The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Health Care Leader Action Guide to Reduce Avoidable Readmissions

Outlines a four-step approach to reducing avoidable hospital readmissions. Suggests interventions during hospitalization, at discharge, and post-discharge, including patient and caregiver education, multidisciplinary care coordination, and home visits

A review of historical developments of quality assessment in industry and healthcare

Purpose: This study reviewed the literature on the historical development of quality assessment methods in industry and in healthcare. A comparative analysis of quality methods in industry and healthcare was conducted to examine the gap between methods in the two sectors. An attempt was then made to examine the latest approaches to quality assessment in healthcare and finally a proposal has been offered for a more effective approach to tackling the problem of quality in healthcare. Design/methodology/approach: Firstly, a review of the evolution of quality assessment in industry and healthcare was conducted. This was based on books written by prominent experts in the field of quality. secondly, a study of the current approaches in healthcare was undertaken. Publications from varied sources were selected and reviewed. The literature consulted includes worldwide operations research and healthcare sources including dissertations, the internet and reference lists of relevant articles. The journal papers and conference proceedings were selected according to the following criteria: Objective: the study must be aimed at measuring or improving quality both. It could also be aimed at developing new ways of measuring the quality of health care; Method: observational studies, experimental trials or systematic reviews; Setting: study should be in a hospital setting and not narrowed to quality of clinical cares. Findings: This study showed that the concept of quality management and its control in healthcare is not as advanced as it is in industry. Moreover, it seemed that most researchers, who set out to assess quality of care in one way or the other, have had differing views of quality and the factors that contribute to its assessment. It was also deduced that the way forward in healthcare quality is the development of systems that give staff ownership and pride in a way that is akin to the era of the craftsmen

Postpartum Depression Screening of Women Veterans in Alaska Quality Improvement Project

A Project Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCE in Nursing SciencePostpartum depression screening guidelines were updated by the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force in 2015 and 2016, respectively. Universal postpartum depression screening is recommended where previously it was not. Postpartum depression screening is relevant to the rapidly growing population of women Veterans served by the Veterans Health Administration (VA) as part of their comprehensive health care benefits. Little information was available on the postpartum depression screening practices within the Alaska VA Healthcare System. Using a quality improvement methodology, the author identified postpartum depression screening as a topic of interest. Current practice was assessed through a retrospective chart audit of all maternity consults placed during the fiscal year 2014. The chart audit revealed an 81% postpartum depression screening rate. Incomplete data limited a full statistical analysis; however, all women who returned to an Alaska VA clinic, received screening and treatment. An informational brochure was developed for women and their health care providers highlighting postpartum depression screening and treatment resources.Title Page / Abstract / Table of Contents / List of Tables / List of Appendices / Introduction / Purpose / Literature Review / Implications for Nursing Practice / Methods / Results / Discussion / Conclusion / References / Appendice

Addressing the Quality and Safety Gap Part II: How Nurses Are Shaping, and Being Shaped by, Health Information Technologies

Explores the role of health information technologies (HIT) in improving patient safety and the role of nurses in designing, implementing, and educating clinicians to use HIT, including electronic health records and bar code medication administration

The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences

Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care

Prescription for nursing informatics in pre-registration nurse education.

Nurses need to be able to use information and communications technology not only to support their own practice, but also to help their patients make best use of it. This article argues that nurses are not currently adequately prepared to work with information and technology through their pre-registration education. Reflecting the lack of nursing informatics expertise, it is recommended that all pre-registration nursing programmes should have access to a nursing informatics specialist. A prescription to meet the informatics needs of the newly qualified nurse is proposed. This places the areas that need to be included in pre-registration education into broad groups that both articulate the competencies that nurses need to develop, and indicate why they are needed, rather than providing context-free checklists of skills. This is presented as a binary scatter chart with two axes, skill to knowledge and technology to information

Electronic adverse incident reporting in hospitals

The purpose of this study was to assess attitudes toward and use of an electronic adverse incident reporting system in all four hospitals in one NHS Scotland Health Board area. A questionnaire was used to assess Medical Consultants', Managers', and Nurses' attitudes and perceptions about electronic adverse incident reporting. Actual adverse incident reporting data were also analysed. The main findings from this study are that Consultants, Managers, and Nurses all had positive attitudes about responsibility for reporting adverse incidents. All respondents indicated that the design of and information collected by the electronic adverse incident reporting system (DATIX) was adequate but Consultants had more negative attitudes and perceptions than Managers and Nurses about DATIX. All respondents expressed negative attitudes about the amount and type of feedback they receive from reporting, and Consultants expressed more negative attitudes about how DATIX is managed than Managers and Nurses. Analysis of adverse incident reporting data found that the proportion of Consultants using DATIX to report incidents was significantly lower than that of Managers and Nurses. The findings suggest that there are no additional barriers to incident reporting associated with the use of a bespoke electronic adverse incident reporting system as compared to other types of systems. Although an electronic adverse incident reporting system may be able to increase incident reporting and facilitate organisational learning by making it easier to report incidents and analyse incident reporting data, strong leadership within hospitals / healthcare professions (or healthcare subcultures) is still required in order to promote and sustain incident reporting to improve patient safety