27,686 research outputs found
Lessons From a Health Information Technology Demonstration in New York Nursing Homes
Outlines the New York State Nursing Home Health Information Technology Demonstration Project; variations in organizational aims in adopting HIT, perceived or real effects, and resulting quality improvement efforts; and considerations for replication
Organizational Strategies for the Adoption of Electronic Medical Records: Toward an Understanding of Outcome Variation in Nursing Homes
[Excerpt] An important element in president-elect Obama\u27s economic stimulus proposal is his plan to invest a significant proportion of federal dollars in installing electronic medical records (EMR) in U.S. healthcare institutions. In emphasizing the need for EMR, Obama is following the advice of numerous healthcare experts who have pointed out that the healthcare sector lags behind other industries in the use of computer technology. They believe the widespread use of EMR would help reduce medical errors, control the costs of healthcare, and lead to significant improvements in the quality of care Americans receive.
In this paper we present preliminary results of an ongoing study of the introduction of EMR in 20 nursing homes in the New York City area. Although most observers believe EMR holds great promise for the improvement of healthcare, in fact recent studies have found mixed evidence regarding the effect of EMR on patient outcomes. The evidence we have gathered to date suggests that whether EMR has beneficial effects on the costs and quality of healthcare depends very much on the purposes and objectives nursing home managers and administrators intend to achieve through its use. That is, management strategy and style, we believe, strongly influences healthcare outcomes associated with technological innovation
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Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.
Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation
Medication administration errors for older people in long-term residential care
Background
Older people in long-term residential care are at increased risk of medication errors. The purpose of this study was to evaluate a computerised barcode medication management system designed to improve drug administrations in residential and nursing homes, including comparison of error rates and staff awareness in both settings.
Methods
All medication administrations were recorded prospectively for 345 older residents in thirteen care homes during a 3-month period using the computerised system. Staff were surveyed to identify their awareness of administration errors prior to system introduction. Overall, 188,249 attempts to administer medication were analysed to determine the prevalence of potential medication administration errors (MAEs). Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Analysis compared data at residential and nursing home level and care and nursing staff groups.
Results
Typically each resident was exposed to 206 medication administration episodes every month and received nine different drugs. Administration episodes were more numerous (p < 0.01) in nursing homes (226.7 per resident) than in residential homes (198.7). Prior to technology introduction, only 12% of staff administering drugs reported they were aware of administration errors being averted in their care home. Following technology introduction, 2,289 potential MAEs were recorded over three months. The most common MAE was attempting to give medication at the wrong time. On average each resident was exposed to 6.6 potential errors. In total, 90% of residents were exposed to at least one MAE with over half (52%) exposed to serious errors such as attempts to give medication to the wrong resident. MAEs rates were significantly lower (p < 0.01) in residential homes than nursing homes. The level of non-compliance with system alerts was low in both settings (0.075% of administrations) demonstrating virtually complete error avoidance.
Conclusion
Potentially inappropriate administration of medication is a serious problem in long-term residential care. A computerised barcode system can accurately and automatically detect inappropriate attempts to administer drugs to residents. This tool can reliably be used by care staff as well as nurses to improve quality of care and patient safety
Integrating Research and Quality Improvement Using TeamSTEPPS: A Health Team Communication Project to Improve Hospital Discharge
Purpose/Objectives:
The purpose of this article is to describe an innovative approach to the integration of quality improvement and research processes. A project with the objective of improving health team communication about hospital discharge provides an exemplar case. Description of the Project/Program:
The TeamSTEPPS 10-step action planning guide provided the structure for planning, developing, and evaluating a redesign of interprofessional health team communication to improve hospital discharge led by 2 clinical nurse specialists. The redesign involved development of processes for team bedside rounding, registered nurse bedside shift reports, and briefing tools to support the rounding processes. Outcome:
Using the TeamSTEPPS process, a 4-phase combined quality improvement and research project was designed and implemented. Implementation is ongoing, supported by process evaluation for continuing process improvement. Longitudinal analysis of research outcomes will follow in the future. Conclusions:
Led by unit-based clinical nurse specialists, use of an integrated process of quality improvement and research creates evidence-based innovation to solve interprofessional practice problems. Incorporating research within the project design allows for data-based decisions to inform the clinical process improvement, as well as documentation of both the processes and outcomes of the local improvements that can inform replications in other sites
Advances in Teaching & Learning Day Abstracts 2004
Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2004
Implementing advance care planning in routine nursing home care : the development of the theory-based ACP+ program
Background
While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice.
Objectives
We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner.
Design
To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling.
Setting and participants
Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer.
Methods
The work was carried out by means of 1) operationalization of key intervention components identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis.
Results
The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning.
Conclusions
The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice
Components of palliative care interventions addressing the needs of people with dementia living in long term care: a systematic review
© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background: People with dementia requiring palliative care havemultiple needs that require complex, multicomponent interventions. Thisneed is amplified in the long term care setting. The European Associationfor Palliative Care (EAPC) White Paper offers recommendations forpalliative care in dementia and highlights domains of care integral forthis population, thus providing useful guidance to developing suchinterventions. This review maps components of palliative careinterventions for people with dementia in LTCFs, with a particular focuson shared decision-making.Peer reviewe
Models for providing improved care in residential care homes: a thematic literature review
This Annotated Bibliography is one output from a review of the available research evidence to support improved care in residential care homes as the needs of older people intensify.
Key findings
The review identified extremely little published evidence on residential care homes; the research base is almost exclusively related to provision of care in nursing homes. Much of this research is from the US or other non-UK sources. Although it could be argued that some findings are generalisable to the UK residential care context, a systematic process is required
to identify which. The literature often makes no distinction between nursing and residential homes; use of generic terms such as ‘care home’ should be avoided.
There is considerable international debate in the quality improvement literature about the relationship between quality of care and quality of life in nursing and residential homes.
Measures of social care, as well as clinical care, are needed. The centrality of the resident’s voice in measuring quality of life must be recognised. Ethnic minority residents are almost entirely absent from the quality improvement literature.
Some clinical areas, internationally identified as key in terms of quality e.g. palliative care, are absent in the general nursing and residential home quality improvement literature. Others such as mental health (dementia and depression), diabetes, and nutrition are present but not fully integrated.
Considerable evidence points to a need for better management of medication in nursing homes. Pharmacist medication reviews have shown a positive effect in nursing homes. It is unclear how this evidence might relate to residential care.
There is evidence that medical cover for nursing and residential care home residents is suboptimal.
Care could be restructured to give a greater scope for proactive and preventive interventions. General practitioners' workload in care homes may be considered against quality-of-care measures.
There is US literature on the relationship between nurse staffing and nursing care home quality, with quality measured through clinical-based outcomes for residents and organisational outcomes. Conclusions are difficult to draw however due to inconsistencies in the evidencebase.
Hospital admission and early discharge to nursing homes research may not be generalisable to residential care. The quality of inter-institutional transfers and ensuring patient safety across settings is important. To date research has not considered transfer from residential to nursing home care.
The literature on district nurse and therapist roles in care homes includes very little research on residential care. Partnership working between district nurses and care home staff appears largely to occur by default at present. There is even less research evidence on therapist input
to care homes.
Set against the context outlined above, the international literature provides evidence of a number of approaches to care improvement, primarily in nursing homes. These include little discussion of cost-effectiveness other than in telecare. Research is needed in the UK on care
improvement in residential homes
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