What You Need to Know about Bar-Code Medication Administration

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and sustainability. The themes that emerged from the literature were poor BCMA design and implementation that resulted in workarounds.The three evidence based strategies proposed to address this gap are, evidence based standardization in planning and implementation, the identification and elimination of workarounds and hard wiring. An evidence based checklist evaluates compliance with standard procedures. The LEAN model of Jodoka is used to assure adaptation of the machine to human workflow. Direct observation provides valuable workflow assessment. An effective BCMA implementation involves careful system design, identification of workflow issues which cause workarounds, and adapting the machine to nursing needs

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Improving waiting times in the Emergency Department

Waiting times in the Emergency Department cause considerable delays in care and in patient satisfaction. There are many moving parts to the ED visit with multiple providers delivering care for a single patient. Factors that have been shown to delay care in the ED have been broken down into input factors such as triaging, throughput factors during the visit, and output factors, which include discharge planning and available inpatient beds for admitted patients. Research has shown that throughput factors are an area of interest to decrease time spent in the ED that will lead to decrease waiting room times. In this Quality Improvement project, we will develop a systematic check in system with ED providers that will allow providers to identify any outstanding issues that may be delaying care or discharge. We hypothesize that this system will increase throughput in the ED by resolving any lab, radiology, or treatments that were overlooked. Reviewing the results of this QI project will allow us to see if we were effective in our timing of scheduled check-ins. Ultimately, this will reduce time spent in the waiting room by allowing more patients to be seen. In the era of the Affordable Care Act, more patients have access to affordable healthcare and will increase volume in the ED. This check-in system will allow more patients to be seen smoothly and in a timely manner that will improve and increase patient care and satisfaction in the ED

Case study: evaluating performance outcomes of a technology change management initiative in a health care organization

The purpose of this research was to examine a case study by evaluating performance outcomes of a technology change management initiative in a health care organization. This study was developed with an array of issues surrounding change management programs with technology platforms, the management of complex change and the amount of criticism that became the impetus behind the implementation of the Electronic Health Records Management Systems (EHRMS) across the healthcare industry and its long-term transformative effects. Despite recognition that user response largely determined the success of a technology implementation or change management program and the fact significant resources are spent on strategic programs to promote acceptance, there was very little research in terms of evaluating performance outcomes which make a change management program more successful in health care settings. The study was challenging and the findings were inconclusive for the research questions. However, the qualitative data gathered from the comments/recommendations section of the eCare Research Survey provided additional information in great detail concerning the research topic. The capture of detailed opinions, attitudes, beliefs and comments/recommendations expressed by the respondents provided suggestions for revisions of the eCare change management program. This qualitative data also provided implications for future research in the field of change management

Health Information System Implementation in a Complex Acute Care Environment: A Sociotechnical Analysis

With the increase of information systems in health care, there is a growing need to better understand factors that contribute to the implementation and use of such technology. This secondary analysis explored the implementation of a health information system in a large acute care hospital from the perspective of hospital leadership and the health information system developers. The purpose of this study was to: (a) explore a group of interprofessional leaders’ perceptions of social and technical factors which impacted an HIS implementation within an acute care hospital organization; and, (b) uncover how the various social and technical forces contributed to, or prevented, successful implementation of the HIS in relation to nursing practice and education. A directed content analysis approach was used to obtain an understanding of participants’ perceptions regarding health information system implementation and use. Sittig and Singh’s (2010) sociotechnical framework was chosen as a theoretical framework to guide the analysis of focus group (n=17, in 3 separate groups) and interview data (n=10) from a longitudinal study at an acute care hospital in Ontario, Canada. Several benefits of the health information system implementation were realized including increased organizational transparency regarding patient flow and improved communication among managers and directors. Findings also indicated that implementation was compromised by problems with inaccurate data stemming from poor interoperability with other health information systems, insufficient training, and turnover of leadership during the implementation process. This type of research is important to support future implementation of information and communication technologies and contribute to a growing body of knowledge regarding the implementation of health information systems in complex healthcare environments. The consolidated evidence generated from this content analysis also has implications for the nursing profession and development of clinical practice. Further evaluation measures must be undertaken to more fully understand the role of nurses in health information systems implementation and optimize the use of these technologies in supporting nursing practice and improving patient care

Perfecting Patient Bed Flow in the Emergency Department

Emergency department (ED) crowding is a serious problem in the United States. Crowding in the ED can result in delays that may negatively affect patient outcomes and increase the cost of care. The purpose of this project was to understand strategies that can help to improve patient flow in the ED. The plan-to-do-study act model for process improvement influenced this project. Secondary data were collected for a 2-month period to determine the impact of workflow processes (patient boarding time in ED, surge capacity and workflow processes including the impact of ancillary departments) on the movement of admitted patients from the ED to the inpatient units. Descriptive statistics were used to provide numerical summaries, frequencies, and percentages for the identified variables. The findings were consistent with an increased length of stay and longer ED boarding of patients due to the workflow process. Resulting recommendations included standardized calls for report on admitted patients within 30 minutes, timely discharge of patients, collaboration with attending physicians to facilitate evaluation of patients and orders, modification of staffing roles to ensure adequate staff, and identification of staff transporters to ensure timely transport of patients to their rooms. The findings helped to inform the development of a Bed Utilization Policy. The policy has been shared with the organization with the recommendation to implement and further evaluate to help manage bed flow. Development of utilization strategies that contribute to facilitating throughput will promote positive social change by providing nurses with the tools to help prepare for and respond to unexpected increases in patient volume. Improving efficiency with flow can help to improve patient care, timeliness, and safety

Translating evidence on medical interpreters into practice: identifying and addressing language needs in primary care

BACKGROUND: Professional interpreters improve care for limited English proficient patients but are underused. Study Design: Mixed methods study evaluating effectiveness and implementation of a rooming protocol to screen patients for language needs and call interpreters OBJECTIVE: Examine barriers and facilitators to protocol implementation and effectiveness to increase interpreter use METHODS: Provider surveys explored baseline and post-implementation attitudes. Simple and multiple logistic regression analyses examined the impact of practicing in the pilot clinics versus comparison clinics on post-implementation responses. Medical Assistants and providers were interviewed regarding barriers and facilitators to implementation. Interview analysis used modified grounded theory. Trends in the number of telephone interpreter calls were examined to determine protocol effectiveness. RESULTS: Context themes included having established teams and workflows; transitioning to a new interpreter vendor; and challenges incorporating the workflow, including providers’ tardiness and clinic understaffing. Evidence themes included beliefs that the protocol improved the patient experience but otherwise mixed responses; preferring live interpreters; and limited buy-in to language screening. Facilitation themes included Medical Assistants needing more support. Providers in the pilot clinics versus comparison clinics had significantly higher odds of positive responses on post-implementation survey questions regarding satisfaction with care (OR 5.3) and communication (OR 6.7). Implementation did not increase the number of telephone interpreter calls in the pilot clinics. CONCLUSION: Ineffectiveness of the protocol was likely due to inconsistent implementation. The protocol may improve patient care but context limited implementation success. The limited buy-in to language screening raises questions about how to better identify patient language needs.2019-11-08T00:00:00

Investigating the impact of health analytics on the cost and quality of care for patients with heart failure

The healthcare industry is under tremendous pressure to improve the quality of care and provide more patient centric care, while reducing costs. The potential use of data analytics to address these health system issues has raised significant interest in both research and practice. Health Analytics is central to informing and realizing the systematic quality improvements and cost reductions required by healthcare reform. Fundamentally, the contribution of IS and analytics research in healthcare is to identify and study the impact of interventions that can make a significant difference to the quality and cost of care. This dissertation is concentrated on patients with heart failure (HF). HF is the number one killer in the world, and is the largest contributor to healthcare costs in the United States. Moreover, HF is one of the six conditions used by the Centers for Medicare and Medicaid Services (CMS) to exercise fiduciary control over health systems by monitoring both the quality and cost of care. Specifically, my larger research question is “How can we identify and inform impactful transition of care interventions that manage costs and improve resource allocation efficiencies while providing improved quality of care for heart failure patients?” We adopted a mixed-method approach to study the impact of transitional care in a healthcare system for patients with heart failure. This dissertation includes three essays. In the first essay, I use qualitative methods to study the nature, sources and impacts of information coordination problems as HF patients’ transition through the patient flow in a health system. I propose a set of interventions based on my analysis of information and control errors along the continuum of care to inform the design of appropriate interventions that improve the cost and quality of care. In the second essay, I empirically evaluate the impact of these interventions on cost and quality of care measures such as all cause readmissions, heart failure readmissions, ER visits, length of stay, and cost of care. Analysis suggests that multicomponent complex transitional interventions have significant impact on reducing 30-day readmission and ER visits. The third essay is dedicated to understanding the impact of heart failure patient’s self-care behaviors. I developed and validated an assessment tool for patients with heart failure to monitor and score their condition accurately. Together, these essays investigate impactful transition of care interventions that can help healthcare organizations improve quality of care and manage costs from the clinical, administrative and patient perspectives