Impact of Healthcare Information Technology on Nursing Practice

PurposeTo report additional mediation findings from a descriptive cross sectional study to examine if nurses’ perceptions of the impact of healthcare information technology on their practice mediates the relationship between electronic nursing care reminder use and missed nursing care.DesignThe study used a descriptive design. The sample (N = 165) was composed of registered nurses working on acute care hospital units. The sample was obtained from a large teaching hospital in Southeast Michigan in the fall of 2012. All eligible nursing units (n = 19) were included.MethodsThe MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Healthcare Information Technology Scale were used to collect data to test for mediation. Mediation was tested using the method described by Baron and Kenny. Multiple regression equations were used to analyze the data to determine if mediation occurred between the variables.FindingsMissed nursing care, the outcome variable, was regressed on the predictor variable, reminder usage, and the mediator variable impact of technology on nursing practice. The impact of healthcare information technology (IHIT) on nursing practice negatively affected missed nursing care (t = ‐4.12, p < .001), explaining 9.8% of variance in missed nursing care. With IHIT present, the predictor (reminder usage) was no longer significant (t = ‐.70, p = .48). Thus, the reduced direct association between reminder usage and missed nursing care when IHIT was in the model supported the hypothesis that IHIT was at least one of the mediators in the relationship between reminder usage and missed nursing care.ConclusionsThe perceptions of the impact of healthcare information technology mediates the relationship between nursing care reminder use and missed nursing care. The findings are beneficial to the advancement of healthcare technology in that designers of healthcare information technology systems need to keep in mind that perceptions regarding impacts of the technology will influence usage.Clinical RelevanceMany times, information technology systems are not designed to match the workflow of nurses. Systems built with redundant or impertinent reminders may be ignored. System designers must study which reminders nurses find most useful and which reminders result in the best quality outcomes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111908/1/jnu12138.pd

The Relationship Between Electronic Nursing Care Reminders and Missed Nursing Care.

Purpose: The purpose of this descriptive study was to: (1) determine the relationship between nurses’ level of use of reminders and missed nursing care, (2) examine mediators that may exist among variables, and (3) compare nurses with positive/negative reports on the impact of health care information technology on practice and level of use, to determine if they have lower levels of missed nursing care. Subjects: The sample (N = 165) consisted of staff nurses employed at a local hospital in the Midwestern United States during Fall 2012. The majority of the respondents held a Bachelor’s Degree as their highest level of education (n = 114, 69.1%). The majority of respondents were female (n = 145, 87.9%) and between the ages of 25 and 34 (n = 61, 37.0%). Methods: Surveys were administered online using the Qualtrics survey software. An email was sent to each nurse inviting him or her to participate. A reminder was sent to each nurse twice per week during the study period. Demographic data were analyzed using descriptive statistics and adjusted relationship, mediation, and comparisons were analyzed using hierarchical multiple regression analysis. Results: There was a significant negative relationship (beta = - .28, p < .001) between nursing care reminder usage and missed nursing care. There was a significant negative relationship (beta = - .34, p < .001) between the impact of healthcare information technology on practice and missed nursing care. Mediation was also determined to be occurring between nursing care reminders, impact of healthcare information technology on practice, and missed nursing care. Nurses with higher reports of reminder usage had decreased reports of missed nursing care (beta = -.22, p < .004). Nurses with higher perceptions of impact of healthcare IT (I-HIT) had decreased reports of missed nursing care (beta = -.27, p = .001). Conclusions: The findings from this study are significant and can be used to encourage nurses to use nursing care reminders, helpful for information system designers when designing nursing care reminders, and helpful to healthcare organizations in assessing the impact of technology on nursing practice.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/99968/1/piscotty_1.pd

AUTOMATED APPOINTMENT REMINDERS AND NO-SHOW RATES AT APPLETREE BAY PRIMARY CARE: A QUALITY ASSURANCE PROJECT

This quality assurance project is aimed to determine how effective a specific primary care office’s current method of reminding patients of scheduled appointments is in reducing the percentage of no-shows. The retrospective data gathered from a calendar month will be evaluated to determine what percentage of patients check-in when reminded with a telephone call. The estimated national no-show is between 23% and 34%. This project reveled a no-show rate of 3.7% at Appletree Bay Primary Care, This rate is important to the health and wellness of their patients. With additional research, the variables affecting this practice’s no-show rates may be exposed, which would provide an opportunity to share the effective methods with other primary care practices

Walla Walla General Hospital: Setting Staff Up for Success in Pneumonia Care

Outlines education and reinforcement strategies, including building a quality culture and implementing a hospitalist program, standardized order sets, and staff supports, that enable high performance on pneumonia care core measures. Lists lessons learned

The Effect of a Multifaceted Reminder Intervention on Nursing Documentation Completeness

Nationwide, nurses must withstand growing patient assignments and increased workloads. The consistency between nursing documentation and technical nursing interventions performed indicates that registered nurses provide much more care than they record. This incongruence has the potential to impact patient safety, but also has significant financial implications, since reimbursement is linked to documented services. The purpose of this EBP project was to implement a multifaceted reminder intervention (including a 10-minute PowerPoint and visual reminder) in an IMCU setting to assist the nursing staff (n = 38) in completing the HAPU documentation components. John Kotter’s Eight-Stage Process and the Iowa Model of EBP were used to guide this project. Retrospective HAPU audit scores from May, June and July 2015 were compared to audit scores from the intervention implementation months of September, October, and November 2015. Statistically signification improvements (p = .05) were found in ‘documentation of Braden scale on admission and every shift’ (p = .000) and ‘wound preventions supplies in room and in use with documentation’ (p = .002). Statistically significant decreases were also noted in ‘full body assessments on admissions and transfers’ (p = .000) and ‘ear protectors applied and documented’ (p = .000). Because there is limited published data regarding strategies to enhance nursing documentation, the results of this EBP project will add to the current literature and highlights the need for further intervention. Furthermore, changes could to be made to current electronic health record systems to meet the workflow requirements of nurses

Reducing No-Shows and Late Cancellations in Primary Care

No-shows and late cancellations are a challenge across medical practices, resulting in costly, fragmented care. Many patients do not understand the impact that not showing or cancelling an appointment less than 48 hours prior to a visit can have. While reminding the patient of the appointment has been a known tactic to improve patient’s attendance, the most effective mode of the reminder can vary significantly across patient populations. Just as critical as reminding the patient of the appointment is to ensure they understand the purpose of the visit along with showing respect for their time and any competing priorities. This quality improvement initiative aimed to reduce the no-show rate of 21.4% and late cancellation rate of 21.1% for the MassHealth population by 5%. Learning from previous studies, a hybrid approach to meet this population’s needs included a 7-day reminder call with a Patient Engagement Coordinator (PEC) and a 2-day automated reminder. During the 7-day reminder call the PEC identified barriers to attending the appointment through concrete planning and motivational interviewing strategies. Appointments were rescheduled as needed, additional information was provided to solidify shared goals for the visit, and patient’s time/obligations were validated. The intervention resulted in positive feedback from the majority of patients and revealed concrete planning prompts to be a very effective communication form. The post-intervention data analysis revealed both the no-show and late cancellation results were reduced for the MassHealth population. Due to data and confounding variable limitations this study is recommended to be a basis for future investigation as the principal investigators enter into the next pilot phase of this model

Interventions to improve hand hygiene compliance in patient care

Background Health care‐associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. Objectives To assess the short‐ and long‐term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care‐associated infection. Search methods We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. Selection criteria We included randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol‐based hand rub (ABHR), or both. Data collection and analysis Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta‐analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. Main results This review includes 26 studies: 14 randomised trials, two non‐randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long‐term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention. Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes. Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low. Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence). Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence. Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence. Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence. Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. Authors' conclusions With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context

Decreasing No-Show Rates in an Outpatient Specialty Clinic

Decreasing Patient No-Show Rates in an Outpatient Specialty Clinic Abstract Problem: Non-attendance or no-shows of patients in an outpatient clinic is a prevalent occurrence that impacts the quality of patient care and cost utilization in the clinic. Context: A collaborative effort was undertaken with the clinic nurse manager to implement a quality improvement intervention to reduce patient no-shows in the optometry and otolaryngology clinics. The electronic health record EPIC data analysis revealed language variability in the occurrence of no-shows, indicating the need for improvements. Interventions: Tools were employed to gather comprehensive information regarding the factors contributing to patient no-shows and identify potential strategies for enhancing communication within the clinic, thereby reducing instances of missed appointments. In addition, patients who did not attend their appointments offered suggestions on communication strategies that could effectively reduce the number of missed appointments in the future. Measures: The data collection encompassed the patient reasons for no-shows. Individuals who failed to attend their appointments provided recommendations regarding communication strategies that could effectively discourage future instances of missed appointments. Results: The data analysis indicated that the most common reason for no-shows was the patients\u27 failure to recall their scheduled appointments. To minimize the occurrence of missed appointments, patients commonly recommended receiving text messages one to two days before their scheduled appointment. A positive correlation was identified between patients who did not have access to MyChart, a platform that enables the transmission of appointment reminders via text messaging, and an increased frequency of missed appointments. Conclusion: The optimal approach for reducing patient no-show rates entails providing patients with comprehensive education on the utilization of MyChart, a platform that offers text messaging in advance of their scheduled appointments. Empowering patients by equipping them with the necessary tools to access MyChart ensures they can effectively manage their healthcare. Keywords: no-show rates, outpatient clinic, patient perceptio

Integration of HeartSmart Kids into Clinical Practice: A Quality Improvement Project

Presented to the Faculty of the University of Alaska, Anchorage in partial fulfillment of requirements for the degree of MASTER OF SCIENCE, FAMILY PRACTICE NURSEIn 2009, the Centers for Medicare & Medicaid (CMS), established “Meaningful Use” regulations through an incentive program, as part of the American Recovery and Reinvestment Act of 2009 (Gance-Cleveland, Gilbert, Gilbert, Dandreaux, & Russell, 2014). Meaningful Use (MU) is tied to reimbursement and focuses on how the Electronic Health Record (EHR) is being used (Center for Disease Control and Prevention, 2012). The goal of MU is to transform the use of the EHR from a documentation tool, to a data reservoir which allows for meaningful reviews and interpretations of the quality of care (Gance-Cleveland et al, 2014).Project / Background / Significance / Review of Literature / Problem Overview / Problem Statement / Purpose / Design / Method / Plan Do Study Act (PDSA) / Ethical Considerations / Significance to Nursing / Dissemination / Conclusion

Innovation in Utilizing Information Technology Systems in Improving the Quality of Nursing Services

Background: Advances in technology in the field of health are increasingly increasing, enabling everyone to use existing technology. Today, advances in information technology that allow for the development of professional nursing services, and the attention of current epidemiology and sociodemography, are very important for nurses. to become familiar with health information systems Methods: The conceptual framework proposed was to look at the theory and empirical literature used in nursing studies and its benefits, which were reviewed from several research results from 2013 to 2018. This study used 17 journals that were reviewed against it. Results: Several innovations in the field of information technology in the field of nursing have been developed and evaluated for its benefits. Based on what is in the literature in this article, Nurse Calling Systems (NCSS), EHR and CDSS, MDTT, computers and infusion management systems are a number of innovations that have been developed for developing technology to provide better quality services. The benefits obtained when using these innovations, namely more efficient management, more effective use of costs, improved planning programs, increased utilization of nurses. The benefits of information systems in nursing more time with, patients and less time in station nurses, reducing the use of paper nursing care automatically the same standard in care (nursing process) reduce the cost of nursing services can be measured Conclusion: it takes several innovations in the field of nursing that have been widely applied, which are carried out on benefits that provide enormous benefits in the practice of nursing services. So it is recommended that in the future Indonesia can implement innovations that can help improve nurse performance in Indonesia according to existing needs Keywords: Innovation, Nursing Information System, Benefit