8,180 research outputs found

    Investigation Interoperability Problems in Pharmacy Automation: A Case Study in Saudi Arabia

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    The aim of this case study is to investigate the nature of interoperability problems in hospital systems automation. One of the advanced healthcare providers in Saudi Arabia is the host of the study. The interaction between the pharmacy system and automated medication dispensing cabinets is the focus of the case system. The research method is a detailed case study where multiple data collection methods are used. The modelling of the processes of inpatient pharmacy systems is presented using Business Process Model Notation. The data collected is analysed to study the different interoperability problems. This paper presents a framework that classifies health informatics interoperability implementation problems into technical, semantic, organisational levels. The detailed study of the interoperability problems in this case illustrates the challenges to the adoption of health information system automation which could help other healthcare organisations in their system automation projects

    Transforming Evidence-based Clinical Obesity Guidelines into Practice: A Literature Review

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    Evidence-based clinical obesity guidelines have been published in the United States by the ~ Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the ~ -4 National Heart Lung and Blood Institute (NHLBI), the US Preventive Services Task Force ~ ~ lllllll ~_. ~ ~ ~ ~ .;sa@t ....@ ~ ,Ji\u27!IJ ~_. -a .a ~ ~_. .a .a ,.a _a ,.a ,.a ,.a -- (USPSTF), and the Institute for Clinical Systems Improvement (ICSI), and in the United Kingdom by the National Institute for Health and Clinical Excellence (NICE). The first federal clinical obesity guidelines were published by the NHLBJ in 1998 (Schuster, Tasosa, & Terwoord, 2008). Unfo11tmately America\u27s health care system seems to have distanced itself from addressing, let alone implementing evidence-based guidelines related to this primary chronic disease risk factor. If allowed unchecked, this disconnect will result in nothing but a disservice to the patient population. The critical question addressed by this paper is whether or not evidence-based solutions exist to guide health care systems towards effectively and efficiently preventing and managing obesity among its patient population. In order to answer this question, a literature review was conducted on articles written in the English language and published between the period of 2002 and 2012 via database searches of the Cochrane Library, MEDLINE, CINAHL, and SCOPUS. Kurt Lewin\u27s Organizational Three-Step Change Theory, Lippitt\u27s Phases of Change Theory, the Total Quality Management (TQM) Theory, and the 5As framework served to guide proposed solution(s). Evidence-based recommendations for guideline implementation were assigned to five categories: prompts, clinician training, clinician health, multi-factorial interventions, and the health care system. Implications for nursing include embracing the practice facilitation role, as well as embedding guideline information and guideline-specific implementation suppo11s into nursing research, practice, policy, and education Keywords: obesity, clinical guidelines, evidence-based practice, and translatio

    Interdisciplinary systematic review: does alignment between system and design shape adoption and use of barcode medication administration technology?

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    BACKGROUND: In order to reduce safety risks associated with medication administrations, technologies such as barcode medication administration (BCMA) are increasingly used. Examining how human factors influence adoption and usability of this technology can potentially highlight areas for improvement in design and implementation. OBJECTIVE: To describe how human factors related determinants for BCMA have been researched and reported by healthcare and human-computer interaction disciplines. DATA SOURCES: The Cumulative Index of Nursing, and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar. STUDY ELIGIBILITY CRITERIA: Primary research published from April 2000 to April 2020, search terms developed to identity different disciplinary research perspectives that examined BCMA use, used a human factors lens and were published in English. SYNTHESIS METHODS: Computerised systematic searches were conducted in four databases. Eligible papers were systematically analysed for themes. Themes were discussed with a second reviewer and supervisors to ensure they were representative of content. RESULTS: Of 3707 papers screened, 11 were included. Studies did not fit neatly into a clinical or human-computer interaction perspective but instead uncovered a range of overlapping narratives, demonstrating consensus on the key themes despite differing research approaches. Prevalent themes were misaligned design and workflow, adaptation and workarounds, mediating factors, safety, users' perceptions and design and usability. Inadequate design frequently led to workarounds, which jeopardised safety. Reported mediating factors included clarity of user needs, pre/post implementation evaluations, analysis of existing workarounds and appropriate technology, infrastructure and staffing. LIMITATIONS: Most studies were relatively small and qualitative, making it difficult to generalise findings. CONCLUSION: Evaluating interdisciplinary perspectives including human factors approaches identified similar and complementary enablers and barriers to successful technology use. Often, mediating factors were developed to compensate for unsuitable design; a collaborative approach between system designer and end users is necessary for BCMA to achieve its true safety potential

    Implementing a Checklist & Hourly Huddles to Increase Situational Awareness During the Second Stage of Labor-A Perinatal Quality Improvement Project

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    Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth outcomes. AIM Statement: The global aim of this project was to reduce variability in practice during the second stage of labor to improve neonatal birth outcomes. The specific aim was to implement a second stage situational awareness checklist with a completion percentage of 80% by July 2015. Method: The theoretical framework guiding this project was Endsley’s theory of Situation Awareness. Pre-implementation chart reviews were conducted to determine what information was currently being documented during the second stage. A 9-item checklist was developed based on hospital preference for use during hourly huddles once second stage was reached. Staff were educated on checklist use pre-implementation. Post-implementation chart reviews were conducted to determine checklist completion percentage. Results: Chart reviews demonstrated an average checklist completion percentage of 43% over the two-week implementation period with a range of 22-89%. Huddles were conducted and documented in 33% of the reviewed delivery charts. Conclusions: Continued follow up and work re-design is needed to consistently incorporate the checklist and huddles into practice. Implications for the CNL: Implications for the CNL include continuing staff education to increase awareness and acceptance of the practice change, and examining project effects on perinatal outcomes including delivery mode and neonatal Apgar scoring

    The impact of redesigning care processes on quality of care: a systematic review

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    Background: This literature review evaluates the current state of knowledge about the impact of process redesign on the quality of healthcare. Methods: Pubmed, CINAHL, Web of Science and Business Premier Source were searched for relevant studies published in the last ten years [20042014]. To be included, studies had to be original research, published in English with a before-and-after study design, and be focused on changes in healthcare processes and quality of care. Studies that met the inclusion criteria were independently assessed for excellence in reporting by three reviewers using the SQUIRE checklist. Data was extracted using a framework developed for this review. Results: Reporting adequacy varied across the studies. Process redesign interventions were diverse, and none of the studies described their effects on all dimensions of quality defined by the Institute of Medicine. Conclusions: The results of this systematic literature review suggests that process redesign interventions have positive effects on certain aspects of quality. However, the full impact cannot be determined on the basis of the literature. A wide range of outcome measures were used, and research methods were limited. This review demonstrates the need for further investigation of the impact of redesign interventions on the quality of healthcare. Keywords: Process redesign, Quality of care, Healthcare processes, Systematic revie

    WORKAROUNDS IN RETAIL WORK SYSTEMS: PREVENT, REDESIGN, ADOPT OR IGNORE?

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    We conducted a case study in a Dutch supermarket chain in order to explore the emergence of workarounds in the retail environment. We studied what types of workarounds occur during the use of retail information systems and how manager can handle the identified workarounds once they become aware of them. The data was acquired qualitatively through interviews, observations, and document analysis, and validated by means of an online survey. After identifying and classifying 29 workarounds, a conceptual framework was developed that links workaround features to workaround categories and then to certain actions as response to them, namely prevent, redesign, adopt and ignore. This study contributes to existing research by categorizing workarounds in an unexplored domain and developing a conceptual framework of workaround categories and re-sponses. We were able to identify patterns of relationships between types of workarounds, some of them similar to those found for other industries and others that appear to be specific to retail work systems, probably due to the inherent characteristics of retail work systems

    Electronic Health Records and Rural Hospitals

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    Nearly 20% of the U.S. population lives in rural areas and are not resistant to many of the U.S. healthcare challenges such as cost, quality, and access. In fact, the distinguishing cultural, social, economic, and geographic traits which characterize rural America place rural populations at greater risk for many diseases and health disorders. Like those in urban settings, people from rural areas have been affected by the use of health information technology, where treatment is now data-intensive, and there are more options and greater expectations of quality and accountability. Due to cost, geographic and social traits, and the digital divide between urban and rural communities, the rapid changes in health information technology have not affected rural communities in the same way they have affected more central and populous areas. The irony is that rural communities are often the ones with the poorest health outcomes and most in need of assistance. Implementation of EHRs is more difficult in rural areas, in comparison to urban ones due to certain barriers. But, with a little more time and effort on behalf of hospital staff, policy makers, and patients, these rural areas can overcome the barriers of implementation and succeed in meeting the meaningful use requirements. Ultimately, this will transform the quality of care within rural healthcare facilities and furthermore improve the health outcomes of rural patients

    Simulation in Nursing Education: A Family Approach

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    Purpose Statement: The project’s purpose is to determine if the use of low-fidelity simulation (role-play) is an effective teaching-learning strategy to educate sophomore level baccalaureate nursing students on the importance of family assessment and communication. Another purpose for the project was to design and develop a credible and reliable simulation rubric which can be used for faculty to evaluate nursing student abilities to conduct family assessment and communication skills in a simulation setting. Finally, this systems change project (SCP) was designed to help redesign the Minnesota State University, Mankato (MSM) basic undergraduate nursing curriculum by integrating a family as client care emphasis within the curriculum. Background: There is a gap in the literature as to whether simulation may be used to teach family assessment and communication skills to undergraduate nursing students. Effectiveness of simulation in these two areas requires further research. The new curriculum will focus on a conceptual model of learning rather than content, with the assumption that students will be better prepared to think critically, adjust to quickly changing work environments, and ultimately deepen the learning experience of the students. Methods: A descriptive study using a pre-survey and 11 week post survey single group design was used to compared pre-intervention data to post-intervention data for sophomore nursing students (N=24) attending a simulation (role-play) teaching-learning experience. Four theories guide this SCP to enhance nursing students’ learning about health and families: The Calgary Family Assessment Model (CFAM), Calgary Family Intervention Model (CFIM), Social Learning Theory, and Fink’s Creating Significant Learning Experiences. Research Questions: Will the use of simulation role-play increase the perceived importance of family as client care in sophomore nursing students? Will sophomore nursing students perceive simulation role-play an effective learning tool for family communication and assessment skills? Will the Van Gelderen Simulation Rubric (2010) indicate to be a reliable and valid instrument for measuring nursing student assessment and communication skills? Hypotheses: Sophomore nursing students will perceive family as client care as more important on post survey versus pre survey results. Sophomore nursing students will perceive simulation role-play an effective learning tool to build family communication and assessment skills. The Van Gelderen Simulation Rubric (2010) will indicate to be a reliable and valid instrument for measuring nursing student assessment and communication skills. Results: The students’ level of perceived importance of family care on post surveys as compared to pre surveys overall showed a trend towards increasing (M=3.79; pre-survey) vs. (M=3.83; post-survey). However, no level of significance was found. The implementation of simulation role-play in undergraduate, sophomore nursing students to build family communication and assessment skills was perceived by the students as a positive learning experience by recommending (3.92/4.0 Likert Scale) that this simulation experience be replicated for future MSM nursing students. All male students endorsed replicating this experience by rating this experience as 4.0/4.0 on a Likert Scale whereas female students endorsed this experience as 3.89/4.0. Using Intra-class Correlation Coefficient, the Van Gelderen Simulation Rubric (2010) was found to have all of its eleven constructs significant at a 5% level (p=.000); indicating agreement among three raters. Cronbach’s Alpha indicated that nine of eleven constructs within the rubric were found to have reliability at (.852 or higher). Two constructs were found to have lower reliability; the construct pertaining to ‘Issues & Concerns’ was (.599) and the ‘Family as Client’ construct was (.671). Implications: Implications for future nursing practice and research are that simulation may be an effective method to transfer family knowledge into clinical practice for nursing students. However, simulation was found to be a better learning experience for male versus female nursing students. With further replication and verification, the Van Gelderen Simulation Rubric (2010) may be used as a tool for nurse educators to measure nursing student ability to conduct family assessment and communication skills. Further Research: An area requiring further research is to investigate whether simulation may be an effective tool for current practicing nurses and graduate nursing students to learn about family based care

    Speaking Up for Fundamental Care: the ILC Aalborg Statement.

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    OBJECTIVE: The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems. KEY ARGUMENTS: We present five propositions for radically transforming fundamental care delivery:Value: fundamental care must be foundational to all caring activities, systems and institutionsTalk: fundamental care must be explicitly articulated in all caring activities, systems and institutions.Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions.Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care. RESEARCH: fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula. CONCLUSION: For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team-educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians-value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change
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