Nursing Diagnosis

1
The impact of Nursing Informatics to
Orsganisations
2
Nursing and Health Organisations
Organisations can be defined as having five
components the top management, the
technostructure, the operating core, the
middle line, and the support staff
1981, Mintzberg
Referring to the above mentioned components
nursing fits into each component 1. The top
management where the organisational mission is
decided 2. The technostructure where systems and
formal planning are designed 3. The operating
core where nursing practice takes place 4. The
middle line where nurse managers are
responsible for division and unit
function 5. The support staff needed to make the
system work
3
Electronic or Information Revolution
The second major revolution is the so-called
electronic or information revolution in wich
electronic circuits are being substituted for
human mental skills. The electronic revolution
is not only replacing the mental processes of
the unskilled laborer - it is creating a
genuine human value dilemma for technologists,
managers, and professionals.
1988, Denis Protti
4
The Evolution of the Health Care Industry
The future of the Health Care Industry is
competition Competition not only in terms of
institutional pride, quality of care, medical
staff prestige, and reputation but the term
is now redifining in order to include price and
marketing as important factors. Health Care
Industry should provide the best possible
care, given the limited resources available. The
solution is in the information revolution
and more specific in an an an integrated
Information System implementing Nursing
Informatics
5
Critical issues to be considered by the Health
Care Industry

• As bedside computer systems are installed in
  hospitals and have the potential to link to
  computerised home monitoring systems, a new
  wave of information will be available.
• Organisational management decisions will
  reflect a relience in this new continuity
  of care data to maintain both cost of care and
  quality of care. Accountability for
  individual actions will be more easily
  tracked. Nurses will be more vital in their
  role in the quality of care, since it will
  be easier to discern whose responsibility it
  was to perform each aspect of care.
• As the trend is to establish a separate
  payment directly to nursing based on actual
  services rendered, information from nursing
  input will be vital to establishing
  accountability for correct payments.

6
The need for Computerisation in Health
Organisations
The need for Computarisation in Health
Organisations is derived from

• The amount of information handling required
• The desire to contain costs, and
• The desire to increase efficiency

7
Computer applications for management purposes in
Health Organisations

• Statistics
• Patient classification
• Staffing
• Claims processing and reibursement
• Budget
• Reports
• Scheduling
• Communication networks
• Case mix management
• Costing nursing care
• Quality assurance

8
Some common applications in Nursing
Informatics and Health Care Administration

• Appointment making
• Kitchen information system
• Patient location system
• Patient information system
• Inpatient information system
• Mail system
• Stock management information system
• Vital signs
• Orders
• Loan administration information system

9
The common goals of Nursing Informatics and
Health Organisations

• Improving patient care quality through
  improved communication
• Improving cost containment via reducing the
  numbers of lost charges, and
• Increasing personnel utilization by reducing
  professional time spent in clerical duties

1980, Hughes
10
Advantages of Nursing Informatics towards the
provision of best possible care, given limited
resources

• Efficiency (accuracy through the promotion of
  consintent, orderly methods for data input
  such as orders, completeness -computer is very
  strict regarding input, and accessibility -
  this information is available to all appropriate
  personnel)
• Speed ( in nursing, time frames are in terms of
  minutes and hours, in computing, time frames
  change to milliseconds, microseconds and
  nanoseconds)
• Cost Containment (hospitals spend between 7 and
  10 billion dollars annually to acquire and
  communicate information, at least one half of
  this information could be automated)
• Versatility The computer is one of the most
  versatile machines ever built its programs
  make it so, Brown, 1983
• Patience (computers will not act if data are
  incorrect, this becomes an advantage in error
  reduction and mastery of the computer)

11
Administrative costs of Data (1)
It is known that at least 30 of the
information required to make decisions about
diagnosis and treatment of patients is not
available at the time the desision needs to be
made. Much of this information is nursing
information.
Dick Steen, 1991
One deficiency in documentation for
administration of medication is adverse drug
events, which add roughly 3 billion per year to
hospital bills.
Melmon, 1971
12
Administrative costs of Data (2)

• Specifically, through automation, the nurse
  administrator can help
• reduce annual costs to hospitals by at least
  12.7 billion by
• Reducing costs associated with adverse medical
  reactions.
• Decrising nursing clerical time.
• Reducing costs associated with record
  maintanance.
• Curtailing malpractice costs.
• Hastening retrieval of valid and reliable
  information.
• Easing aggregation of medical information for
  research.
• Improving internal and external review of
  records.

Little, 1992
13
Administrative costs of Data (3)
The cost of automating a nurses office for
nursing administrative purposes has decreased
from an estimated 4 million in 1972 to less than
5,000 in 1992 for a computer with the same power.
Hannah, 1993
14
Precautions!!

• Planning
• Analysis

Before starting to implement Nursing Informatics,
planning and analysis is recquired
15
Need Analysis

• If, how, and what information can be automated
• Priorisation for which reports,etc., should be
  automated and in what order
• Outdated materials or new purposes for old
  reports
• Input and output data and formats

16
Common problems in Health Organisations regarding
Nursing Information Systems (1)

• Assessment
• Inadequate cost investigation
• Expecting computerisation to solve all the
  problems
• Not involving users, especially nurses, in
  assessing the system needed
• Planning
• Trying to automate too much
• Not planning an integrated system
• Failing to include long-range plans, with
  results in extensive reprogramming
• Not considering the ergonomics of
  computerisation
• Not considering confidentiality problems
• Appointing committees that are too large
• Trying to maintain all reports, forms, etc.,
  exactly as they are in a manual system
• Ignoring the change process

17
Common problems in Health Organisations regarding
Nursing Information Systems (2)

• Implementation
• Trying to implement to fast
• Not providing role models
• Failing to remember that errors show up faster
• Inadequate training in breadth, depth and time
• Evaluation
• Failure to plan for evaluation at the beginning
• Not establishing baseline data prior to
  computerisation that can
• be used for a computer-contrast evaluation
• Failure to provide for continuous evaluation
• Inadequate attention to qualitive evaluation in
  addition to
• quantitive evaluation

18
Quality Assurance
Key words Effectiveness, Efficiency, and Outcomes
Nursing Informatics could

• provide accessimble clinical data that
  characterise patients conditions, prior
  management, and current treatment.
• provide clear and defined databases to permit
  epidemiologic assessment of patient
  outcomes and patterns of practice,
  revealing the merits of management strategies
  that are higly desirable and identifying
  strategies that are not desirable.
• provide interactive decision support tools on
  information derived from large groups of
  patients.
• decrease administrative record keeping and
  standardise forms for reimbursement.

V.Saba, K. McCormick, 1996
19
Communication Networks
A common communication network has the following
features

• Send notices of patient appoitments, admissions
  notification, discharges, and hospital census.
• Provide summary information on laboratory test,
  medications, and other orders.
• Locate patients.
• Identify current charges and patient needs.
• Provide accurate billing.

Filosa, 1978