Performance management data systems for nursing service organizations

Increasing demands are being placed on nursing administrators to manage the cost-efficiency and quality-effectiveness of the nursing service organization. One effective administrative tool that can be used for both internal management and external reporting of a nursing service organization performance is the performance management data system described in this article. While efforts are underway to build essential elements of a performance management data system, including the structure and content of nursing-sensitive databases and data management methods, no consensus has been reached. The author reviews the relevant literature and offers guidelines to take the nursing administrator through the process of developing a performance management data system. Beginning with a conceptualization of the nursing service organization as a system, the 5-phased process moves through data variable selection, data variable measurement, and data analysis to the final internal and external reporting of the organization's performance.     

实验室信息系统在临床微生物检验中的应用

目的建立一套能全面控制临床微生物检验分析全过程及内部管理和外部服务的实验室信息系统(LaboratoryInformationSystem,LIS),做到无纸化管理,提高工作效率,全面提升服务质量。方法在windows2003操作系统中采用SQLserver2000系统数据库,用Powerbuilder9.0编写应用程序,各病房电脑终端与LIS服务器相连,通过检验医嘱模块打印检验项目申请条码;LIS系统内部建立录入模块、分析模块、数据处理及报告模块、院感管理及统计模块、数据库维护模块、质控模块、试剂管理模块、物资管理模块、设备管理模块等。结果实现了标本的自动接收、记费、内部条形码、数据的自动传输和审核、工作量及医院感染统计、耐药分析等模块的应用,大量减少了手工劳动及差错率。结论建立一套全面的临床微生物信息管理系统,是提高工作效率,全面提升服务质量的有效途径,也是促进工作模式转变和建立实验室标准化的基础。     

Clinical decision support systems for outcome measurement and management

Clinical decision support systems are the foundation for outcome management programs through the measurement of specific outcomes, data storage, data analysis, predictive modeling, and risk-adjusted comparison of actual outcomes with predicted outcomes. Many clinical decision support tools or databases are available to clinicians. This article reviews two widely available tools that provide clinical decision support for critical care clinicians, the Project IMPACT and APACHE III Critical Care Series clinical decision support systems. These tools are discussed with regard to risk adjustment methodology, validity, reliability, database size and representation, retrospective and prospective data and analysis, and quality control. Clinical application of clinical decision support systems for benchmarking and use in process improvement and outcome management is reviewed.     

Critical elements of documentation for data-based research

Scientific integrity and progress are enhanced by precise documentation of the conceptual development and information management aspects of research. Careful and complete documentation of the research process supports accurate reporting. The exercise of documenting data management activities provides an opportunity for nurse researchers to reflect on a study to guide current work and inform and enhance future research. The literature includes many references to the need for data management but contains little advice regarding the nuts and bolts of documenting data management activities. This article describes specific steps for documenting data-based research beginning with the study design and ending with data analysis. The documentation framework and examples presented are sufficient to guide the comprehensive record keeping required for complex studies and can be modified to meet the simpler needs of smaller research projects.     

Development of a universal connectivity and data management system

Point-of-care testing (POCT) is an increasingly popular method of delivering laboratory testing. Management of POCT is challenging given the variety of devices, locations, and staff that need to be coordinated to ensure quality results and meet regulatory guidelines. Electronic capture and transfer of data are preferred for managing POCT, but there is currently no standard method of connecting different devices. Johns Hopkins Medical Institutions (JHMI) developed a common data management system with interfaces to all of its POCT devices. All POCT data are collected in one database and analyzed in a similar fashion. Where data were once collected by carrying laptops to each nursing unit, the POCT devices can now connect directly to the database over the Internet. Algorithms have been created to automate the data analysis and review process. Over the several years that this software has been used, JHMI has experienced improved quality, accuracy, and management of its POCT program. The labor saved by increased automation of data review is refocused on enhancing the performance and scope of the program. Current connectivity and analysis algorithms have future application to remote consultation, management of home self-monitoring patients, and examination of real-time data.     

An introduction to research: a primer for the nurse anesthetist

The goals of this article are to provide an overview of the research process and highlight some of the most important aspects. In the process, the definition of research and some general terminology will be reviewed. Discussions of how to define a problem, reviewing the literature, types of study designs, sampling, types of measurement, reliability and validity, limitations and assumptions, data analysis, ethical concerns with human subjects, and time management are included, as are examples of published research.     

Comparison of paper-based and electronic data collection process in clinical trials: Costs simulation study

An alternative to clinical trial paper-based data collection (PDC) is internet based electronic data collection (EDC), where the investigators over the internet enter data directly in the electronic database by themselves. In our study we considered clinical trial as a business process. Our objective was to model PDC and EDC process and to estimate the difference of the costs of PDC and EDC process for a sample clinical trial based on these models.We used Extended Event-driven Process Chains (eEPC) modeling technique to model PDC and EDC process. In order to evaluate the costs of the processes we assigned costs functions to each process function which appears in the model. The parameters which appear in these functions include efforts, staff prices and data quality parameters. We estimated the values of all these parameters and performed costs calculations for a sample clinical trial.Through an analysis and modeling efforts we identified sub-processes which contain main differences affecting duration and costs of the PDC and EDC process: data gathering at the research center; monitoring; and data management. The most significant model difference between PDC and EDC process appeared in data management sub-process. For the sample clinical trial considered in our simulation study and our parameters estimations the EDC process decreased data collection costs for 55%. For different scenarios of parameters variations we show that the EDC process may bring from 49% to 62% of savings when compared to PDC process.     

L’erreur médicamenteuse: nouveaux textes de loi et expériences en France

Drug error is the omission or the non-intentional realization of an act during the drug process that may harm the patient. The error may be confirmed, potential or latent. Drug errors are the most frequent among medical errors. Age (older and younger patients) and co-morbidities are the commonly reported risk factors for drug errors. Two recent French laws regarding the management of drug errors in the hospital are presented. The hospital, patient, health, territory (HPST) law (July 2009) assigns the management of quality and safety of health care to hospitals. The law focusing on the quality of drug management in hospitals (April 2011) recommends to set up a quality management system in each hospital to ensure the quality and security of drug use. In addition, a national evaluation of drug errors has been organized, allowing a direct intervention of national health authorities to modify drug presentation and labeling, if required. Two examples of drug error management processes, one in a university hospital and the other in an intensive care unit, are presented. Multidisciplinary management, absence of informant sanction, and collection of anonymous data are the reasons for the success of those systems. If a drug error is related to practices, then analysis and improvement of practices by local management are mandatory. Participation of all health professionals involved in the drug process as well as a strong commitment of hospital staff are the two essential conditions to make the drug error management process successful.     

Concept analysis: an approach to teaching physiologic variables

Establishment of a knowledge base for nursing practice has been an ongoing goal of nurse professionals for the past decade. Because nurses are especially concerned with management of the body's potential or actual response to illness, the development and use of materials that reflect these body responses seems appropriate. This article is an effort to promote the use of concepts as a basis for nursing practice. A concept analysis approach for didactic instruction, currently being used for organizing and synthesizing pathophysiologic data present in literature, is presented. The process is exemplified by excerpts from the concept "inflammation." Advantages and disadvantages identified by graduate students for the use of concepts and the analysis process as a teaching/learning strategy are included.     

Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice

mahomed r., st john w. & patterson e. (2012)?Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice. Journal of Advanced Nursing68(11), 2538-2549. ABSTRACT: Aims. To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice. Background. Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses. Design. A grounded theory study underpinned by a relativist ontological position and a relativist epistemology. Methods. Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007-April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods. Results. Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care. Conclusion. Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction.     

Improving platelet supply chains through collaborations between blood centers and transfusion services

BACKGROUND: Blood centers and hospital transfusion services are challenged with maintaining an adequate platelet (PLT) inventory to minimize the number of outdated units without risking a major shortage. A novel approach to inventory management was established at our institution through a collaboration between the Stanford University Medical Center (SUMC) Transfusion Service, the Stanford Blood Center (SBC), and the Department of Management Science and Engineering.
STUDY DESIGN AND METHODS: An analysis of the supply chain performance between SBC and SUMC Transfusion Service was performed. First, the interaction between processes, such as blood collection, rotation, and inventory management, was studied. Second, changes were implemented based on the recommendations from the analysis team. Finally, a postanalysis was performed reflecting on the improvement of the operations between SUMC and SBC.
RESULTS: A comprehensive data analysis of the PLT supply chain allowed the identification of three series of improvements to be implemented: 1) on SBC's PLT collection, 2) on SBC's rotation process, and 3) on the PLT inventory management policy at SUMC. A postimplementation analysis showed a reduction in the overall PLT outdate rate from 19% in the first quarter of 2006, down to 9% in the third quarter of 2008.
CONCLUSION: A multidisciplinary effort among SUMC Transfusion Service, SBC, and experts in supply chain management resulted in a process improvement, which reduced the rate of PLT outdate at both SBC and SUMC Transfusion Service down to 9%, with a significant cost reduction of more than half a million dollars per year.     

过程能力指数在临床生化实验室中的运用

目的通过调查临床生化实验室11个检测项目的过程能力指数,将已在工业生产、公共服务等多个领域广泛应用的过程能力指数(Cp及Cpk)引入临床实验室。方法运用过程能力指数公式,结合Minitab软件计算11个生化检查项目两个质控浓度从2014年8月～2015年2月连续7个月的Cp及Cpk。结果低浓度质控血清中77个Cp中有16个Cp≤1.33,61个Cp>1.33;高浓度质控血清中77个Cp有9个Cp ≤1.33,68个Cp>1.33。结论过程能力分析是一种以数据和事实为决策依据的管理方法,是一种更为客观、全面、科学的管理方法。     

Issues for consideration when choosing a qualitative data management system

A primary issue in conducting qualitative research is the time required for data analysis Qualitative research can be costly, since data analysis is generally labour intensive and our tune factors into money There is, unfortunately, no magic formula for hastening the conceptual tasks associated with qualitative analysis, yet effective qualitative data management systems (QDMS) expedite the mechanical tasks, those tasks associated with storing and retrieving qualitative data Rapid and smooth data management increases the time one can allot to data analysis Although computer QDMS are increasingly recommended for their time-saving potential in relation to data management, some significant issues associated with the adoption of a computer versus a manual QDMS have not yet been fully explored The purpose of this paper is to present major issues researchers should consider in choosing a computer or a manual QDMS These issues include availability and accessibility, comfort, appropriateness, efficiency, thoroughness and contextualization     

School nurses’ perceptions and experiences with an interprofessional concussion management team in the secondary school setting

Following a concussion, both cognitive and physical rest are imperative aspects of injury management. The inclusion of academic adjustments and the formation of an interprofessional concussion management team (ICMT) provide a mechanism to manage academic issues following a concussion. As one of the sole healthcare providers presents during school hours, the school nurse may offer unique insight regarding the infrastructure of an ICMT in the secondary school setting. The purpose of this study was to explore school nurses’ perceptions of and experiences with an ICMT for adolescents following a concussion in the secondary school setting. The consensual qualitative research approach was used to guide this study. Semi-structured individual telephone interviews were conducted with 15 school nurses employed in the secondary school setting across the United States. During data analysis, themes and categories were established based on a consensus process by the research team. Study findings indicated that school nurses identified several stakeholders regarding the concussion management team that are essential to include in the concussion management process. In addition to the school nurse, participants perceived an ICMT should include a physician, athletic trainer, school counsellor, teachers, and other stakeholders such as the patient and their parents. Additionally, participants discussed their perceptions of their own role as a member of an ICMT in the secondary school setting. The inclusion of an ICMT to aid the recovery following a concussion is vital to ensure proper care for the adolescent patient. Furthermore, the school nurse and athletic trainer must effectively collaborate, when possible, to ensure that concussed adolescents are allowed sufficient cognitive rest via the incorporation of academic adjustments during the recovery process.     

Caregivers dealing with stroke pull together and feel connected.

Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemann's framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.     

Differences in the Clinical Reasoning Process of Expert and Novice Cardiorespiratory Physiotherapists

Through the process of clinical reasoning, physiotherapy practitioners critically evaluate their interventions in the management of patients. This qualitative investigation focused upon the thought processes of two groups of physiotherapists as they engaged in the consideration of a presented respiratory paper case scenario; identifying problems, possible diagnoses, and finally proposing a treatment plan. One group of 15 physiotherapists were designated ‘expert’ in their practice, whereas the second group of 15 were relatively inexperienced junior physiotherapists. The aim of the study was to investigate the differences in the clinical reasoning process of the novice versus the expert group.After considering the presented paper case scenario, each therapist completed an open questionnaire. A corroborated content thematic analysis of the presenting data was performed. Through this analysis common themes were identified across the data, and differences presenting between novice and expert practitioners were explored.A number of differences in the clinical reasoning process were identified between the novice and expert groups. It is postulated that the mechanisms for storage and retrieval of knowledge are more refined in the expert group. This in turn impacts upon practitioner problem-solving ability and hence clinical judgement. These findings support those of previous studies, which have not, however, included a consideration of the clinical reasoning process in the field of cardiorespiratory physiotherapy.Clinically the results provide information on the different thought processes of novice and expert practitioners in the field of respiratory physiotherapy. This has implications for day-to-day management of physiotherapy staff and for the continuing professional development of practitioners.     

临床生物样本库信息系统建设与发展

随着转化医学的快速发展, 临床生物样本库的作用日益凸显, 其建设和应用日益受到关注和重视。信息管理系统是样本库的核心部分, 其建设应立足于支撑样本库的运营、管理和服务全过程, 通过建立样本信息数据采集流程、数据集成与交换系统及安全系统, 形成一体化整合数据库和公共门户网站, 实现生物样本、临床资料和分子数据等各种资源的高效管理和全面共享。