Design and Implementation of Hospital Automatic Nursing Management Information System Based on Computer Information Technology

Clinical nursing work fails to integrate various nursing tasks such as basic care, observation of patients' conditions, medication, treatment, communication, and health guidance to provide continuous and full nursing care for patients. Based on this, this paper uses the Internet of Things (IoT) technology to optimize the infusion process and achieve closed-loop management of medications and improve the efficiency and safety of infusion and medication administration by using a rational and effective outpatient and emergency infusion and medication management system. The system was built by applying wireless network, barcode technology, RFID, infrared tube sensing, and other technologies and was combined with actual nursing work to summarize application techniques and precautions. The application of this system will become a new highlight of medical informatization, improve patient experience, monitor infusion safety, enhance nursing care, reduce emergency medical disputes, improve patient satisfaction, and will create good social and economic benefits for the hospital.

A Qualitative Exploration of Chief Nursing Officer Perspectives on Maintaining Magnet® Designation

OBJECTIVE

The purpose of this study was to determine chief nursing officer (CNO) perspectives on how to sustain the infrastructure required for successful American Nurses Credentialing Center (ANCC) Magnet® redesignation.

BACKGROUND

American Nurses Credentialing Center Magnet designation is a prestigious achievement reflective of years of dedication, innovation, mentoring, and leadership support. As challenging as the initial attainment of Magnet status can be, sustaining the success and becoming redesignated is considered even more difficult by many CNOs. However, there have been no published reports indicating how to be successful in Magnet redesignation.

METHOD

A grounded theory qualitative approach was used, and data were collected through telephone interviews with CNOs who had successfully attained at least 1 redesignation.

RESULTS

Fourteen CNOs participated; data were organized into 6 themes and 15 subthemes describing the critical elements for Magnet redesignation.

CONCLUSION

Relationships among the 6 themes and subthemes are theorized in the form of a wheel with 6 spokes. When "set in motion," the wheel gathers momentum and all of the model elements become coalesced into the organizational ethos.

Quantification of nursing care and creation of economic indicators: an observational study protocol

BACKGROUND

The literature on hospital admissions costs shows that classification of hospitalization systems such as the DRG system used in Italy, do not reflect the real cost of the production factors used, including those of nursing care in relation to the complexity of the hospital effort.

OBJECTIVE

This concept paper outlines the study protocol and the methodology used to measure nursing care in economic terms. The objective of the study is developed on the assumption of creating economic indicators from a quantitative analysis of nursing activities provided to specific patients, in order to determine not only who costs but also the reasons for the cost, and demonstrate the variability of nursing not only for DRG, but also each individual patient.

METHODS

A retrospective study and a longitudinal prospective study will be performed. In the first phase of the study, using a bottom-up Microcosting methodology the type, volume, time and costs of nursing activities for DRG will be determined and the incidence of nursing costs on reimbursement will be highlighted.In the second phase, the above analysis will be supplemented by the recognition of the complexity of individual cases measured through the Corridor Triage(Tri-CO), in order to figure out the incidence of costs of nursing activities on the reimbursement in relation to the level of care complexity. Main sources of data: hospital discharge card (SDO); Professional Assessment Instrument (PAI); datasets for collecting the time of delivery of nursing activities on PAI. Power calculation: For retrospective study, the survey will be conducted on a sample of 150 patients hospitalized in the first quarter of 2016. For the longitudinal prospective study, 150 patients will be included in the first quarter of 2017 after the structured introduction of Tri-CO as a valuation tool of care complexity. The sample examined is approximately 30% of the total number of admissions per year.

RESULTS

The study started in February 2016 and the results are expected for May 2017. Through this study it is expected to verify whether by implementing a unbundling approach, ie the "unpacking" of the production factors (nursing activity costs) used for the explication of hospitalization, and by adopting a methodology based on standard analytical costs, a more detailed knowledge of the overall DRG rate data available today will be obtained, which is currently lacking of explicit notation of all the amounts that make up it.

Mitigating the Impact of Nurse Manager Large Spans of Control

Nurse managers are instrumental in achievement of organizational and unit performance goals. Greater spans of control for managers are associated with decreased satisfaction and performance. An interprofessional team measured one organization's nurse manager span of control, providing administrative assistant support and transformational leadership development to nurse managers with the largest spans of control. Nurse manager satisfaction and transformational leadership competency significantly improved following the implementation of large span of control mitigation strategies.

In-reach nursing services improve older patient outcomes and access to emergency care

AIMS

To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care.

METHODS

Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services.

RESULTS

Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007).

CONCLUSIONS

There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.

Nonoccupational postexposure HIV prophylaxis in sexual assault programs: a survey of SANE and FNE program coordinators

This cross-sectional study describes sexual assault nurse examiner (SANE)/forensic nurse examiner (FNE) program practices related to HIV testing, nonoccupational postexposure prophylaxis (nPEP), and common barriers to offering HIV testing and nPEP. A convenience sample of 174 SANE/FNE programs in the United States and Canada was drawn from the International Association of Forensic Nurses database, and program coordinators completed Web-based surveys. Three fourths of programs had nPEP policies, 31% provided HIV testing, and 63% offered nPEP routinely or upon request. Using χ(2) and Fisher's exact tests, a greater proportion of Canadian programs had an nPEP protocol (p = .010), provided HIV testing (p = .004), and offered nPEP (p = .0001) than U.S.-based programs. Program coordinators rated providing pre- and/or posttest counseling and follow-up as the most important barrier to HIV testing, and medication costs as the most important barrier to providing nPEP. Our results indicate HIV-related services are offered inconsistently across SANE/FNE programs.

What are 12-hour shifts good for?

In the UK many hospitals use 12-hour shifts, believing it to be a cost-efficient means of providing 24-hour nursing care on wards. While healthcare organisations need to find ways to deliver nursing care around the clock and efficiency is a key consideration, nurse leaders have raised concerns about ' whether nurses can function effectively and safely when working long hours (Calkin, 2012; Rogers et al, 2004). In this Policy Plus, we focus specifically on what is known about the impact of shift length on patient safety, employee health and quality of care.

Using fishbone analysis to investigate problems

To ensure patients get the best care, there is a need to analyse and change nursing practice, demonstrated in the report on the Mid Staffordshire public inquiry. This article, the first in a three-part series on change management tools, examines how using fishbone analysis to identify the cause of problems, leading to solutions and action plans, can assist staff to make changes to their service to benefit both patients and staff. A case study of a team trying to reduce clinic waiting times is discussed.

Value-based resource management: a model for best value nursing care

With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities at Srinagarind Hospital

BACKGROUND

A holistic nursing care system for patients with cleft lip-palate (CLP) and/or craniofacial deformities was arranged by the Nursing Department, Srinagarind Hospital, which provides tertiary nursing care. The nursing care system was developed as per system theory via participating management with action research following the Deming Cycle (PDCA) divided into 3 phases. Participants included 117 nurses from 8 divisions caring for patients with CLP and 128 parent caregivers. The research instruments included: 1) situation analysis, 2) meeting and planning and 3) self-administered questionnaire. Groups were divided according to the age, physical and mental aspects of the patients.

RESULTS

1) The nursing care system under study comprised psychosocial care, breastfeeding, counseling, providing assistance in various ways in order to respond to problems of patients/families by the multidisciplinary team. There was also follow-up to evaluate the results and in order to give patients/families longitudinal and continuing care. 2) Minor research of 4 nursing sections was initiated. 3) Nursing care standards, manuals, regulations and innovations for the organization of eight nursing sections were created and implemented.

CONCLUSION

The present study on developing a nursing care system for patients with CLP helped the team to (a) understand the overall nursing care system (b) to develop the organization of nurses by conducting research and (c) to create 12 works for developing care. The latter aimed to establish or create standards, nursing manuals, caring manuals, regulations, innovations, CDs, portfolios and informative cartoons to be applied systematically and shared across and between communities. The model for nursing care for patients with CLP in tertiary hospitals was clearly demonstrated.

The development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital, Khon Kaen, Thailand

BACKGROUND

The highest incidence of cleft lip-palate and craniofacial deformities in Thailand occur in the Northeastern Region. There is the necessity for an interdisciplinary care team as well as the specialized care center with systematic coordinated care, thus "Tawanchai Cleft Center" is becoming a superior medical center for patients with cleft lip-palate and craniofacial deformities. Therefore, the development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital is extremely important and necessary.

OBJECTIVE

To develop the nursing care system appropriate for a super tertiary hospital (Tawanchai Cleft Center).

MATERIAL AND METHOD

It is a participation study which has 3 steps as follows, 1) Analyzing the situations and collecting the opinions of the 22 Out-patient Surgery Department staff and Tawanchai Cleft Center staff by using 6 questions, 2) Summarizing of the situation analysis from the meetings and the questionnaires, then using such summary as the guidelines for developing the nursing care system from January 2011 onwards, 3) evaluating the satisfaction after the 4 month development period (May-August 2011) with 106 caregivers by using 8 questions and being analyzed by the average value, percentage and standard deviation.

RESULTS

1) The nursing care system consisted of psychosocial care, breast feeding, counseling and other assistance as required. This various assistance responded to the patient/family problems by following the treatment guideline of the multidisciplinary team which uses the continuous evaluation processes for the holistic patient/family care. 2) The patients with complete cleft lip-palate were the most common type, found in 44 cases or 41.53 percent. The highest number of caregivers were mothers which were 68 percent; the average age of those mothers was 36 years old. The highest number of them finished elementary school at 43 percent and 40 percent were farmers. The satisfaction for the services of Tawanchai Cleft Center showed the average for each satisfaction subject all at very good level (x = 3.56, SD = 0.13).

CONCLUSION

The care for patients with CLP and craniofacial deformities at Tawanchai Cleft Center Srinagarind Hospital has been developed in order to have the appropriate nursing care system to provide superior quality care, which provides patient-holistic care, as well as improving effective accessibility to the services. Thus, the patients/caregivers who are satisfied with given services, get continuing monitoring and treatment and are able to live their lives in the society happily.

Impact of localizing general medical teams to a single nursing unit

BACKGROUND

Localization of general medical inpatient teams is an attractive way to improve inpatient care but has not been adequately studied.

OBJECTIVE

To evaluate the impact of localizing general medical teams to a single nursing unit.

DESIGN

Quasi-experimental study using historical and concurrent controls.

SETTING

A 490-bed academic medical center in the midwestern United States.

PATIENTS

Adult, general medical patients, other than those with sickle cell disease, admitted to medical teams staffed by a hospitalist and a physician assistant (PA).

INTERVENTION

Localization of patients assigned to 2 teams to a single nursing unit.

MEASUREMENTS

Length of stay (LOS), 30-day risk of readmission, charges, pages to teams, encounters, relative value units (RVUs), and steps walked by PAs.

RESULTS

Localized teams had 0.89 (95% confidence interval [CI], 0.37-1.41) more patient encounters and generated 2.20 more RVUs per day (CI, 1.10-3.29) compared to historical controls; and 1.02 (CI, 0.46-1.58) more patient encounters and generated 1.36 more RVUs per day (CI, 0.17-2.55) compared to concurrent controls. Localized teams received 51% (CI, 48-54) fewer pages during the workday. LOS may have been approximately 10% higher for localized teams. Risk of readmission within 30 days and charges incurred were no different. PAs possibly walked fewer steps while localized.

CONCLUSION

Localization of medical teams led to higher productivity and better workflow, but did not significantly impact readmissions or charges. It may have had an unintended negative impact on hospital efficiency; this finding deserves further study.

Developing a nurse-led child sedation service

This article explores nurse-led sedation of children in preparation for investigations such as magnetic resonance imaging or minor surgical procedures. The importance of the multidisciplinary team in setting up, implementing and evaluating this new nurse-led initiative is described. Effective planning, involvement, agreement and training are key to a successful change in practice, with responsibility being delegated to competent nursing staff. Evaluation has shown all-round benefits. Trained nurse-led sedation is safe, effective and efficient and nurses are motivated to undertake this extended role.

Journey to Magnet: cost vs. benefits

As hospitals and health systems strive to be an "Employer of Choice", one important goal for their nursing leaders has been the decision to embark on their journey of becoming a designated Magnet facility. Approximately 12 months ago, conversations with a few chief nursing executives uncovered a hot topic concerning the achievement/designation of Magnet status and specifically its cost benefits. With more and more hospitals obtaining Magnet status, these nurse leaders did not know how other organizations felt about their journey including outcomes and were very interested in learning more details about their colleagues' experiences.

Bridging the communication gap through implementation of a Patient Navigator program

All healthcare providers working in an acute setting need to be empowered to provide an optimal patient experience with quality outcomes. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a national standardized survey instrument designed to assess the patient's perspective of hospital care for public reporting purposes. These results are posted on the Center for Medicare and Medicaid Services (CMS) website for consumers to access comparison data related to a hospital's performance, create new incentives for hospitals to improve quality outcomes and enhance accountability through transparency (1). HCAHPS has 10 measures that evaluate the patient's recent hospital experience. Six of these are summary measures. One key measure, "communication with nurses," can directly affect both the patient satisfaction and patient safety scores (2). Patients tend to rate this domain based on the caregivers, and this rating can have a financial impact upon the institution. The skills and art associated with service are neither innate nor automatic. Communication skills are acquired and refined only through practice. The Magnet recognition program was developed to recognize health care organizations that provide nursing excellence and a vehicle for disseminating successful nursing practices and strategies (3). To assist the nurse in the patient's perception to care, a Patient Navigator program was developed to provide patients with the best possible hospital experience. The Patient Navigator program compliments the direct patient care that is provided on the patient care unit. HCAHPS is a national standardized survey instrument designed to assess the patients' perspective of hospital care for public reporting purposes. There are a total of 27 survey items that are divided into six composite measures, two individual items and two global ratings. The six summary measures and two global ratings are listed below.

Clinical supervision using the 4S model 3: how to support supervisors and sustain schemes

This final article in a three part series on establishing clinical supervision discusses essential support for supervisors after training, and how to sustain supervision schemes, including issues such as evaluation and ongoing training. Part 1 examined initial structural arrangements and policy development; part 2 described training for supervisors.

Magnetism and the nursing workforce

The focus of this chapter is to highlight practice exemplars and research findings related to the five components of the new Magnet Model. A brief overview of the historical development and professional evolution of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program is presented followed by a brief overview of the original fourteen forces of magnetism. Content related to empirical practice-based research framed under the components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation, and improvement; and empirical outcomes is presented and discussed. The authors provide key findings from scholarly publications and describe how the findings contribute to the creation of work environments based on the tenets of magnetism. The chapter concludes with a brief over of the ANCC Pathway to Excellence Program.

A study of a nursing department performance measurement system: using the Balanced Scorecard and the Analytic Hierarchy Process

The health care industry is under pressure from government and private entities as well as from market conditions to contain costs. In an effort to respond to these pressures, the case hospital in this study implemented a Balanced Scorecard (BSC) in January 2003 and integrated it with the hospital's formal incentive plan for non-physicians in January 2005. The nursing department's performance improved in the 2 years following the introduction of the plan. This study contributes to the literature by demonstrating the performance improvement that results from integrating the BSC with an incentive plan in the nursing field. The results provide insight into the current BSC performance metrics applied by the case nursing department, and could be used as guidelines by other health care organizations that wish to implement BSC-based incentive plans.

The American Association of Critical Care Nurse's Beacon Award: a framework for quality

The Beacon Award for Critical Care Excellence recognizes individual critical care units that have met rigid criteria for excellence, exhibiting high-quality standards and exceptional care of patients and their families. Used as a framework for quality, the award criteria focus on structure, process, and outcomes that enable quality to emerge in the critical care environment. The journey toward meeting Beacon Award criteria can produce long-lasting changes that transform unit-based culture and lead to sustained excellence.

The changing reimbursement landscape: nurses' role in quality and operational excellence

Operational excellence, care quality, and financial performance are increasingly linked as key drivers of hospital performance. This environment may be seen as a challenge, but it is also an excellent opportunity for nursing services to further demonstrate their value in patient care outcomes and support financial performance. Nursing contributions toward reduced complications, reductions in length of stay, and lower costs per case should be measured, rewarded, and made transparent to the public. Staff nurses should not view quality as simply another task on which to focus their attention, but rather a continuous process that requires critical thinking about how care is delivered and its effect on the entire care progression of a patient. Nursing management must focus on continually educating their staff on appropriate care, as well as developing and supporting a culture of safety and accountability. Nursing leadership must improve nurse retention and recruiting efforts, encourage interdisciplinary collaboration and, most importantly, demonstrate to the rest of the organization the value nursing brings to the organization through consistently tracking quality and financial indicators and tying them to nursing initiatives.

Work environment, health outcomes and magnet hospital traits in the Canadian nephrology nursing scene

Nephrology, like others areas of health care, is confronting a nursing shortage. Unless action is taken to address nursing shortages, patient care may be negatively affected (American Nephrology Nurses' Association, 2007). Previous studies have been conducted on magnet hospital traits, quality of nursing worklife, empowerment, job satisfaction, burnout, health outcomes, and their influence on nursing retention in Canada. However, there is little research in this area specific to nephrology nursing. This descriptive study examined whether magnet hospital traits, empowerment, and organizational support contribute to Canadian nephrology nurses' job satisfaction, health outcomes, and perceived quality of patient care. A randomly selected sample of 300 nurse members of the Canadian Association of Nephrology Nurses and Technologists (CANNT) was asked to complete a survey consisting of four instruments: The Nursing Work Index (Lake, 2002), the Conditions of Work Effectiveness Questionnaire II (Laschinger, Finegan, Shamian, & Wilk, 2001), the Pressure Management Indicator (Williams & Cooper, 1998), and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). There was a 48.1% response rate. Results demonstrated that some aspects of the Canadian nephrology nursing environment were rated quite favourably (e.g., high standards of care are expected; good working relationships with peers), but areas requiring improvement were evident (e.g., assignments that foster continuity of care). Overall, the nurses felt empowered. The results of the Pressure Management Indicator and Maslach Burnout Inventory indicated that nephrology nurses are generally coping well, but that some of them are struggling. Strategies that improve work environments could promote the recruitment and retention of nephrology nurses. Further research in this area is warranted.