Rescheduling sudden absences of nursing staff in hospital settings

The aim of this study is to evaluate the management of sudden absences of nursing staff in hospital settings. In addition, this study aims to describe nurse managers’ daily work regarding rescheduling due to sudden absences of nursing staff, from the perspectives of using a paper-based system or an IT-based rescheduling solution. The dissertation also includes an analysis of experiences of nursing staff floating. In Phase I, a scoping review was carried out to identify the IT-based rescheduling solutions for the daily rescheduling of nursing staff in a hospital setting, and rescheduling outcomes for patients, nursing staff and originations. In Phase II, a developed IT-based rescheduling solution was implemented at one university hospital department and a quasi-experimental pre- and post-test design was used to evaluate the nurse managers’ (n=17) work tasks with the Rescheduling Task Survey (RTS) during the rescheduling process of nursing staff. The quasi-experimental pre- and post-test design was repeated with a large sample of nurse managers (n=61), and the duration of the rescheduling process was observed. The usability of the IT-based rescheduling solution was evaluated with the System Usability Scale (SUS). In Phase III, the associations between stress, psychosocial factors and floating experience among nursing staff (n=1336) was evaluated, and the experiences nursing staff (n=747) with floating shifts during the past year were described. There is limited research on IT-based rescheduling staffing solutions and their outcomes for nursing staff, organizations and patients. Before and after implementation, the IT-based rescheduling solution nurse managers reported a total of 2,612 sudden absences with 5,800 rescheduling tasks such as phone calls and conversations. The main reason for sudden absence was unplanned sick leave (79%). After the implementation of the IT-based rescheduling solution, nurse managers’ rescheduling tasks, unstaffed and unplanned shift changes, the use of float pool nurses and floating nurses increased significantly. The implementation of the IT-based rescheduling process also revealed significant cost saving opportunities for hospitals. During this study’s short follow-up period, altogether €31,878 was saved with the use of floating nurses to cover sudden absences. There are no previous studies investigating floating and its association with stress among nursing staff. In this study, reported experience of stress did not differ significantly between participants with or without floating experience. However, there are factors related to floating that increase stress among nurses. Nurse managers need to ensure clear instructions for floating shifts on their units and that those instructions are followed.Hoitohenkilökunnan äkillisten poissaolojen hallinta sairaaloissa Tämän tutkimuksen tarkoituksena oli analysoida hoitotyön esimiesten päivittäiseen resursointiin liittyvää työtä, heidän korvatessaan hoitajien äkillisiä poissaoloja. Päivittäisen resursoinnin prosessia tutkittiin ennen ja jälkeen sähköisen resursointisovelluksen käyttöönottoa. Lisäksi kartoitettiin hoitohenkilökunnan kokemuksia koetusta stressistä sekä tehdyistä lainavuoroista. Lainavuoroilla tässä tutkimuksessa tarkoitetaan työvuoroa, jossa hoitaja siirtyy tilapäisesti toiseen yksikköön tekemään suunnitellun työvuoronsa, mikäli oman yksikön tilanne sen sallii. Tämä tutkimus toteutettiin kolmessa vaiheessa. Tutkimuksen ensimmäisessä vaiheessa toteutettiin kirjallisuuskatsaus, jonka avulla kartoitettiin päivittäiseen resursointiin soveltuvia sovelluksia sekä päivittäisen resursoinnin seurauksia potilaalle, hoitohenkilökunnalle ja organisaatiolle. Toisessa vaiheessa implementoitiin kehitetty päivittäisen resursoinnin sovellus yhden yliopistollisen sairaalan toimialueelle. Lisäksi hoitotyön lähijohtajien (n=17) käyttämiä työsuoritteita arvioitiin ennen ja jälkeen päivittäiseen resursointiin tarkoitetun sovelluksen käyttöönottoa. Tutkimus toistettiin suuremmalla otoksella (n=61), lisäksi työsuoritteiden ajallinen kesto arvioitiin havainnoinnin avulla sekä päivittäisen resursoinnin sovelluksen käytettävyys arvioitiin. Tutkimuksen kolmannessa vaiheessa tutkittiin hoitajien (n=1336) koetun stressin, työn psyykkisten ja sosiaalisten tekijöiden sekä lainavuorokokemusten välistä yhteyttä. Tutkimustulokset osoittivat, että päivittäiseen resursointiin soveltuvia järjestelmiä on kuvattu vähän ja tietoa päivittäisen resursoinnin seurauksista on saatavilla rajoitetusti, erityisesti potilaiden näkökulmasta. Tässä tutkimuksessa hoitotyön esimiehet raportoivat yhteensä 2612 äkillistä poissaoloa, joiden pääasiallinen syy oli äkillinen sairausloma (79 %). Työsuoritteita, esim. puhelu tai keskustelu, raportoitiin yhteensä 5800. Päivittäiseen resursointiin tarkoitetun sovelluksen käyttöönoton jälkeen esimiesten työsuoritteet vähenivät merkitsevästi, kuin myös aliresursoidut työvuorot ja hoitohenkilökunnan äkilliset työvuorojen vaihdot. Myös vara- ja lainahenkilöstön käyttö tehostui. Sovelluksen käyttöönotto toi sairaaloille myös kustannussäästöjä; seuranta-ajan (neljä viikkoa) aikana kustannussäästöjä syntyi yhteensä 31 878 euroa. Tämän tutkimuksen mukaan lainavuorokokemus ei lisännyt hoitajien kokemaa stressiä. Sen sijaan lainavuoroon liittyy tekijöitä, jotka stressaavat hoitajia. Hoitotyön esimiesten tulee varmistaa, että lainavuoromallille on laadittu selkeät ohjeet, joita yksiköissä noudatetaan

Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. METHODS: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. RESULTS: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90% (27/30) of participants completing at least 5 steps and 67% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t27=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t27=-2.03, P=.05. CONCLUSIONS: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft

Implementation Plan for EMR and Beyond

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties and continue operating. As a result, EMR’s have been implemented in numerous healthcare facilities over the last decade. However, implementation does not guarantee acceptance. Many organizations have tried to implement something new and failed. Healthcare facilities need to build implementation plans into their development of any new innovations. In particular, end users need to buy in and accept new system usability in order to improve compliance and employee satisfaction. Our EMR is being developed in stages, so our processes are constantly changing with requires fast transitions in the end user learning. We have moved through the first two stages and are moving into the third stage in the next few months. This project describes an implementation plan for an electronic medical record development that we have used during our first two stages. The project plan has a strategic focus on end user acceptance of meaningful use guidelines that is sustainable for continued growth. The elements of this plan can be applied to other types of innovative change in healthcare

Readiness for improving safe care delivery through web-based hospital nurse scheduling & staffing technology: A multi-hospital approach

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare worker fatigue on patient outcomes (IOM, 2004; Stimpfel & Aiken, 2013). The impending nursing shortage has the potential to exacerbate the problem of high quality care delivery and could lead to devastating impacts to the profession as well as patients. Though Kaiser Permanente (KP) is generally known for being a healthcare trailblazer, staffing technology was lagging. The purpose of this project is to prepare KP nursing for transformative change with web-based hospital scheduling and staffing. This work addresses the readiness for deployment across the KP system. Complexity and change theories frame this project. Hospital staffing epitomizes complexity. This planned change provides a road map for other nurse leaders to navigate the lessons learned. Satisfaction surveys from 222 nursing staff receiving training in the new technology reveal a favorable intent for technology adoption. Future work will focus on the impact realization of nurse-sensitive outcome indicators and registered nurse overtime

Enhancing Nurses\u27 Pain Reassessment and Documentation Using Clinical Decision Support: A Quality Improvement Project in Acute Care

Purpose: The project aimed to educate medical-surgical registered nurses (RNs) on using the clinical decision support (CDS) tools to complete pain reassessment and documentation. Objectives were to increase pain reassessment compliance, identify perceived pain reassessment barriers, and change current pain reassessment and documentation behaviors. Background: Nurses are responsible for assessing, reassessing, and managing patients’ pain. Quality pain reassessment and documentation are essential to effective pain management. Methods: Participants were accrued via convenience sampling in addition to inclusion and exclusion criteria. The Plan-Do-Check-Act (PDCA) Cycle was used to guide the pilot project conducted in one medical-surgical unit. Implementation interventions: asynchronous computer-based learning module with step-by-step instruction and demonstration on how to use the CDS tools, dissemination of tip sheets to reinforce learning module content, unit rounding, and distribution of information on the importance of pain reassessment and documentation. Participants were also invited to complete an electronic questionnaire to evaluate demographics and perceived pain reassessment barriers. Results: 18 participants completed the project. The educational intervention had a small effect on the participants’ pain reassessment compliance one-week post-intervention. By the second post-intervention week, compliance dipped and regressed to baseline. The primary barriers contributing to participants’ pain reassessment compliance rates were time constraints, competing patient care priorities, heavy workload, inadequate staffing, and forgetfulness. Conclusion: The project results suggest that an educational intervention focused on CDS tools could improve nurses’ pain reassessment and documentation compliance and behaviors

Share2Quit: Web-Based Peer-Driven Referrals for Smoking Cessation

BACKGROUND: Smoking is the number one preventable cause of death in the United States. Effective Web-assisted tobacco interventions are often underutilized and require new and innovative engagement approaches. Web-based peer-driven chain referrals successfully used outside health care have the potential for increasing the reach of Internet interventions. OBJECTIVE: The objective of our study was to describe the protocol for the development and testing of proactive Web-based chain-referral tools for increasing the access to Decide2Quit.org, a Web-assisted tobacco intervention system. METHODS: We will build and refine proactive chain-referral tools, including email and Facebook referrals. In addition, we will implement respondent-driven sampling (RDS), a controlled chain-referral sampling technique designed to remove inherent biases in chain referrals and obtain a representative sample. We will begin our chain referrals with an initial recruitment of former and current smokers as seeds (initial participants) who will be trained to refer current smokers from their social network using the developed tools. In turn, these newly referred smokers will also be provided the tools to refer other smokers from their social networks. We will model predictors of referral success using sample weights from the RDS to estimate the success of the system in the targeted population. RESULTS: This protocol describes the evaluation of proactive Web-based chain-referral tools, which can be used in tobacco interventions to increase the access to hard-to-reach populations, for promoting smoking cessation. CONCLUSIONS: Share2Quit represents an innovative advancement by capitalizing on naturally occurring technology trends to recruit smokers to Web-assisted tobacco interventions

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Considerations for introducing a cloud service in health informatics: user experience monitoring of information systems

This thesis will show concrete examples about how user experience monitoring will improve security of health information systems, patient safety, efficiency, and ease of use. This thesis will prove how the current EMR systems that are stand alone in nature lack the ability of advanced error monitoring capabilities. As part of this research, I will demonstrate with detailed interviews and data collection surveys how automated user monitoring systems improve data record accuracy consistently. Key terminology to Electronic Medical Records (EMR’s) and the usability of cloud computing software solutions will be defined. EMR’s are the primary software used in hospitals for charting patient information and this research focuses on the summarization of key information to the history of healthcare technologies and their functionalities. Usability testing, cloud computing, and how security and trust are affecting the adoption of cloud-based services will also be discussed in more detail. Along with the importance of market research, how to create buyer personas, and what drives their need to buy. The study was conducted in collaboration with Adusso Ltd. in Helsinki, Finland to gain better understanding about what motivates hospital IT departments to buy and the main issues with EMR systems. In collaboration with Adusso we investigated a use case example of their existing customer Apotti leveraging the user error reduction and cost saving benefits they experienced after deploying Adusso’s UX2play system. We sought answers to these topics using semi-structured interviews and analyzing our customer profiles. We found that UI layout, interoperability, and the number of clicks that nurses spend in the EMR are major issues that most EMR systems have. This implies that companies using EMR’s should implement user monitoring to pinpoint the issues they do have so that they can be fixed and the work of physicians and clinicians can be improved