Enhancing Clinical Nurse Workflow Through Redesign Of-Books Pdf

Enhancing Clinical Nurse Workflow through Redesign of
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Heslop et al electronic Journal of Health Informatics 2011 6 3. 1 highlight ways in which the mobile wireless lap Parker Baldwin 15 discuss a study at Alegent. top computers were used by nurses in practice Lakeside Hospital USA This hospital used WOWs. and with their barcode medication administration and. documentation system Problems with this ap, 2 detect and describe ergonomic and functional de. proach such as lack of satisfaction for nurses were. sign issues experienced by nurses using mobile, addressed by introducing a new device called Mo. wireless laptop computers at the point of care, tion C5 A pilot study of Motion C5 was conducted. It was found that the use of this device enabled, 1 2 Current use of Portable Computing nurses to increase documentation at the point of. in Unit Health Care Settings a Literature care which improved accuracy of clinical documen. Review tation and reduced duplications 15 p 14 There. fore this study reveals an improvement on WOWs, The use of portable computing has been shown to.
enable clinicians to readily communicate and ex An expert commentary 16 promotes the use of. change information such as improved access to pa WOWs in hospitals but makes it clear that their ef. tient data 5 8 Evaluation and implementation fectiveness and acceptance are conditional on vari. studies show that portable devices enhance clini ous factors WOWs are the principal mobile device. cians use of patient management and clinical sys at the point of care but selection of WOWs should. tems by providing decision support and clinical in not be driven from an ICT or hardware perspective. formation exchange at the point of care 4 9 11 Instead effectiveness and acceptance of WOWs. needs efforts to be directed at factors such as strong. In our previous research we identified the unique promotion of new care models to relevant stake. characteristics of the unit setting as having the fol holders training in devices clinical and clinician. lowing ramifications for mobile wireless implemen leadership in various areas and provision of re. tation 4 quired quantities of devices to fully support clini. Staff compete for a small number of fixed work cians. stations Key directions for development in Mobile Informa. The workforce is mobile tion Communication Technology MICT imple. Equipment is electronically sensitive mentation studies suggest that substantive research. should elaborate the fit between user and task 17, Needs vary according to the role for example 19. nurse or doctor, High level of reliability and security required. Different levels of security and access are required 2 Methods. Information workflow is complex, Complex professional bureaucracy 2 1 Description of the Case Site or Unit. The focus of much research on clinician experience Setting and Existing IT Infrastructure. with portable computing devices has been on inves and Capability in the Unit Setting. tigating the use and application of hand held Per The study was conducted in a unit setting of a major. sonal Digital Assistants PDAs by doctors Wilcox teaching research and referral health service in Aus. La Tella 12 report that PDA usage is growing in tralia Computer terminal usage on the unit seemed. popularity among health care professionals Aaron to be managed in a laissez faire manner Nurses on. et al 13 reported that more than half of doctors un the unit setting were not allocated a personal work. der 35 in the United States use PDAs for tasks in station Terminals were accessed by staff for vary. cluding accessing drug reference databases 80 ing requirements Access included information. personal scheduling 67 and medical calculations gathering and input Computer access was required. 61 Garritty Emam s systematic review 14 for, of PDA usage in health care settings indicated phy. sicians were the highest users accessing pathology results. Very few studies were available that investigated tracking in patient admissions communication be. wireless laptop computers for enhancing multi tween staff with nurses creating a handover sheet. disciplinary workflow processes in unit settings between shifts. Two reports of the use of workstations on wheels stock order with the unit clerk ordering stores via. WOWs are found in 15 and 16 computer, Heslop et al electronic Journal of Health Informatics 2011 6 3.
e mail observe and then describe how the technology was. invoicing for cross charging of services used by nursing staff The study received approval. from the health service and university ethics com, accessing intranet for policies mittee. compiling staff rosters, Although the study was carried out in 2006 it is still. staff and patient allocation connecting pagers and of relevance today The ergonomic orientation of. phones to allocated staff accessing bed status in this work to our knowledge has not been published. formation before Hence we provide unique findings regard. word processing for procedures protocol standing ing ergonomics in relation to use of networked wire. orders memoranda drug stock equipment and less computers in the unit setting Our review of the. linen orders literature on this topic shows that insufficient re. Medical and allied health personnel competed for search has been conducted on this topic Addition. access to the computers There were constant ally a finding presented later in the paper regards. queues at the terminals for patient administrative the new area of multi disciplinary team meetings. work and frustration levels ran high Because ac This area has experienced very little research until. cess to computer terminals was a problem the full now therefore the finding as reported in this paper. range of existing applications available to clinical is unique. and administrative staff were not used to their full. advantage 2 3 Materials, Two wireless laptop computers were fixed on trol. 2 2 Design leys so they could be wheeled to the patients bed. An observational study design was chosen to ex and around the unit The MICT infrastructure and. plore ergonomic and functionality issues the net portable devices established in this unit as part of. worked wireless computer the interaction between the larger project interacted with the existing legacy. task technology and the user and to reveal the hospital network and software systems but also had. practical utility of the networked wireless computer the ability to seamlessly migrate to future hardware. for clinical workflow processes Structured obser and software platforms Although a number of staff. vation of a small group of nurses working in a unit used the mobile wireless laptops the observation in. setting was conducted in the Victorian public health this study was limited to a small group of about 6 8. care sector over a six month period concluding in nurses. 2006 As part of the larger project previously men, tioned the research team engaged with clinicians to 2 4 Data Collection. establish the wireless infrastructure and devices and. to make process improvements and practical adapta The second author collected data recording obser. tions to the technology in order to improve uptake vations weekly in a journal while in the unit setting. of the mobile devices and access to information at Descriptions of the observations were collated each. the bedside The observation study reported here week by the first author A working party for the. allowed for detailed observation of nurses use of implementation phase of the MICT project com. technology within the context of their interprofes prised senior unit staff and hospital information sys. sional practice and to identify design and ergonomic tems personnel who provided assistance and input to. issues associated with the networked wireless lap the study. tops The infrastructure supporting the networked, wireless computers were in early stages of deploy 2 5 Analysis.
ment and structured observation was an ideal, method to support the larger implementation pro The data collated weekly by the second author over. ject The virtues of the observation to view design the six month period were analysed with a focus on. issues in the direct context of the work environment how the descriptions from the observations elabo. are well known 20 rated how clinical nurses applied the technology. and what design issues needed to be addressed to, Observations critical to the research objectives were support them to effectively use the technology. recorded weekly in a journal and the content was, identified reflection by the research team at the. end of each month This approach allowed the re, search team to focus on specific design issues and to. Heslop et al electronic Journal of Health Informatics 2011 6 3. 3 Results 3 1 2 Diagnostics, The unit had 30 beds notionally designated as 16 Nursing staff used the wireless laptops to check the.
neurosurgical beds 4 neurology beds and 10 stroke results of diagnostic tests with interprofessional col. beds Patient allocation to beds was flexible and al leagues With physiotherapists they used the lap. location depended on clinical status Staff com tops to check the CT scans of patients with chest. prised 59 nurses 30 allied health professionals six problems With speech therapists they used the lap. medical Registrars four Resident Medical Officers tops to check video fluoroscopy the process of X. as well as other clinicians who visited the unit on a ray fluoroscopic imaging where an image intensi. regular basis 1 clerical staff and a Nurse Unit Man fier video camera system is used to convert the dy. ager For a typical day 9 nurses at different levels namic X ray images into an electronic format image. 0 5 medical personnel 0 3 allied health and one that can be displayed in real time on standard or. clerical staff would be on the unit special purpose monitors Nurses remarked about. the time saving and convenience of access to patient. Two computer terminals were available on the unit information at the bedside without having to return. one in the Nurse Unit manager s office and one at to a central workstation. the nurse base All staff needed to access the same. records and the same data to track patients, 3 1 3 Multi Disciplinary Team Meetings. 3 1 Nursing Staff Usage of Wireless Using the wireless laptops nurses and other inter. professional staff attending the multi disciplinary. Laptop on Trolley, team meetings MTMs were able to view pathology. It was observed that nurses used the mobile wireless results and radiology information such as CT scans. laptop during their everyday work within the multi on the computer screen The laptop computer was. disciplinary team for four main purposes for unit also used to record the MTM meeting minutes. rounds diagnostic information team meetings and Rather than using hand written notes that would be. education required to be keyed into the computer at a later. time comments about the patient were entered di, 3 1 1 Unit Rounds rectly into the MTM record at the actual meeting. With the wireless infrastructure and mobile devices. The neurosurgical neurology and stroke teams con in place it was possible to formulate action plans. ducted unit rounds each morning and grand rounds during the meeting and record them electronically. were held on Thursdays The round time period was Following the meeting a printout was filed in the. more than 2 hours The nurses stated that they were paper based medical records. pleased to be able to use the mobile wireless laptops. to enter data into patient records as it became avail It was observed that there are several limitations for. able at the bedside and while fresh in their mind what could be captured in electronic at the MTM. Direct input of data at the bedside was preferred by meetings For example the computer programs. the nurses who stated that this could lead to im used did not interface with other programs used for. proved safety and patient care A PC tablet was also patient management which captured patient infor. used on the unit rounds so that x rays could be seen mation such as social information Staff at these. on a reasonable sized 32cm screen meetings stated that such social information i e the. availability of carers or the community services, All nurses agreed that access to diagnostic results available counselling services visiting nursing ser. during unit rounds enhanced decision making by vice physiotherapist or case worker in the commu. avoiding the need to leave the bedside to access ra nity was necessary for discharge planning One. diology images and pathology results Nurses indi nurse suggested that if there was a way of electroni. cated that this led to an enhanced level of pa cally capturing the discharge environment or re. tient carer involvement as nurses and other clinical sources in use an enormous amount of time could. staff could show results of investigations as an im be saved The information on the wireless laptops. age to the patient which often conveyed more than was able to assist with many aspects of the patient. an explanation The image was provided in real discharge process but lack of online information de. time Several nurses reported that patients and car tailing the type and availability of discharge services. ers felt confident with their treatment processes necessitated time intensive enquiries by telephone. when they saw up to date technology in use fax or email before discharge could be finalised. Heslop et al electronic Journal of Health Informatics 2011 6 3. tion C5 A pilot study of Motion C5 was conducted It was found that the use of this device enabled nurses to increase documentation at the point of care which improved accuracy of clinical documen tation and reduced duplications 15 p 14 There fore this study reveals an improvement on WOWs An expert commentary 16 promotes the use of

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