to nurse-assessed patient safety among intensive care unit nurses? A serial multiple mediation analysis. Aust Crit Care 2024:S1036-7314(24)00078-X. [PMID: 38762342 DOI: 10.1016/j.aucc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 05/20/2024] Open
Abstract
AIM The aim of this study was to test whether rumination and negative affectivity mediate the relationship between work-family conflict and nurse-assessed patient safety among intensive care unit nurses. BACKGROUND Most intensive care unit nurses experience work-family conflicts that jeopardise patient safety. Although prior studies have explored the effect of work-family conflict on patient safety, few have investigated whether work-family conflict is associated with patient safety through rumination and negative affectivity among intensive care unit nurses. DESIGN Cross-sectional study. METHODS This study included 209 intensive care unit nurses from five general hospitals. The Work-Family Conflict Scale, the Ruminative Response Scale, the Positive and Negative Affect Schedule-Negative Affectivity, and three items indicating nurses' perception of overall patient safety were used to gather data. Associations between work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were assessed using correlation and serial multiple mediation analysis. RESULTS Work-family conflict, rumination, negative affectivity, and nurse-assessed patient safety were significantly correlated (p < 0.01). Work-family conflict can have not only a direct negative impact on the nurse-assessed patient safety (effect = -0.0234; standard error [SE] = 0.0116; 95% confidence interval [CI]: lower limit [LL] = -0.0464, upper limit [UL] = -0.0005) but also an indirect impact on nurse-assessed patient safety through three paths: the independent mediating role of rumination (effect = -0.0118; SE = 0.0063; 95% CI: LL = -0.0251, UL = -0.0006), the independent mediating role of negative affectivity (effect = -0.0055; SE = 0.0039; 95% CI: LL = -0.0153, UL = -0.0001), and the chain-mediating role of rumination and negative affectivity (effect = -0.0078; SE = 0.0031; 95% CI: LL = -0.0152, UL = -0.0027). CONCLUSION Our findings indicated that work-family conflict could influence nurse-assessed patient safety through increasing rumination and negative affectivity among intensive care unit nurses. Based on the results, interventions aimed at decreasing work-family conflict would be beneficial for intensive care unit nurses' emotional stability and patient safety.
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Affiliation(s)
- Qianqian Yang
- Liaocheng People's Hospital, Medical School of Liaocheng University, Liaocheng, Shandong Province, 252000, China; School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong Province, 250012, China.
| | - Linlin Yang
- Nursing Department of Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Chunling Yang
- Nursing Department of Liaocheng People's Hospital, Liaocheng, Shandong, China.
| | - Xia Wu
- Nursing Department of Taian City Central Hospital, Taian, Shandong, China.
| | - Zhen Xu
- Intensive Care Unit of Taian City Central Hospital, Taian, Shandong, China.
| | - Xiaobing Wang
- Obstetrics Department, Liaocheng People's Hospital, China.
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Neirat D, Batran A, Ayed A. Development of an electronic medical records project for Al-Razi hospital in Palestine. J Public Health Res 2023; 12:22799036231217795. [PMID: 38058992 PMCID: PMC10697050 DOI: 10.1177/22799036231217795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Electronic medical records (EMR) are considered an important aspect to improve medical services provided to patients. The purpose of this study was to assess the development of an Electronic Medical Records Project for Al-Razi hospital in Palestine. Design and Methods The study was mixed method, qualitative and quantitative. The use of a questionnaire for the staff in the Al-Razi hospital and seven administrators' participants were meat as focus group. Results Approximately 136 participants in the study. The study findings reported that employees perceived the use of EMRs to have several benefits. The most common benefits include promoting patient safety culture and drug error reduction. In addition, the study findings reported that employees perceived the use of EMRs to have several challenges. The most common challenges include lack of knowledge and skill, insufficient time to use EMR, and limited of computers. Conclusions Health informatics brings various benefits to the healthcare system. Some participants believed that the EMR system would improve patient care and it will improve patient satisfaction.
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Affiliation(s)
- Doaa Neirat
- Faculty of Graduate Studies, Arab American University, Palestine
| | - Ahmad Batran
- Faculty of Allied Medical Sciences, Department of Nursing, Palestine Ahliya University, Bethlehem, Palestine
| | - Ahmad Ayed
- Faculty of Nursing, Arab American University, Bethlehem, Palestine
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Jung Y, Kim HL, Hyun SS. The Impact of Airline's Smart Work System on Job Performance of Cabin Crew. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12414. [PMID: 36231714 PMCID: PMC9566674 DOI: 10.3390/ijerph191912414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Extant studies in medical and educational fields have demonstrated that employees' device use (smartphones, tablet PCs, etc.) can enhance job performance. Correspondingly, global airline companies have made substantial investments to enhance passenger services. An earlier study examined the impact of flight attendants' technology usage on job satisfaction by investigating the causal relationship between the benefits of tablet PC use, job performance, and its consequences. Based on the literature review, four advantages of technology use were derived: (1) efficiency, (2) convenience, (3) service effectiveness, and (4) pride. Additionally, three consequences of job satisfaction were derived: (1) team performance, (2) organizational commitment, and (3) turnover intention. Empirical data were collected from 208 flight attendants working for a South Korean airline, which provided tablet PCs for its employees. Data analysis revealed that work efficiency, convenience, and pride had a significant and positive impact on job satisfaction. However, flight preparation did not show a similar impact. This study is the first to investigate the benefits of using technology in the airline industry. Furthermore, it examined the convergence of airline management and information technology. The findings provide managerial implications for airline companies that are considering providing tablet PCs to flight attendants.
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Affiliation(s)
- Yongjin Jung
- School of Tourism, College of Social Sciences, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
| | - Haeok Liz Kim
- Computational Social Science Center, Hanyang University, Seoul 04763, Korea
| | - Sunghyup Sean Hyun
- School of Tourism, College of Social Sciences, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
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Do Patient Engagement IT Functionalities Influence Patient Safety Outcomes? A Study of US Hospitals. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:505-512. [PMID: 35867503 DOI: 10.1097/phh.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patient engagement using health information technology (IT) functionalities can be a powerful tool in managing their own care for better health outcomes. Therefore, this study explores whether patient engagement IT functionalities and electronic health record (EHR) can affect patient safety outcomes. DESIGN Using longitudinal study design for general acute care hospitals within the United States, we examine the interaction effects of EHR and patient engagement IT functionalities on patient safety outcomes (adverse incident rate) using a generalized estimating equation. SETTING Our national sample consisted of 9759 hospital-year observations from 2014 to 2018. Overall, we found a significant association between adverse incident rate and patient engagement level and EHR adoption level. RESULTS On average, as the combined effects of patient engagement level and EHR adoption level increases, the adverse incident rate decreases by approximately 0.49 (P < .01). Incorporating patient engagement functionalities is becoming an essential tool to improve health outcomes and will play an instrumental role in meeting meaningful use standards. CONCLUSIONS Our study provides insights into the potential synergy between a hospital's existing EHR maturity and patient engagement health IT functionalities in affecting organizational performance. Organizational culture and capabilities pertinent to adopting patient engagement health IT functionalities infrastructure should be established first to provide the impetus for this synergy.
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Althumairi A, Alzahrani A, Alanzi T, Al Wahabi S, Alrowaie S, Aljaffary A, Aljabri D. Factors affecting compliance with national accreditation essential safety standards in the Kingdom of Saudi Arabia. Sci Rep 2022; 12:7562. [PMID: 35534657 PMCID: PMC9085763 DOI: 10.1038/s41598-022-11617-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
Accreditation is a widespread culture internationally and nationally. The effectiveness of compliance with accreditation standards was positively correlated with health care settings' performance in multiple aspects: leadership, professional performance, patient safety and organizational culture. There is limited knowledge of the national compliance rate with accreditation standards. Therefore, it is important to assess the hospital compliance with accreditation rate in the Kingdom Saudi Arabia (KSA) and its related factors. This paper presents a quantitative cross-sectional study. Data were extracted from the annual Essential Safety Requirement (ESR) survey database from the Central Board for Accreditation of Health care Institutions (CBAHI) research center during the period 2016 to 2018. Hospitals that started their operation after the first ESR survey round in 2016 or shut down during the study period were excluded. The hospital scoring was on a scale of 0 to 100 and classified as follows: score 2 if the hospital satisfactory compliance (Fully Met) was ≥ 80% and score 1 if particular compliance (Partially Met) was ≥ 50% to < 80%. Then, a score of 0 indicated insufficient compliance (Not Met) when < 50% and a score of not applicable (NA) if the standard does not apply to the hospital. A total of 437 hospitals were surveyed in 20 regions in the KSA and had an overall compliance rate on average that was higher among private hospitals than among public hospitals (77% vs. 66%). Overall, private hospitals had a significantly better compliance rate than public hospitals (mean rate = 84% vs. 68%, respectively, P = 0.019). Large hospitals had more compliance with some standards than smaller hospitals. After adjusting for the year of the survey report, the private hospital type was more compliant than the public hospital. This study supports mandatory accreditation programs for both public and private health sectors, with increased monitoring by the concerned parties (i.e., CBAHI and the Ministry of Health). The authors encourage the application of accreditation for specialized and independent health services.
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Affiliation(s)
- Arwa Althumairi
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P. O. Box 2954, Dammam, 6603-34211, Saudi Arabia.
| | - Amal Alzahrani
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P. O. Box 2954, Dammam, 6603-34211, Saudi Arabia
| | - Turki Alanzi
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P. O. Box 2954, Dammam, 6603-34211, Saudi Arabia
| | - Salem Al Wahabi
- Central Board for Accreditation of Healthcare Institutions-CBAHI, Riyadh, Saudi Arabia
| | - Summaya Alrowaie
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P. O. Box 2954, Dammam, 6603-34211, Saudi Arabia
| | - Afnan Aljaffary
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P. O. Box 2954, Dammam, 6603-34211, Saudi Arabia
| | - Duaa Aljabri
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, P. O. Box 2954, Dammam, 6603-34211, Saudi Arabia
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Gnanlet A, Sharma L, McDermott C, Yayla-Kullu M. Impact of workforce flexibility on quality of care: moderating effects of workload and severity of illness. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2021. [DOI: 10.1108/ijopm-04-2021-0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAs a way of alleviating nursing workforce shortages, health care managers are employing two types of workforce flexibility: supplemental staffing and floating among units. In this paper, the authors investigate the moderating effects of two critical situational variables – namely, job-level workload and severity of illness (SOI) in a given unit – on the relationship between workforce flexibility and quality of care as assessed by the nurses at the unit-level.Design/methodology/approachThe authors empirically test the relationship between a unit's floating of nurses and the use of supplemental workforce on the quality of patient care and the moderating role of patient SOI and job-level workload on this relationship using 357 hospital-unit observations.FindingsThe authors find that situational variables play a critical role in flexible staffing strategies and they should be accounted for carefully to obtain the best quality of care outcomes. The authors find that the well-known negative effect of supplemental staffing on quality of care is not universal and appears to be moderated by the situational factors studied in this paper.Practical implicationsFor best outcomes, staffing manager who oversee multiple units should use supplemental staff on units that have lower job-level workload and on units that have high severity of illness. The authors also find that managers of units with patients who are less-severely ill should encourage nurses to float out and return to their home unit. This strategy will improve quality of patient care in the home unit.Originality/valueWhile some research analyzes the direct link between flexibility and quality performance, how this relationship is affected by varying situational factors within a unit has not been studied so far.
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Resource-based view on safety culture's influence on hospital performance: The moderating role of electronic health record implementation. Health Care Manage Rev 2021; 45:207-216. [PMID: 30157101 DOI: 10.1097/hmr.0000000000000217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient safety and safety culture have received increasing attention from agencies such as the Agency of Healthcare Research and Quality and the Institute of Medicine. Safety culture refers to the fundamental values, attitudes, and perceptions that provide a unique source of competitive advantage to improve performance. This study contributes to the literature and expands understanding of safety culture and hospital performance outcomes when considering electronic health record (EHR) usage. PURPOSE Based on the resource-based view of the firm, this study examined the association between safety culture and hospital quality and financial performance in the presence of EHR. METHODOLOGY/APPROACH Data consist of the 2016 Hospital Survey on Patient Safety, Hospital Compare, American Hospital Association's annual survey, and the American Hospital Association's Information Technology supplement. Our final analytic sample consisted of 154 hospitals. We used a two-part nested regression model approach. RESULTS/CONCLUSION Safety culture has a direct positive relationship with financial performance (operating margin). Furthermore, having basic EHR as compared to not having EHR further enhances this positive relationship. On the other hand, safety culture does not have a direct association with quality performance (readmissions) in most cases. However, safety culture coupled with basic EHR functionalities, compared to not having EHR, is associated with lower readmissions. PRACTICE IMPLICATIONS Hospitals should strive to improve patient safety culture as part of their strategic plan for quality improvement. In addition, hospital managers should consider implementing EHR as a resource that can support safety culture's effect on outcomes such as financial and quality performance indicators. Future studies can examine the differences between basic and advanced EHR presence in relation to safety culture.
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Li P, Chen B, Rhodes E, Slagle J, Alrifai MW, France D, Chen Y. Measuring Collaboration Through Concurrent Electronic Health Record Usage: Network Analysis Study. JMIR Med Inform 2021; 9:e28998. [PMID: 34477566 PMCID: PMC8449299 DOI: 10.2196/28998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/23/2021] [Accepted: 08/02/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Collaboration is vital within health care institutions, and it allows for the effective use of collective health care worker (HCW) expertise. Human-computer interactions involving electronic health records (EHRs) have become pervasive and act as an avenue for quantifying these collaborations using statistical and network analysis methods. OBJECTIVE We aimed to measure HCW collaboration and its characteristics by analyzing concurrent EHR usage. METHODS By extracting concurrent EHR usage events from audit log data, we defined concurrent sessions. For each HCW, we established a metric called concurrent intensity, which was the proportion of EHR activities in concurrent sessions over all EHR activities. Statistical models were used to test the differences in the concurrent intensity between HCWs. For each patient visit, starting from admission to discharge, we measured concurrent EHR usage across all HCWs, which we called temporal patterns. Again, we applied statistical models to test the differences in temporal patterns of the admission, discharge, and intermediate days of hospital stay between weekdays and weekends. Network analysis was leveraged to measure collaborative relationships among HCWs. We surveyed experts to determine if they could distinguish collaborative relationships between high and low likelihood categories derived from concurrent EHR usage. Clustering was used to aggregate concurrent activities to describe concurrent sessions. We gathered 4 months of EHR audit log data from a large academic medical center's neonatal intensive care unit (NICU) to validate the effectiveness of our framework. RESULTS There was a significant difference (P<.001) in the concurrent intensity (proportion of concurrent activities: ranging from mean 0.07, 95% CI 0.06-0.08, to mean 0.36, 95% CI 0.18-0.54; proportion of time spent on concurrent activities: ranging from mean 0.32, 95% CI 0.20-0.44, to mean 0.76, 95% CI 0.51-1.00) between the top 13 HCW specialties who had the largest amount of time spent in EHRs. Temporal patterns between weekday and weekend periods were significantly different on admission (number of concurrent intervals per hour: 11.60 vs 0.54; P<.001) and discharge days (4.72 vs 1.54; P<.001), but not during intermediate days of hospital stay. Neonatal nurses, fellows, frontline providers, neonatologists, consultants, respiratory therapists, and ancillary and support staff had collaborative relationships. NICU professionals could distinguish high likelihood collaborative relationships from low ones at significant rates (3.54, 95% CI 3.31-4.37 vs 2.64, 95% CI 2.46-3.29; P<.001). We identified 50 clusters of concurrent activities. Over 87% of concurrent sessions could be described by a single cluster, with the remaining 13% of sessions comprising multiple clusters. CONCLUSIONS Leveraging concurrent EHR usage workflow through audit logs to analyze HCW collaboration may improve our understanding of collaborative patient care. HCW collaboration using EHRs could potentially influence the quality of patient care, discharge timeliness, and clinician workload, stress, or burnout.
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Affiliation(s)
- Patrick Li
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Bob Chen
- Epithelial Biology Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Evan Rhodes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jason Slagle
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mhd Wael Alrifai
- Department of Pediatric, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Computer Science, Vanderbilt University, Nashville, TN, United States
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Abebe E, Scanlon MC, Chen H, Yu D. Complexity of Documentation Needs for Children With Medical Complexity: Implications for Hospital Providers. Hosp Pediatr 2021; 10:670-678. [PMID: 32727931 DOI: 10.1542/hpeds.2020-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Care coordination is a core component of pediatric complex care programs (CCPs) supporting children with medical complexity (CMC) and their families. In this study, we aim to describe the purpose and characteristics of clinical care notes used within a pediatric CCP. METHODS We conducted observations of provider-family interactions during CCP clinic visits and 5 focus groups with members of the CCP. Focus groups were recorded and transcribed. Field observation notes and focus group transcripts were subjected to qualitative content analyses. RESULTS Four major themes help characterize clinical care notes: (1) Diversity of note types and functions: program staff author and use a number of unique note types shared across multiple stakeholders, including clinicians, families, and payers. (2) motivations for care note generation are different and explain how, why, and where they are created. (3) Program staff roles and configuration vary in relation to care note creation and use. (4) Sources of information for creating and updating notes are also diverse. Given the disparate information sources, integrating and maintaining up-to-date information for the child is challenging. To minimize information gaps, program staff devised unique but resource-intensive strategies, such as accompanying families during specialty clinic visits or visiting them inpatient. CONCLUSIONS CMC have complex documentation needs demonstrated by a variety of professional roles, care settings, and stakeholders involved in the generation and use of notes. Multiple opportunities exist to redesign and streamline the existing notes to support the cognitive work of clinicians providing care for CMC.
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Affiliation(s)
- Ephrem Abebe
- Department of Pharmacy Practice, College of Pharmacy and
| | - Matthew C Scanlon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Haozhi Chen
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana; and
| | - Denny Yu
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana; and
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Subbe CP, Tellier G, Barach P. Impact of electronic health records on predefined safety outcomes in patients admitted to hospital: a scoping review. BMJ Open 2021; 11:e047446. [PMID: 33441368 PMCID: PMC7812113 DOI: 10.1136/bmjopen-2020-047446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Review available evidence for impact of electronic health records (EHRs) on predefined patient safety outcomes in interventional studies to identify gaps in current knowledge and design interventions for future research. DESIGN Scoping review to map existing evidence and identify gaps for future research. DATA SOURCES PubMed, the Cochrane Library, EMBASE, Trial registers. STUDY SELECTION Eligibility criteria: We conducted a scoping review of bibliographic databases and the grey literature of randomised and non-randomised trials describing interventions targeting a list of fourteen predefined areas of safety. The search was limited to manuscripts published between January 2008 and December 2018 of studies in adult inpatient settings and complemented by a targeted search for studies using a sample of EHR vendors. Studies were categorised according to methodology, intervention characteristics and safety outcome.Results from identified studies were grouped around common themes of safety measures. RESULTS The search yielded 583 articles of which 24 articles were included. The identified studies were largely from US academic medical centres, heterogeneous in study conduct, definitions, treatment protocols and study outcome reporting. Of the 24 included studies effective safety themes included medication reconciliation, decision support for prescribing medications, communication between teams, infection prevention and measures of EHR-specific harm. Heterogeneity of the interventions and study characteristics precluded a systematic meta-analysis. Most studies reported process measures and not patient-level safety outcomes: We found no or limited evidence in 13 of 14 predefined safety areas, with good evidence limited to medication safety. CONCLUSIONS Published evidence for EHR impact on safety outcomes from interventional studies is limited and does not permit firm conclusions regarding the full safety impact of EHRs or support recommendations about ideal design features. The review highlights the need for greater transparency in quality assurance of existing EHRs and further research into suitable metrics and study designs.
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Affiliation(s)
- Christian Peter Subbe
- School of Medical Sciences, Bangor University, Bangor, UK
- Medicine, Ysbyty Gwynedd, Bangor, UK
| | | | - Paul Barach
- Pediatrics, Wayne State University, Detroit, Michigan, USA
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Optimizing the Cognitive Space of Nursing Work Through Electronic Medical Records. COMPUTERS, INFORMATICS, NURSING : CIN 2020; 38:545-550. [PMID: 32826398 DOI: 10.1097/cin.0000000000000666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incorporation of electronic medical records into nursing practice highlights the need to facilitate communication among nurses. The extensive use of information suggests that electronic medical records should be considered in the cognitive workspace to manage information and facilitate communication. The purpose of this study was to construct an integrative model to explain the role of electronic medical records in the cognitive workspace. This work is grounded in the Theory of Swift and Even Flow and Distributive Cognition. The Distributive Cognitive model views the workplace as a cognitive system, such that cognitive processes do not occur in individual clinicians, but as a collaborative effort among nurses. The Theory of Swift and Even Flow was used to explain the flow of information among nurses. We used a qualitative approach to gather data from nurses at local inpatient facilities. Seven focus groups among three facilities were completed (n = 34). A semistructured questionnaire guided the focus group sessions. The results suggest that electronic medical records contribute to the cognitive workspace by serving as a conduit for information to be collected and distributed. These systems may positively influence nursing care when the quality, quantity, and timeliness of information are optimized.
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Vaismoradi M, Tella S, A. Logan P, Khakurel J, Vizcaya-Moreno F. Nurses' Adherence to Patient Safety Principles: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062028. [PMID: 32204403 PMCID: PMC7142993 DOI: 10.3390/ijerph17062028] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/18/2022]
Abstract
Background: Quality-of-care improvement and prevention of practice errors is dependent on nurses’ adherence to the principles of patient safety. Aims: This paper aims to provide a systematic review of the international literature, to synthesise knowledge and explore factors that influence nurses’ adherence to patient-safety principles. Methods: Electronic databases in English, Norwegian, and Finnish languages were searched, using appropriate keywords to retrieve empirical articles published from 2010–2019. Using the theoretical domains of the Vincent’s framework for analysing risk and safety in clinical practice, we synthesized our findings according to ‘patient’, ‘healthcare provider’, ‘task’, ‘work environment’, and ‘organisation and management’. Findings: Six articles were found that focused on adherence to patient-safety principles during clinical nursing interventions. They focused on the management of peripheral venous catheters, surgical hand rubbing instructions, double-checking policies of medicines management, nursing handover between wards, cardiac monitoring and surveillance, and care-associated infection precautions. Patients’ participation, healthcare providers’ knowledge and attitudes, collaboration by nurses, appropriate equipment and electronic systems, education and regular feedback, and standardization of the care process influenced nurses’ adherence to patient-safety principles. Conclusions: The revelation of individual and systemic factors has implications for nursing care practice, as both influence adherence to patient-safety principles. More studies using qualitative and quantitative methods are required to enhance our knowledge of measures needed to improve nurse’ adherence to patient-safety principles and their effects on patient-safety outcomes.
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Affiliation(s)
- Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway
- Correspondence: ; Tel.: +47-75517813
| | - Susanna Tella
- Faculty of Health and Social Care, LAB University of Applied Sciences, 53850 Lappeenranta, Finland;
| | - Patricia A. Logan
- Faculty of Science, Charles Sturt University, 2795 Bathurst, Australia;
| | - Jayden Khakurel
- Research Centre for Child Psychiatry, Department of Child Psychiatry, Faculty of Medicine, University of Turku, 20014 Turku, Finland;
| | - Flores Vizcaya-Moreno
- Nursing Department, Faculty of Health Sciences, University of Alicante, 03080 Alicante, Spain;
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Redley B, Douglas T, Botti M. Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review. J Clin Nurs 2020; 29:1477-1487. [PMID: 32045059 DOI: 10.1111/jocn.15213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/09/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To systematically locate, assess and synthesise research to describe methods used to examine technology in relation to the quality of nursing work in acute care. Specific objectives were to (a) describe the types of nursing work examined; (b) describe methods used to examine technology in nursing work; (c) identify outcomes used to evaluate technology in relation to the quality of nursing work; and (d) make recommendations for future research. BACKGROUND New technologies can offer numerous benefits to nurses; however, it is challenging to evaluate health information technologies in relation to the quality of nurses' complex day-to-day work. DESIGN A systematic integrative review using a five-step process. METHODS Five databases were searched using search terms "nurs*," "workload," "task," "time." Data screening, extraction and interpretation were conducted independently by at least two authors and agreement verified by discussion. Data extraction followed PRISMA guidelines. RESULTS Of the 41 studies included, most (87.8%, n = 36) examined physical dimensions of nursing work; 31.7% (n = 13) organisational dimensions; 17.1% (n = 8) cognitive dimensions; and only 12.2% (n = 5) emotional dimensions. More than half (58.5%, n = 24) examined only one dimension; one captured all four dimensions. Most frequently examined technologies were electronic medical/health records (36.5%) and electronic medication management (19.5%). Direct observation (58.8%, n = 28) and multiple methods (19.5%, n = 8) were the most common methods; nurse tasks, frequency, duration and time distribution were variables most often measured. CONCLUSIONS Examinations of technology in nursing work often failed to capture the multiple dimensions of this work nor did they recognise the complexity of day-to-day nursing work in acute care. There is a paucity of literature to inform how and what technology should be measured in relation to the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE The outcomes inform useful research methods to comprehensively examine technology to enhance the quality of complex nursing work.
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Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research - Monash Health Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Tracy Douglas
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Mari Botti
- Centre for Quality and Patient Safety Research - Epworth Healthcare Partnership, School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
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Data Entry Automation Improves Cost, Quality, Performance, and Job Satisfaction in a Hospital Nursing Unit. J Nurs Adm 2019; 50:34-39. [PMID: 31804410 DOI: 10.1097/nna.0000000000000836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An Automated Data Entry Process Technology tool was developed to free nurses from data entry tasks, thus creating time for patient care and other activities associated with improvements in performance and job satisfaction. BACKGROUND Manually transferring data from patient measurement devices to electronic health records (EHRs) is an intensive, error-prone task that diverts nurses from patient care while adversely affecting job performance and employee satisfaction. METHODS Performance improvement analytics were used to compare matched sets of manual and automated EHR data entries for 1933 consecutive vital signs records created by 49 RNs and certified nursing assistants in a 23-bed medical-surgical unit at a large tertiary hospital. Performance and quality effects were evaluated via nurses' responses to a postintervention survey. RESULTS Data errors decreased from approximately 20% to 0; data transfer times were reduced by 5 minutes to 2 hours per measurement event; nurses had more time for direct patient care; and job satisfaction improved. CONCLUSION Data entry automation eliminates data errors, substantially reduces delays in getting data into EHRs, and improves job satisfaction by giving nurses more time for direct patient care. Findings are associated with improvements in quality, work performance, and job satisfaction, key goals of nursing leaders.
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Ang RJ. Use of content management systems to address nursing workflow. Int J Nurs Sci 2019; 6:454-459. [PMID: 31728400 PMCID: PMC6839280 DOI: 10.1016/j.ijnss.2019.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 12/01/2022] Open
Abstract
Nurses are at the forefront of providing healthcare services to individuals of all age groups and with varying medical conditions. Aside from the critical knowledge and technical skills from nursing science, advancement in technology has assisted nurses in delivering quality nursing care by streamlining workflow processes and ensuring that data can easily be retrieved or modified. Electronic health records dramatically changed the landscape of the healthcare practice by providing an electronic means to store data and for healthcare professionals to retrieve and manipulate health information in a secured and collaborative environment. But with the nature of data being stored in the electronic health records, nurses still need to organize and process these data into relevant information, knowledge or wisdom so they can provide better holistic care to patients. This discussion paper details the role of content management systems in addressing nursing workflow by providing a mechanism for nurses to be developers themselves, and not just users or consumers of health innovative technologies. By using content management systems as platform for application development, nurses or other healthcare professionals, may be able to address problems with internal workflow without having to incur huge amounts in software development, or having to extensively learn programming languages.
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Affiliation(s)
- Raymund John Ang
- Health Carousel, LLC., OH, USA.,Regional Hospital of Scranton, Scranton, PA, USA
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Hardiker NR, Dowding D, Dykes PC, Sermeus W. Reinterpreting the nursing record for an electronic context. Int J Med Inform 2019; 127:120-126. [PMID: 31128823 DOI: 10.1016/j.ijmedinf.2019.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/15/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This article seeks to facilitate the re-imagining of nursing records purposefully within an electronic context. It questions existing approaches to nursing documentation, critically examines existing nursing record systems and identifies new requirements. METHODS A comprehensive literature review was conducted to identify themes, that might meaningfully contribute to a new approach to nursing record systems development, around four key interrelated areas - standards, decision making, abstraction and summarization, and documenting. Studies were analyzed using narrative synthesis to provide a critical analysis of the current 'state of the art', and recommendations for the future. RESULTS Included studies collectively described aspects of current best practice, both in terms of nursing record systems themselves, and how nurses and other health professionals contribute to and engage with those systems. A number of cross-cutting themes identified more novel approaches taken by nurses to systems development: going back to basics in determining purpose; firming up informatics foundations; nuancing or tailoring to suit different requirements; and engagement, involvement and participation. CONCLUSION There is a paucity of research that specifically focuses on the nature of the electronic nursing record and its impact on patient care processes and outcomes. In addition to further research in these areas, there is a need: to reinterpret nurses as knowledge workers rather than as 'data collectors'; to agree on the application in practice of appropriate standards and terminologies; and to work together with system developers to change the ways in which data are captured and care is documented.
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Affiliation(s)
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, UK.
| | - Patricia C Dykes
- Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, USA.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Belgium.
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Factors Influencing Information and Communication Technology Knowledge and Use Among Nurse Managers in Selected Hospitals in the Volta Region of Ghana. ACTA ACUST UNITED AC 2019; 37:171-177. [DOI: 10.1097/cin.0000000000000477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Park YS, McNaughton DB, Mathiason MA, Monsen KA. Understanding tailored PHN interventions and outcomes of Latina mothers. Public Health Nurs 2018; 36:87-95. [DOI: 10.1111/phn.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/03/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Young Shin Park
- School of Nursing; University of Minnesota; Minneapolis Minnesota
| | - Diane B. McNaughton
- Department of Community, Systems, and Mental Health Nursing; Rush University Medical Center; Chicago Illinois
| | | | - Karen A. Monsen
- School of Nursing; University of Minnesota; Minneapolis Minnesota
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Qualität der pflegerischen Dokumentation und Auswirkungen auf die pflegerische Praxis – ein integratives Review. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s16024-018-0316-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Booth R, Sinclair B, McMurray J, Strudwick G, Watson G, Ladak H, Zwarenstein M, McBride S, Chan R, Brennan L. Evaluating a Serious Gaming Electronic Medication Administration Record System Among Nursing Students: Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e138. [PMID: 29807885 PMCID: PMC5996180 DOI: 10.2196/resprot.9601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background Although electronic medication administration record systems have been implemented in settings where nurses work, nursing students commonly lack robust learning opportunities to practice the skills and workflow of digitalized medication administration during their formative education. As a result, nursing students’ performance in administering medication facilitated by technology is often poor. Serious gaming has been recommended as a possible intervention to improve nursing students’ performance with electronic medication administration in nursing education. Objective The objectives of this study are to examine whether the use of a gamified electronic medication administration simulator (1) improves nursing students’ attention to medication administration safety within simulated practice, (2) increases student self-efficacy and knowledge of the medication administration process, and (3) improves motivational and cognitive processing attributes related to student learning in a technology-enabled environment. Methods This study comprised the development of a gamified electronic medication administration record simulator and its evaluation in 2 phases. Phase 1 consists of a prospective, pragmatic randomized controlled trial with second-year baccalaureate nursing students at a Canadian university. Phase 2 consists of qualitative focus group interviews with a cross-section of nursing student participants. Results The gamified medication administration simulator has been developed, and data collection is currently under way. Conclusions If the gamified electronic medication administration simulator is found to be effective, it could be used to support other health professional simulated education and scaled more widely in nursing education programs. Trial Registration ClinicalTrials.gov NCT03219151; https://clinicaltrials.gov/show/NCT03219151 (Archived by WebCite at http://www.webcitation.org/6yjBROoDt) Registered Report Identifier RR1-10.2196/9601
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Affiliation(s)
- Richard Booth
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Barbara Sinclair
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Josephine McMurray
- Business Technology Management/Health Studies, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gavan Watson
- Teaching Support Centre, Western University, London, ON, Canada
| | - Hanif Ladak
- Department of Medical Biophysics, Faculty of Engineering, Western University, London, ON, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Susan McBride
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Ryan Chan
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Laura Brennan
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
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Does electronic health record use improve hospital financial performance? Evidence from panel data. Health Care Manage Rev 2018; 41:267-74. [PMID: 26052785 DOI: 10.1097/hmr.0000000000000068] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to examine the impact of electronic health record (EHR) adoption on hospital financial performance. METHODOLOGY/APPROACH We constructed a longitudinal panel using data from the three secondary sources: (a) the 2007-2010 American Hospital Association (AHA) Annual Survey, (b) the 2007-2010 AHA Annual Survey Information Technology Supplement, and (c) the 2007-2011 Medicare Cost Reports from Centers for Medicare and Medicaid Services. Because potential financial benefits attributable to EHR adoption may take some time to accrue, we ran regressions with lags of 1 and 2 years that included hospital and year fixed effects to examine the relationship between the level of EHR adoption and three hospital financial performance measures. FINDINGS A change in the level of EHR adoption was not associated with changes in operating margin or return on assets within hospitals. However, total margin was significantly improved, after 2 years, in hospitals that moved from no EHR to having a comprehensive EHR in all areas of their hospital (β = 0.030, p < .034). On the other hand, hospitals that increased their level of EHR adoption but did not achieve hospital-wide comprehensive adoption did not experience changes in any financial performance measures examined. PRACTICE IMPLICATIONS The improvements in total margin, as opposed to operating margin, are likely due to hospital incentive payments under the Health Information Technology for Economic and Clinical Health Act that are reflected in nonpatient revenues and therefore show up in total margin calculations. Thus, after 2 years of EHR adoption, hospital financial performance is observed to improve based only on meaningful use incentive payments. More research will be needed to determine whether EHR adoption impacts financial performance on a longer time horizon.
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Tubaishat A. The effect of electronic health records on patient safety: A qualitative exploratory study. Inform Health Soc Care 2017; 44:79-91. [PMID: 29239662 DOI: 10.1080/17538157.2017.1398753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly used in healthcare settings and it is believed that they have brought benefits to patients and healthcare services alike. Few previous studies, however, have explored the impact of these records on patient safety. AIM The overall purpose of this study was to explore the effect of EHRs on patient safety, as perceived by nurses. METHODS This qualitative exploratory study was conducted using semi-structured interviews with staff nurses working in hospitals that employed the same EHR system in Jordan. Seventeen nurses were interviewed working in various units and wards of ten hospitals which had used EHRs between 1 and 5 years. Field notes were taken during interviews and analyzed thematically. RESULTS Two major themes emerged from the data. One regarded the enhancements that EHRs have made to patient safety; and the other surrounded concerns raised by the use of these systems. Under each main theme there were four subthemes. EHRs directly or indirectly improved patient safety by minimizing medication errors, improving documentation of data, enhancing the completeness of data, and improving the sustainability of data. The interviewees expressed concern that the following may jeopardize patient safety: data entry errors, technical problems, minimal clinical alerts, and poor use of system communication channels. CONCLUSION A range of opinions were reported by the interviewees, from being fully supportive of EHRs to being reluctant to agree with the idea that they can improve patient safety. However, the concerns raised by the interviewees might be associated with poor system design or improper human use of the system. Thus, it is necessary to design systems with specifications that support patient safety and, moreover, involving nurses in this process might facilitate this outcome.
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Affiliation(s)
- Ahmad Tubaishat
- a Adult Health Nursing Department, Faculty of Nursing , AL AL-Bayt University , Mafraq , Jordan
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Strudwick G, Booth RG, Bjarnadottir RI, Collins S, Srivastava R. Exploring the role of the nurse manager in supporting point-of-care nurses' adoption of electronic health records: protocol for a qualitative research study. BMJ Open 2017; 7:e018129. [PMID: 29025847 PMCID: PMC5652540 DOI: 10.1136/bmjopen-2017-018129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION An increasing number of electronic health record (EHR) systems have been implemented in clinical practice environments where nurses work. Findings from previous studies have found that a number of intended benefits of the technology have not yet been realised to date, partially due to poor system adoption among health professionals such as nurses. Previous studies have suggested that nurse managers can support the effective adoption and use of the technology by nurses. However, no known studies have identified what role nurse managers have in supporting technology adoption, nor the specific strategies that managers can employ to support their staff. Therefore, the purpose of this research is to better understand the role of the nurse manager in point-of-care nurses' use of EHRs, and to identify strategies that may be effective in supporting clinical adoption. METHODS AND ANALYSIS This study will use a qualitative descriptive design. Interviews with both nurse managers and point-of-care nursing staff will be conducted in a Canadian mental health and addiction healthcare organisation where an EHR has been implemented. A semistructured interview guide will be used, and interviews will be audio recorded. Transcripts will be analysed using a directed content analysis technique. Strategies to ensure the trustworthiness of the data analysis procedure and findings will be employed. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained. Dissemination strategies may include a paper submission to a peer-reviewed journal, a conference submission and meetings to share findings with the study site leadership team. Findings from this research will be used to inform a future study which aims to assess levels of competencies and perform a psychometric analysis of the Nursing Informatics Competency Assessment for the Nurse Leader instrument in a Canadian context.
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Affiliation(s)
- Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Richard G Booth
- Arthur Labatt School of Nursing, Western University, London, Canada
| | | | - Sarah Collins
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rani Srivastava
- Professional Practice, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Booth RG, Sinclair B, Strudwick G, Brennan L, Tong J, Relouw H, Hancock M, Vlasic W. Identifying Error Types Made by Nursing Students Using eMAR Technology. Clin Simul Nurs 2017. [DOI: 10.1016/j.ecns.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Nurses comprise the largest segment of the healthcare workforce. As such, their perceptions of any new technology are important to understand, as it may ultimately mean the difference between acceptance and rejection of a product. The three-stage meaningful use program is intended to help improve and standardize data capture and advance clinical processes to improve patient and population outcomes in the US. With more than 471 000 healthcare providers having already received meaningful use incentive payments totaling more than $20 billion as of June 2015, it is critical to understand how these technologies are being viewed and utilized in practice. Understanding nurses' attitudes toward healthcare technology may help drive acceptance, as well as maximize the inherent potential of the new technologies toward improving patient care. Thus, the purpose of this integrative review is to highlight what is known about nurses' attitudes toward meaningful use technologies.
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Sood HS, McNeil K. How is health information technology changing the way we deliver NHS hospital care? Future Healthc J 2017; 4:117-120. [PMID: 31098447 PMCID: PMC6502612 DOI: 10.7861/futurehosp.4-2-117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
As NHS England and the health system makes further investments in the deployment of health information technology (HIT) across NHS sites, this review article considers some of the benefits HIT can provide in secondary care, including the potential of creating innovation ecosystems.
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Bae J, Rask KJ, Becker ER. The Impact of Electronic Medical Records on Hospital-Acquired Adverse Safety Events: Differential Effects Between Single-Source and Multiple-Source Systems. Am J Med Qual 2017; 33:72-80. [DOI: 10.1177/1062860617702453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Guru PK, Singh TD, Passe M, Kashani KB, Schears GJ, Kashyap R. Derivation and Validation of a Search Algorithm to Retrospectively Identify CRRT Initiation in the ECMO Patients. Appl Clin Inform 2016; 7:596-603. [PMID: 27437064 DOI: 10.4338/aci-2015-12-ra-0183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/28/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of extracorporeal membrane oxygenation (ECMO) in refractory cardiorespiratory failure is gaining momentum with recent advancements in technology. However, the need for dialysis modes such as continuous renal replacement therapy (CRRT) has also increased in the management for acute kidney injury. Establishing the exact timing of CRRT initiation in these patients from the electronic medical record is vital for automated data extraction for research and quality improvement efforts. OBJECTIVES We aimed to derive and validate an automated Electronic Health Records (EHR) search strategy for CRRT initiation in patients receiving ECMO. METHODS We screened 488 patients who received ECMO and a total of 213 patients underwent CRRT. We evaluated random 120 patients, 60 for derivation and 60 for validation cohorts. Following implementation of eligibility criteria, the algorithm was derived in 55 out of 120 ECMO/CRRT patients. The search algorithm was developed using first-time chart entry of 'access pressure drop' at CRRT initiation. The algorithm was then validated in an independent subset of 52 patients from the same time period. The overall agreement between electronic search algorithm and a comprehensive manual medical record review in the derivation and validation subsets, using 'access pressure drop' as the reference standard, was compared to assess CRRT initiation time. RESULTS In the derivation subset (N=55), the automated electronic search strategy achieved an excellent agreement with manual search (κ =0.99, 54 were identified electronically, and 55 upon manual review). There was no time difference observed in 49/54(89%) patients, while in the remaining 5 (9%) patients time difference was within 15 minutes. In the validation cohort (N=52), agreement was 100 % (κ = 1.0, both methods identified 52 patients). Out of 52 patients, 47 (90%) had no time difference between the methods, for the remaining 5 (10%) patients, differences were within 15 minutes. CONCLUSIONS The use of an electronic search strategy resulted in determining an accurate CRRT initiation time among ECMO patients.
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Affiliation(s)
- Pramod K Guru
- Department Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, MN, USA
| | - Tarun D Singh
- Department of Neurology, Division of Critical Care, Mayo Clinic , Rochester, MN, USA
| | - Melissa Passe
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic , Rochester, MN, USA
| | - Kianoush B Kashani
- Department Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Department Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Gregory J Schears
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic , Rochester, MN, USA
| | - Rahul Kashyap
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic , Rochester, MN, USA
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Qiao Y, Asan O, Montague E. Factors associated with patient trust in electronic health records used in primary care settings. HEALTH POLICY AND TECHNOLOGY 2015. [DOI: 10.1016/j.hlpt.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hessels A, Flynn L, Cimiotti JP, Bakken S, Gershon R. Impact of Heath Information Technology on the Quality of Patient Care. ON-LINE JOURNAL OF NURSING INFORMATICS 2015; 19:http://www.himss.org/impact-heath-information-technology-quality-patient-care. [PMID: 27570443 PMCID: PMC5001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the relationships among Electronic Health Record (EHR) adoption and adverse outcomes and satisfaction in hospitalized patients. MATERIALS AND METHODS This secondary analysis of cross sectional data was compiled from four sources: (1) State Inpatient Database from the Healthcare Cost Utilization Project; (2) Healthcare Information and Management Systems Society (HIMSS) Dorenfest Institute; (3) Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) and (4) New Jersey nurse survey data. The final analytic sample consisted of data on 854,258 adult patients discharged from 70 New Jersey hospitals in 2006 and 7,679 nurses working in those same hospitals. The analytic approach used ordinary least squares and multiple regression models to estimate the effects of EHR adoption stage on the delivery of nursing care and patient outcomes, controlling for characteristics of patients, nurses, and hospitals. RESULTS Advanced EHR adoption was independently associated with fewer patients with prolonged length of stay and seven-day readmissions. Advanced EHR adoption was not associated with patient satisfaction even when controlling for the strong relationships between better nursing practice environments, particularly staffing and resource adequacy, and missed nursing care and more patients reporting "Top-Box," satisfaction ratings. CONCLUSIONS This innovative study demonstrated that advanced stages of EHR adoption show some promise in improving important patient outcomes of prolonged length of stay and hospital readmissions. Strongly evident by the relationships among better nursing work environments, better quality nursing care, and patient satisfaction is the importance of supporting the fundamentals of quality nursing care as technology is integrated into practice.
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Affiliation(s)
- Amanda Hessels
- Postdoctoral Research Fellow at the Center for Interdisciplinary Research to Prevent Infections (CIRI), Columbia University, School of Nursing and Nurse Scientist at Meridian Health in New Jersey
| | - Linda Flynn
- Professor and the Associate Dean of Academic Programs at the University of Colorado College Of Nursing
| | - Jeannie P Cimiotti
- Associate Professor and the Dorothy M. Smith Endowed Chair at the University of Florida College Of Nursing
| | - Suzanne Bakken
- Alumni Professor of Nursing and Professor of Biomedical Informatics at Columbia University
| | - Robyn Gershon
- Professor of Epidemiology and Biostatistics and Core Faculty in the Philip R. Lee Institute for Health Policy Studies in the School of Medicine at University of California, San Francisco
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Abstract
BACKGROUND Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes. OBJECTIVE To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet. RESEARCH DESIGN Retrospective, 2-stage panel design using 4 secondary data sources. SUBJECTS One hundred thirty-six Pennsylvania hospitals (11 emerging Magnets and 125 non-Magnets). MEASURES American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index. METHODS Fixed-effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet. RESULTS Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (P<0.01) and 6.1 fewer deaths per 1000 patients (P=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes. CONCLUSIONS In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals.
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Perioperative Nurses' Attitudes Toward the Electronic Health Record. J Perianesth Nurs 2015; 30:23-32. [DOI: 10.1016/j.jopan.2014.01.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 09/17/2013] [Accepted: 01/07/2014] [Indexed: 11/21/2022]
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Abbott AA, Fuji KT, Galt KA. A Qualitative Case Study Exploring Nurse Engagement With Electronic Health Records and E-Prescribing. West J Nurs Res 2015; 37:935-51. [PMID: 25576327 DOI: 10.1177/0193945914567359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a national focus on the adoption and use of electronic health records (EHRs) with electronic prescribing (e-Rx) for the goal of providing safe and quality care. Although there is a large body of literature on the benefits of adoption, there is also increasing evidence of the unintentional consequences resulting from use. As little is known about how use of EHR with e-Rx systems affects the roles and responsibilities of nurses, the purpose of this qualitative case study was to describe how nurses adapt to using an EHR with e-Rx system in a rural ambulatory care practice. Six themes emerged from the data. Findings revealed that nurses adjust their routine in response to providers' preferential behavior about EHR with e-Rx systems yet retained focus on the patient and care coordination. Although perceived as more efficient, EHR with e-Rx adoption increased workload and introduced safety risks.
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Affiliation(s)
- Amy Ann Abbott
- Creighton University Center for Health Services Research and Patient Safety, Omaha, NE, USA Creighton University College of Nursing, Omaha, NE, USA
| | - Kevin T Fuji
- Creighton University Center for Health Services Research and Patient Safety, Omaha, NE, USA Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Kimberly A Galt
- Creighton University Center for Health Services Research and Patient Safety, Omaha, NE, USA Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
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The promises and challenges of health information technology in primary health care. Prim Health Care Res Dev 2014; 15:227-30. [DOI: 10.1017/s1463423614000231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Bani-issa W, Rempusheski VF. Congruency between educators' teaching beliefs and an electronic health record teaching strategy. NURSE EDUCATION TODAY 2014; 34:906-911. [PMID: 24525090 DOI: 10.1016/j.nedt.2014.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 01/04/2014] [Accepted: 01/14/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Technology has changed healthcare institutions into automated settings with the potential to greatly enhance the quality of healthcare. Implementation of electronic health records (EHRs) to replace paper charting is one example of the influence of technology on healthcare worldwide. In the past decade nursing higher education has attempted to keep pace with technological changes by integrating EHRs into learning experiences. Little is known about educators' teaching beliefs and the use of EHRs as a teaching strategy. AIM This study explores the composition of core teaching beliefs of nurse educators and their related teaching practices within the context of teaching with EHRs in the classroom. METHODS A collective case study and qualitative research approach was used to explore and describe teaching beliefs of seven nurse educators teaching with EHRs. Data collection included open-ended, audio-taped interviews and non-participant observation. Content analysis of transcribed interviews and observational field notes focused on identification of teaching belief themes and associated practices. FINDINGS Two contrasting collective case studies of teaching beliefs emerged. Constructivist beliefs were dominant, focused on experiential, student-centered, contextual and collaborative learning, and associated with expanded and a futuristic view of EHRs use. Objectivist beliefs focused on educators' control of the context of learning and were associated with a constrained, limited view of EHRs. Constructivist educators embrace technological change, an essential ingredient of educational reform. CONCLUSIONS We encourage nurse educators to adopt a constructivist view to using technology in teaching in order to prepare nurses for a rapidly changing, technologically sophisticated practice.
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Affiliation(s)
- Wegdan Bani-issa
- University of Sharjah, College of Health Sciences, Department of Nursing, P.O. Box No. 27272, Sharjah, United Arab Emirates.
| | - Veronica F Rempusheski
- University of Delaware School of Nursing, 207 McDowell Hall, 25 N. College Avenue, Newark, DE 19716, USA.
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Rishi MA, Kashyap R, Wilson G, Hocker S. Retrospective derivation and validation of a search algorithm to identify extubation failure in the intensive care unit. BMC Anesthesiol 2014; 14:41. [PMID: 24891838 PMCID: PMC4041644 DOI: 10.1186/1471-2253-14-41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/09/2014] [Indexed: 02/07/2023] Open
Abstract
Background Development and validation of automated electronic medical record (EMR) search strategies is important in identifying extubation failure in the intensive care unit (ICU). We developed and validated an automated search algorithm (strategy) for extubation failure in critically ill patients. Methods The EMR search algorithm was created through sequential steps with keywords applied to an institutional EMR database. The search strategy was derived retrospectively through secondary analysis of a 100-patient subset from the 978 patient cohort admitted to a neurological ICU from January 1, 2002, through December 31, 2011(derivation subset). It was, then, validated against an additional 100-patient subset (validation subset). Sensitivity, specificity, negative and positive predictive values of the automated search algorithm were compared with a manual medical record review (the reference standard) for data extraction of extubation failure. Results In the derivation subset of 100 random patients, the initial automated electronic search strategy achieved a sensitivity of 85% (95% CI, 56%-97%) and a specificity of 95% (95% CI, 87%-98%). With refinements in the search algorithm, the final sensitivity was 93% (95% CI, 64%-99%) and specificity increased to 100% (95% CI, 95%-100%) in this subset. In validation of the algorithm through a separate 100 random patient subset, the reported sensitivity and specificity were 94% (95% CI, 69%-99%) and 98% (95% CI, 92%-99%) respectively. Conclusions Use of electronic search algorithms allows for correct extraction of extubation failure in the ICU, with high degrees of sensitivity and specificity. Such search algorithms are a reliable alternative to manual chart review for identification of extubation failure.
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Affiliation(s)
- Muhammad Adeel Rishi
- Multidisciplinary Epidemiological and Translational Research in Critical Care Medicine (METRIC), Mayo Clinic, Rochester, MN, USA
| | - Rahul Kashyap
- Multidisciplinary Epidemiological and Translational Research in Critical Care Medicine (METRIC), Mayo Clinic, Rochester, MN, USA
| | - Gregory Wilson
- Multidisciplinary Epidemiological and Translational Research in Critical Care Medicine (METRIC), Mayo Clinic, Rochester, MN, USA
| | - Sara Hocker
- Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA
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Evaluation of AHRQ's on-time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes. Med Care 2014; 52:258-66. [PMID: 24374408 DOI: 10.1097/mlr.0000000000000080] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pressure ulcers present serious health and economic consequences for nursing home residents. The Agency for Healthcare Research & Quality, in partnership with the New York State Department of Health, implemented the pressure ulcer module of On-Time Quality Improvement for Long Term Care (On-Time), a clinical decision support intervention to reduce pressure ulcer incidence rates. OBJECTIVE To evaluate the effectiveness of the On-Time program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents. RESEARCH DESIGN AND SUBJECTS We employed an interrupted time-series design to identify impacts of 4 core On-Time program components on resident pressure ulcer incidence in 12 New York State nursing homes implementing the intervention (n=3463 residents). The sample was purposively selected to include nursing homes with high baseline prevalence and incidence of pressure ulcers and high motivation to reduce pressure ulcers. Differential timing and sequencing of 4 core On-Time components across intervention nursing homes and units enabled estimation of separate impacts for each component. Inclusion of a nonequivalent comparison group of 13 nursing homes not implementing On-Time (n=2698 residents) accounts for potential mean-reversion bias. Impacts were estimated via a random-effects Poisson model including resident-level and facility-level covariates. RESULTS We find a large and statistically significant reduction in pressure ulcer incidence associated with the joint implementation of 4 core On-Time components (incidence rate ratio=0.409; P=0.035). Impacts vary with implementation of specific component combinations. CONCLUSIONS On-Time implementation is associated with sizable reductions in pressure ulcer incidence.
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Abstract
Nursing is grounded in care of the body. This article examines nursing as bodywork, as experienced intersubjectively by nurses together with patients and collectively as a body within the health care labor force. The relation of nurses to the body generates conflicting and contradictory social meanings from intimate and sacred work to dirty work. Such meanings have contributed to stigmatizing the work and the worker within the labor force as well contributing to an ongoing stratification in the labor force as nurses have shifted bodywork "to lower level" or ancillary workers.
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Nagliate PDC, Rocha ESB, de Godoy S, Mazzo A, Trevizan MA, Mendes IAC. Individualized teaching programming for a virtual learning environment: development of content concerning nursing records. Rev Lat Am Enfermagem 2014; 21 Spec No:122-30. [PMID: 23459899 DOI: 10.1590/s0104-11692013000700016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/06/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Describe the planning of contents on nursing records for use in a virtual learning environment, based on Individualized Teaching Programming, a didactic resource that uses basic principles of behavioral analysis. METHOD Final objectives were specified, after defining the intermediary components to achieve each final objective, as well as the preliminary requirements for each intermediary component. At the end of this process, teaching activities were planned and organized in steps the students need to develop. RESULTS By breaking up the contents into behaviors, seven action categories emerged: impartiality, organization, honesty, objectiveness, coherence, readability and discernment. CONCLUSION the use of Individualized Teaching Programming as a didactic resource to plan contents on nursing records is feasible to identify the units and modules for the development of a course in a virtual learning environment for nursing professionals.
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Affiliation(s)
- Patrícia de Carvalho Nagliate
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Brazil
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Challenges and facilitators to nurse use of a guideline-based nursing information system: Recommendations for nurse executives. Appl Nurs Res 2014; 27:25-32. [DOI: 10.1016/j.apnr.2013.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/17/2013] [Accepted: 10/28/2013] [Indexed: 11/21/2022]
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Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention. Adv Skin Wound Care 2014; 26:83-92; quiz p.93-4. [PMID: 23337649 DOI: 10.1097/01.asw.0000426718.59326.bb] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine those factors that are associated with nursing homes' success in implementing the On-Time quality improvement (QI) for pressure ulcer prevention program and integrating health information technology (HIT) tools into practice at the unit level. DESIGN Observational study with quantitative analysis of nursing home characteristics, team participation levels, and implementation milestones collected as part of a QI program. SETTING Fourteen nursing homes in Washington, District of Columbia, participating in the On-Time Pressure Ulcer Prevention program. MAIN OUTCOME MEASURES The nursing home level of implementation was measured by counting the number of implementation milestones achieved after at least 9 months of implementation effort. MAIN RESULTS After at least 9 months of implementation effort, 36% of the nursing homes achieved level III, a high level of implementation, of the On-Time QI-HIT program. Factors significantly associated with high implementation were high level of involvement from the administrator or director of nursing, high level of nurse manager participation, presence of in-house dietitian, high level of participation of staff educator and QI personnel, presence of an internal champion, and team's openness to redesign. One factor that was identified as a barrier to high level of implementation was higher numbers of health inspection deficiencies per bed. CONCLUSION The learning from On-Time QI offers several lessons associated with facility factors that contribute to high level of implementation of a QI-HIT program in a nursing home.
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Nurse-related variables associated with patient outcomes: A review of the literature 2006–2012. TEACHING AND LEARNING IN NURSING 2013. [DOI: 10.1016/j.teln.2013.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Smischney NJ, Velagapudi VM, Onigkeit JA, Pickering BW, Herasevich V, Kashyap R. Retrospective derivation and validation of a search algorithm to identify emergent endotracheal intubations in the intensive care unit. Appl Clin Inform 2013; 4:419-27. [PMID: 24155793 DOI: 10.4338/aci-2013-05-ra-0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/16/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The development and validation of automated electronic medical record (EMR) search strategies are important in identifying emergent endotracheal intubations in the intensive care unit (ICU). OBJECTIVE To develop and validate an automated search algorithm (strategy) for emergent endotracheal intubation in the critically ill patient. METHODS The EMR search algorithm was created through sequential steps with keywords applied to an institutional EMR database. The search strategy was derived retrospectively through a secondary analysis of a 450-patient subset from the 2,684 patients admitted to either a medical or surgical ICU from January 1, 2010, through December 31, 2011. This search algorithm was validated against an additional 450 randomly selected patients. Sensitivity, specificity, and negative and positive predictive values of the automated search algorithm were compared with a manual medical record review (the reference standard) for data extraction of emergent endotracheal intubations. RESULTS In the derivation subset, the automated electronic note search strategy achieved a sensitivity of 74% (95% CI, 69%-79%) and a specificity of 98% (95% CI, 92%-100%). With refinements in the search algorithm, sensitivity increased to 95% (95% CI, 91%-97%) and specificity decreased to 96% (95% CI, 92%-98%) in this subset. After validation of the algorithm through a separate patient subset, the final reported sensitivity and specificity were 95% (95% CI, 86%-99%) and 100% (95% CI, 98%-100%). CONCLUSIONS Use of electronic search algorithms allows for correct extraction of emergent endotracheal intubations in the ICU, with high degrees of sensitivity and specificity. Such search algorithms are a reliable alternative to manual chart review for identification of emergent endotracheal intubations.
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Narcisse MR, Kippenbrock TA, Odell E, Buron B. Advanced Practice Nurses' Meaningful use of electronic health records. Appl Nurs Res 2013; 26:127-32. [DOI: 10.1016/j.apnr.2013.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 12/12/2012] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
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Dancet EAF, D'Hooghe TM, Spiessens C, Sermeus W, De Neubourg D, Karel N, Kremer JAM, Nelen WLDM. Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients. Hum Reprod 2013; 28:1584-97. [PMID: 23508250 DOI: 10.1093/humrep/det056] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
STUDY QUESTION What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients? SUMMARY ANSWER Safety, effectiveness and patient centeredness were the most important quality dimensions. All six quality dimensions can be assessed with a set of 24 quality indicators, which is face valid and acceptable according to both professionals from different disciplines and patients. WHAT IS KNOWN ALREADY To our knowledge, no study has weighted the relative importance of all quality dimensions to infertility care. Additionally, there are very few infertility care-specific quality indicators and no quality indicator set covers all six quality dimensions and incorporated the views of professionals and patients. STUDY DESIGN, SIZE AND DURATION A three-round iterative Delphi survey including patients and professionals from four different fields, conducted in two European countries over the course of 2011 and 2012. PARTICIPANTS/MATERIALS, SETTINGS AND METHODS Dutch and Belgian gynaecologists, embryologists, counsellors, nurses/midwifes and patients took part (n = 43 in round 1 and finally 30 in round 3). Respondents ranked the six quality dimensions twice for importance and their agreement was evaluated. Furthermore, in round 1, respondents gave suggestions, which were subsequently uniformly formulated as quality indicators. In rounds 2 and 3, respondents rated the quality indicators for preparedness to measure and for importance (relation to quality and prioritization for benchmarking). Providing feedback allowed selecting indicators based on consensus between stakeholder groups. Measurable indicators, important to all stakeholder groups, were selected for each quality dimension. MAIN RESULTS All stakeholder groups and most individuals agreed that safety, effectiveness and patient centeredness were the most important quality dimensions. A total of 498 suggestions led to the development of 298 indicators. Professionals were sufficiently prepared to measure 204 of these indicators. Based on importance, 52 (7-15 per dimension; round 2) and finally 24 (4 per dimension; round 3) quality indicators were selected. LIMITATIONS, REASONS FOR CAUTION The final quality indicator set does not cover the entire care process, but rather takes a 'sample' of each quality dimension. Although the quality indicators are face valid and acceptable, their psychometric characteristics need to be tested by further research. WIDER IMPLICATIONS OF THE FINDINGS Quality management should focus on safety, effectiveness and patient centeredness of care. Clinics can use the quality indicator set to assess all quality dimensions of their care.
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Affiliation(s)
- E A F Dancet
- Leuven University Hospital, Leuven University Fertility Centre, Herestraat 49, Leuven 3000, Belgium
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Determinants of primary care nurses' intention to adopt an electronic health record in their clinical practice. Comput Inform Nurs 2013; 30:496-502. [PMID: 22592453 DOI: 10.1097/nxn.0b013e318257db17] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A provincial electronic health record is being developed in the Province of Quebec (and in all other provinces in Canada), and authorities hope that it will enable a safer and more efficient healthcare system for citizens. However, the expected benefits can occur only if healthcare professionals, including nurses, adopt this technology. Although attention to the use of the electronic health record by nurses is growing, better understanding of nurses' intention to use an electronic health record is needed and could help managers to better plan its implementation. This study examined the factors that influence primary care nurses' intention to adopt the provincial electronic health record, since intention influences electronic health record use and implementation success. Using a modified version of Ajzen's Theory of Planned Theory of Planned Behavior, a questionnaire was developed and pretested. Questionnaires were distributed to 199 primary care nurses. Multiple hierarchical regression indicated that the Theory of Planned Behavior variables explained 58% of the variance in nurses' intention to adopt an electronic health record. The strong intention to adopt the electronic health record is mainly determined by perceived behavioral control, normative beliefs, and attitudes. The implications of the study are that healthcare managers could facilitate adoption of an electronic health record by strengthening nurses' intention to adopt the electronic health record, which in turn can be influenced through interventions oriented toward the belief that using an electronic health record will improve the quality of patient care.
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Singh B, Singh A, Ahmed A, Wilson GA, Pickering BW, Herasevich V, Gajic O, Li G. Derivation and validation of automated electronic search strategies to extract Charlson comorbidities from electronic medical records. Mayo Clin Proc 2012; 87:817-24. [PMID: 22958988 PMCID: PMC3538495 DOI: 10.1016/j.mayocp.2012.04.015] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/20/2012] [Accepted: 04/13/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop and validate automated electronic note search strategies (automated digital algorithm) to identify Charlson comorbidities. PATIENTS AND METHODS The automated digital algorithm was built by a series of programmatic queries applied to an institutional electronic medical record database. The automated digital algorithm was derived from secondary analysis of an observational cohort study of 1447 patients admitted to the intensive care unit from January 1 through December 31, 2006, and validated in an independent cohort of 240 patients. The sensitivity, specificity, and positive and negative predictive values of the automated digital algorithm and International Classification of Diseases, Ninth Revision (ICD-9) codes were compared with comprehensive medical record review (reference standard) for the Charlson comorbidities. RESULTS In the derivation cohort, the automated digital algorithm achieved a median sensitivity of 100% (range, 99%-100%) and a median specificity of 99.7% (range, 99%-100%). In the validation cohort, the sensitivity of the automated digital algorithm ranged from 91% to 100%, and the specificity ranged from 98% to 100%. The sensitivity of the ICD-9 codes ranged from 8% for dementia to 100% for leukemia, whereas specificity ranged from 86% for congestive heart failure to 100% for leukemia, dementia, and AIDS. CONCLUSION Our results suggest that search strategies that use automated electronic search strategies to extract Charlson comorbidities from the clinical notes contained within the electronic medical record are feasible and reliable. Automated digital algorithm outperformed ICD-9 codes in all the Charlson variables except leukemia, with greater sensitivity, specificity, and positive and negative predictive values.
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Key Words
- cci, charlson comorbidity index
- ci, confidence interval
- ddqb, data discovery and query builder
- emr, electronic medical record
- icd-9, international classification of disease, ninth revision
- icu, intensive care unit
- iqr, interquartile range
- mclss, mayo clinic life sciences system
- npv, negative predictive value
- ppv, positive predictive value
- snomed-ct, systematized nomenclature of medicine–clinical terms
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Affiliation(s)
- Balwinder Singh
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Amandeep Singh
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Adil Ahmed
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Gregory A. Wilson
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Brian W. Pickering
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Vitaly Herasevich
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Ognjen Gajic
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Guangxi Li
- Multidisciplinary Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Guang An Men Hospital, China Academy of Chinese Medical Science, Beijing
- Correspondence: Address to Guangxi Li, MD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Kapoor B, Kleinbart M. Building an Integrated Patient Information System for a Healthcare Network. JOURNAL OF CASES ON INFORMATION TECHNOLOGY 2012. [DOI: 10.4018/jcit.2012040103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The recent healthcare reform act provides incentive payments to providers for their ‘meaningful use’ of electronic health records to achieve significant improvements in care. The HITECH Act 2009 provides incentives payments through Medicare and Medicaid to clinicians and hospitals when they achieve specified improvements in care delivery. Citrus Valley Health Partners’ (CVHP) goals are bigger than just to comply with the regulations or simply to qualify for incentives, but rather include transforming their business to the next level in care delivery. They are seeking cooperation from their affiliates to build a community health information exchange that will allow CVHP and the affiliates to share and integrate patient health related information between their medical centers and the private physicians in their community. The integrated system will help community healthcare providers to work as a single operating entity focused and aligned on improving patient care, operational efficiency and cost effectiveness.
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