Outcome calculations based on nursing documentation in the first generation of electronic health records in the Netherlands

OBJECTIVES: Previous studies regarding nursing documentation focused primarily on documentation quality, for instance, in terms of the accuracy of the documentation. The combination between accuracy measurements and the quality and frequencies of outcome variables such as the length of the hospital stay were only minimally addressed. METHOD: An audit of 300 randomly selected digital nursing records of patients (age of >70 years) admitted between 2013-2014 for hip surgery in two orthopaedic wards of a general Dutch hospital was conducted. RESULTS: Nursing diagnoses: Impaired tissue perfusion (wound), Pressure ulcer, and Deficient fluid volume had significant influence on the length of the hospital stay. CONCLUSION: Nursing process documentation can be used for outcome calculations. Nevertheless, in the first generation of electronic health records, nursing diagnoses were not documented in a standardized manner (First generation 2010-2015; the first generation of electronic records implemented in clinical practice in the Netherlands)

A comprehensive evaluation of outcomes from patient handling interventions

Assisting less able people to move in a healthcare setting is a very common occurrence but carries risks to staff and patients. The scientific study of patient handling activities and interventions to help reduce musculoskeletal disorders in the workplace is a relatively new but growing area. Recent literature reviews have identified two key factors, the lack of high quality studies and the lack of strong links between patient handling interventions and reduced musculoskeletal injury. This study has systematically reviewed the available literature and investigated the potential outcome measures used to show benefits of improved patient handling. A wide range of outcomes has been identified concentrated on the benefits to staff, patients and organisations. No methods were identified to compare different benefits, outcomes or intervention strategies. This study used mixed methods to develop a tool to compare the results of all types of interventions: a.Focus group studies in four EU countries recorded a priority list of the 12 most important outcomes from patient handling interventions b.The most suitable method for examining the 12 outcomes was identified c.The Intervention Evaluation Tool (IET) was developed as a single measurement tool d.The IET was translated and used in four EU countries to evaluate its usability and its usefulness to patient handling practitioners The EU trials and subsequent expert review have given favourable feedback for the IET. The IET creates 12 outcome evaluations with detail and differentiation, and an overall performance score to assist an organisation to target its future interventions. The method can be used to compare interventions, and the performance between organisations and countries across the EU. Though the IET needs more field trials and validity testing it is hoped that a wider application may be to create a benchmarking method that can assist in the improvement of patient handling systems across Europe

A retrospective data analysis in veterans with inflammatory bowel disease: Using Wagner\u27s Chronic Care Model to explore medication adherence

Background Medication adherence in inflammatory bowel disease (IBD) ranges between 7-72% . Increased healthcare utilization has been associated with non-adherence in IBD. Wagner\u27s Chronic Care Model (CCM) posits that care coordination between primary and gastroenterology (GI) specialty care could improve adherence and healthcare utilization. Methods Guided by the CCM, a retrospective analysis was conducted in veterans with IBD to: describe medication adherence rates; describe healthcare utilization measured by ER visits and inpatient admissions; and describe care coordination measured by primary care and GI specialty care use. A secondary study aim was to explore the relationships between those key outcome variables and select demographic/health history characteristics. A local Veteran\u27s Affairs database was used to extract a cohort of individuals with Crohn\u27s disease and ulcerative colitis for fiscal year (FY) 2011. Medical utilization and IBD medication refills were collected. A dichotomized medication possession ratio (MPR .80) was used in logistic regression to identify factors affecting medication adherence. Logistic regression was also used to examine factors affecting ER visits, inpatient utilization, and care coordination. Results The cohort consisted of 165 White male veterans 75 with Crohn\u27s disease and 89 with ulcerative colitis. The overall rate of adherence was 50.9% with a median MPR of .82. Regression models did not render any statistically significant predictors of adherence. ER utilization was significantly associated with adherence (OR=.314, 95%CI=.111-.886, p=.029) and care coordination (OR=45.73,95%CI=9.053-231,p=.001) in multivariate analysis. Inpatient admission was associated with: younger age (OR=.108,95%CI:.019-.609,p=.012), adherence (OR=.113,95%CI=.014-.939,p=.044), IBD diagnosis (OR=.117,95%CI=.017-.784,p=.027), and care coordination (OR=11.89,95%CI=1.228-115,p=.033). Logistic regression identified statistically significance associations with care coordinated between primary and GI specialty care and the following factors: taking both a 5-ASA and immunomodulating medication (OR=5.122,95%CI=1.874-14.00, p=.001), younger age (OR=.905,95%CI=.871-.940,p=.001), and having a comorbidity (OR=2.643,95%=1.171-5.965,p=.027). Conclusions No predictors of medication adherence emerged. However, the CCM element of care coordination provided additional insight into the healthcare utilization of veterans with IBD as statistically significant associations between care ER visits and hospitalization were identified. Further inquiry into the influences of medication adherence and healthcare utilization in this population is warranted

Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement

It is no longer possible to ignore the issue of quality in health care. Care institutions strive to provide all patients with effective, efficient, safe, timely, patient-centered care. Increased attention for quality is also found in discussions regarding use of information and communication technologies (ICTs) in health care processes. In these discussions, ICT is almost always brought into a direct relationship with improving the quality of care, especially ICTs that professionals use directly in patient care, which are also known as patient care information systems (PCIS) [1-4]. Well-known quality reports from the US Institute of Medicine, such as To Err is Human [5] and Crossing the Quality Chasm [6], identify the lack of and delay in ICT development and implementation as a partial explanation for quality problems in existing healthcare systems. Both reports call for wider-scale imple

Determining risk factors for surgical wound dehiscence: Development and internal validation of a risk assessment tool

Whilst surgical procedures are considered safe, complications such as surgical wound dehiscence (SWD) may occur despite advances in surgical techniques, infection control practices and wound care. A SWD risk assessment tool was developed from identified risk factors based on a review of the literature and a retrospective case control study. A prospective clinical validation of the tool yielded a predictive power of 71% with an interrater reliability of 100%

Medication Safety in Municipal Health and Care Services

Medicines constitute an essential part of healthcare delivery and help to prevent or treat illness, influence quality of life, and generally increase life expectancy. However, medications can also cause harm if prescribed irrationally, dispensed or used incorrectly, and monitored or followed up insufficiently. In this anthology, we showcase the challenges of medication management and the rational use of medicines in municipal health and care services, and present various strategies and measures related to medication safety. The contributors are researchers representing a wide range of disciplines, with experience from different levels of healthcare services and different areas within the research and education sectors. We hope to raise awareness, engage and enable discussion of initiatives and strategies to improve patient safety related to medications in municipal health and care services, and create a basis for further research to promote safe medication management and rational use of medicines. This anthology will be of interest to anyone involved in or concerned with medication safety, primarily healthcare professionals, academic staff, researchers, policymakers, and managers in healthcare services