Capturing district nursing through a knowledge-based electronic caseload analysis tool (eCAT)

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts.

Caseload analysis in district nursing: the impact on practice

This paper describes a ten-year journey in managing a district nursing service using caseload analysis as a method of workforce planning and performance management. Caseload management is at the heart of district nursing practice and the process of measuring and comparing caseload information can be used to improve the quality of care. However, it is crucial to assess the information provided by district nurses for reliability and validity. Allocating staff to teams on the basis of accurate information on patient case-mix, nursing need, and dependency can result in every member of the population gaining equitable access to a consistent quality nursing service.

Part 3: Defining the unique role of the specialist district nurse practitioner

The third of a series of articles concludes the unique role of the District Nurse. District Nurses are proud of their profession and seek to demonstrate their advanced skills through further case scenarios. As Government policy continues to expect health care providers to keep patients in the community who have complex health and social care needs, District nursing is the obvious profession that remainss constant in ever changing times.

Assessment of the side effects of antipsychotic medication

BACKGROUND

Antipsychotic medication is the first-line treatment for people with psychosis in the State Hospital, Carstairs: Scotland's only high-security forensic hospital. The Clinical Standards for Schizophrenia (Clinical Standards Board for Scotland 2001) require clinicians to use standardised rating scales to monitor the side effects associated with medication. Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) (Day et al 1995) was implemented in the hospital in December 2003. A baseline audit was carried out following its implementation to establish the incidence of side effects. Of those patients audited (n=152), 87 (57 per cent) reported either low or medium (n=51, 34 per cent) LUNSERS scores, indicating an acceptable level of medication tolerance.

CONCLUSION

It is expected that clinicians will continue to use LUNSERS as part of their routine clinical practice to help inform patients and meet national standards.

Nursing unit characteristics and patient outcomes

In this exploratory cross-sectional study, nursing unit organizational characteristics and how they influenced patient outcomes in the form of nurse-sensitive adverse events and failure to rescue were examined. Results showed significant associations between characteristics and adverse events at the unit level. Autonomy/collaboration was associated with pressure ulcer and failure to rescue, practice control with urinary tract infection, and continuity/specialization with death. Unit-level study provided a better understanding of the effect of unit work environment upon nursing practice and outcomes.

Infection control audit of hand hygiene facilities

BACKGROUND

The socio-economic costs of healthcare associated infections (HCAIs) are continually rising. The focus for reducing the incidence of HCAIs should be on maintaining a microbiologically safe environment Hand hygiene is of paramount importance in preventing the transmission of infection, as it is a low-tech, low-cost, effective intervention. Hand hygiene is as important in the non-acute care setting as in the acute setting, as community or non-acute patients are often admitted to acute facilities.

CONCLUSION

This audit, conducted in 2000-2001, examined hand hygiene facilities at one non-acute trust. The results confirmed that although handwashing is considered the most important factor in preventing the spread of infection, it cannot always be carried out successfully if facilities are inadequate. Recommendations were made that will encourage safe practice, improve service delivery and raise clinical standards.

Preventing falls in older people: charting practice change by audit

Before an audit project in one trust there was no formal means of assessing the risk of falling among older patients. By raising staff awareness and consulting on the best evidence available, a specific falls-risk assessment has been developed and is now widely used. Follow-up audits have demonstrated a change in practice which it is hoped will bring about a reduction in falls.

Development of a student nurse practitioner computerized clinical log

A computerized clinical log was developed and revised over a period of three semesters by the family nurse practitioner students at the University of Texas Health Science Center in San Antonio, Texas. Students entered data on a disk formatted in Microsoft Access, and results were analyzed by the Statistical Packages for the Social Sciences (SPSS). More than 4,000 patient encounters were documented during three semesters. The development and refinement of the computerized log are described. Results are presented and the implications of the database for educational, curricular and employment purposes are discussed.

The use of 'dementia care mapping' as a method of evaluating care received by patients with dementia--an initiative to improve quality of life

'Dementia care mapping' (DCM) is a method of assessing care standards as received by dementia victims. Through the application of this tool, short-comings in care practice can be highlighted in the hope of achieving improvements. The method was employed by the Elderly Mentally III (EMI) unit of a National Health Service trust in South Wales. Baseline evaluations were undertaken on each of the EMI wards containing dementia patients, and reports delivered to the appropriate members of staff. Mean care scores for the unit as a whole were found to lie in the "good' category, as defined by the method. Staff training in the underlying principles of DCM will be followed by re-evaluations of care standards to evaluate the outcome of the attempts made to engender improvements.

A telephone survey of day-surgery eye patients

The objective of this research study was to evaluate the nursing care processes and patient satisfaction with the new day-surgery services. Forty-five adult day-surgery eye patients were selected at random to take part in a telephone survey. The response rate was 84.4% (38). Patients were contacted 48 hours post-surgery to obtain their view of the entire surgical experience. The research result found that the majority of the patients were satisfied with the day-surgery services. The main problems experienced by patients were long waiting times to see the doctor during pre-operation assessment, unsatisfactory journeys to and from theatre, and difficulty in remembering verbal advice. Twenty-eight (73.6%) of the day-surgery patients would prefer day-surgery again for a similar operation, but 10 (26.3%) would prefer a longer stay in hospital. The main implications for practice are that realistic assessment time should be allocated to reduce waiting time, verbal advice should be accompanied by written leaflets or audio-tape, and patients should be encouraged to make an informed choice about day or in-patient surgery. A regular survey of day-surgery eye patients should be part of a general audit.

The effect of quality assurance on flight nurse documentation

This study was developed to evaluate if a structured quality assurance program has an effect on nursing documentation. A randomized, retrospective audit of records was conducted from 1985 to 1989, and in November 1987, a structured QA program was initiated for flight nurses. Each chart was audited for completeness of 69 elements from seven categories: administrative information, patient history, physical exam, management plan, vital signs, medications and intravenous access. A comparison of audit results was conducted before and after the QA program was initiated. A total of 224 charts were audited, 123 before the QA program and 101 after. There was statistically significant improvement in 4 of 13 administrative, 5 of 7 history, 21 of 31 physical exam, 2 of 6 management, 2 of 2 vital signs, 0 of 4 medication, and 0 of 6 intravenous access elements. Twenty-five of 35 categories that did not show improvement had initial completion rates greater than 90 percent. The significant improvement in documentation by flight nurses after a formal QA program was initiated lead the authors to conclude that QA benefits air medical programs by providing a mechanism to improve documentation.

Organizing audit: strategy for development of nursing and midwifery audit in Wales

Outlines the approach of the Welsh Nursing and Midwifery Committee to “organizing” nursing and midwifery audit in Wales. Describes the strategy developed by the Committee and reports progress on the implementation plan. The strategy identifies a philosophy for the development of nursing audit and midwifery, setting out the principles for underpinning the process, the key strategic objectives, and the implementation plan. The focus is on education and preparation for audit, the acquisition of skills necessary to carry out audit, and the provision of support mechanisms for those involved in developmental activity. Describes the implementation plan which includes audit facilitators, education and training programmes, audit demonstration sites, a resource centre, and monitoring and evaluation methods. Proposes the use of a systematic strategic approach to the development of clinical audit.