The PARTNERS programme: an evaluation report

Abstract

The focus of this project is inter- agency communication. This report evaluates how formal terminology underpinned by health informatics standards can assist health care providers to communicate patient centred information across traditional service boundaries more efficiently and effectively. It provides evidence on how nurses work between different environments across different settings. The tool devised for shared care by the project team may serve as a starting point for those individuals who are engaged in the development of discharge or transfer of patient centric care documentation e.g. the newly established clinical directorates. The participants in this project who are primarily nurses recognise that formal communication processes involving interagency communication between the primary care, continuing care, and acute care sectors is currently dependent on informal communication processes such as the telephone or fax machine. The process of approaching formal communication using health informatics standards and adopting formalised concepts and terms facilitates shared meaning between health care parties which the group maintain could enhance existing inter agency communication. In the longer term such initiatives may directly impact upon patient safety. This report is an evaluation of phase one of a pilot study project entitled PARTNERS, which is an acronym for Participatory Action Research To develop Nursing Electronic RecordS. The PARTNERS project identified two key objectives, firstly to educate and train nurses in health informatics, specifically in relation to a health informatics standard developed internationally to guide nursing records development on nursing diagnosis and interventions (ISO 18104). Secondly, to identify formalised concepts and reference terminologies for future inclusion in nursing documentation practices. The identified set of concepts and terms in this report, whilst crude, may inform future interagency communication on discharge planning or transfer of care, not only for nurses but also other members of the multidisciplinary team. To demonstrate these objectives in action a purpose built assessment form using a set of design restrictions in the form of an archetype was devised. The archetype is designed in accordance with a health informatics standard entitled EHRcom (EN13606) and is defined as follows “an agreed, formal and interoperable specification of the data and their inter-relationships that must or may be logically ©PARTNERS 2010 7 persisted within an electronic health record for documenting a particular clinical observation, evaluation, instruction or action” (Kalra 2004). These two objectives were made possible by liaising with the Dublin Institute of Technology on a research programme entitled EHRland. The EHRland project supported by the Health Information and Quality Authority (HIQA) is a research programme which is testing the health informatics standard EN13606. The standard EN13606 is the European standard for the electronic health care record. The PARTNERS group defined the requirements, concepts and terms for the archetype and the EHRland group designed the archetype and created a database for use for the duration of the pilot study. The information presented in this evaluation will draw from both of the PARTNERS and EHRland projects. This is made possible as the author is the Principal Investigator of the PARTNERS project and is a member of the EHRland project team. Whilst the focus of the project was the development of an archetype to enhance interagency communication the EHRland group also devised a prototype information system to collect and store patient centred outcomes as defined by Almost et al (2003). The PARTNERS group were keen to collect patient data which could minimally present patient centred outcomes, and involve the patient in the decision making processes relating to their care. For example did the patients like the idea of having access to and keeping their own record? Because of the size and resources associated with the project, the project team opted to complete a small pilot study and evaluate the overall effectiveness on a group of over 65 year olds and on those practitioners who sought to pilot the tool (practitioners n = 14, Cases n = 16 Settings = 6). Initial thoughts suggested that this evaluation would focus on whether the PARTNERS assessment form was effective or indeed ineffective, simply stated putting into practice the 3 W’s which are if the prototype archetype/s ( assessment form) worked for whom and under what circumstances. Over time it became apparent that the evaluation required a more inclusive focus. This evaluation therefore focuses on exploring both the mechanisms (processes) and outcomes relating to the assessment form and also seeks to identify those mechanisms which will impact on the overall sustainability of such practice development initiatives in the future. In this way the PARTNERS group can offer the reader an honest account of the lessons learnt by practitioners, patients and the evaluator’s overall experience