Hi all, I'm doing research regarding the affect of a change of system
from manual to openehr on nursing. I'm trying to understand where
nurse indicators can be measured and which indicators to use. Goks
thesis about the implementation of openEHR in the austin hospital has
been helpful. The usual indicators are falls, pressure ulcers and
nosocomial events but the link from them to a change in system is
tenuous. I think I would be better served looking at what nurse
outcome indicators would fit into a template. Any ideas?
Phil.
Hi Phil,
I have recently been involved with a project to implement computerisation of a manual nursing process. It has only just gone live and is probably too early to be of much use to your project but I am happy to discuss more off-line if you wish.
I would be cautious about trying to causally associate changes in indicators to computerisation. There is normally so much other associated change in clinical practice that directly attributable outcomes can be hard to ascertain.
I am not quite sure what you mean by ‘what nurse outcome indicators would fit into a template’?
If you haven’t read it the book ‘Connected for Health’ by the Kaiser Permanente team responsible for EHR development has an excellent chapter on nursing computerisation.
Ian
Dr Ian McNicoll
office +44 (0)1536 414 994
+44 (0)2032 392 970
fax +44 (0)1536 516317
mobile +44 (0)775 209 7859
skype ianmcnicoll
ian.mcnicoll@oceaninformatics.com
Clinical Modelling Consultant, Ocean Informatics, UK
openEHR Clinical Knowledge Editor www.openehr.org/knowledge
Honorary Senior Research Associate, CHIME, UCL
BCS Primary Health Care www.phcsg.org
Hi Phil,
There are several ongoing projects in Sweden with the parameters you are mentioning. Some examples are
- nosocomial infections (both a detecting system, a tracking system and a system for registering and feedback of healthcare associated infections, antibiotics precribed, catheter use, ventilator use, performed surgical procedures)
- patient safety risks for elderly (malnutrition, fall injuries and pressure ulcers)
Particularly in nosocomial infections we have data on how clinical behaviour actually changes from the feedback to the users (clinical staff). For example decreasing number of infections and decreasing use of broad spectrum antibiotics (e.g. 75 percent decrease of the use of cephalosporines which was a permanent shift). This is achieved by a mandatory registration at every antibiotic order which takes a few seconds, which the ordering physicians are accepting, because of the design of the feedback.
To my knowledge, this change of clinical behaviour (which took place in just 2-3 months and then was permanent) is rather unusual. I haven’t heard of any project/function/system which can so radically change a behaviour within a population of users (physicians) in such a short time frame, and make it permanent.
There are a number of indicators used in different projects mentioned above. Patient safety risks in the elderly are for instance useing a number of international indicators. OpenEHR, though, is not used in more than a few of these areas (yet, I am one of the people trying to stimulate the projects in using more of the work in OpenEHR). So I figure it depends on whether you want to study the explicit effect of OpenEHR, or if you have a broader interest in behaviour modification or patient safety indicators.
I would be happy to discuss further if you find any of the areas mentioned above interesting.
Best regards,
Rikard Lövström
2011/5/4 Ian McNicoll <Ian.McNicoll@oceaninformatics.com>