Electronic Whiteboard in the Inpatient Care Management: Nurses' Perceptions About the Use.

In the hospital setting, the traditional method of information for nurses is to consult the Electronic Health Records (EHR) on several occasions to check the continuous updates of the prescriptions. This process, in practice, involves time and multiple setbacks such as: availability of equipment (there is no computer per nurse in the office), number of patients assigned (it involves entering each EHR one by one). This is how the implementation of the tool known as electronic whiteboard (e-whiteboard) came about. The aim of this study was to explore perceptions of nurses after implementation of e-whiteboard, recently introduced at Hospital Italiano de Buenos Aires. A Qualitative study, which consisted of 5 group interviews with a total of 27 participants. A convenience sampling was used (selection of nurses from different shifts), corresponding to 4 sectors of adult patient admissions and 1 sector of pediatric patients. The main findings were positive aspects such as: it was a simple, intuitive and easy to navigate interface, it allowed communication with other health professionals (physicians, nutritionists and kinesiologists), and it facilitated the visualization of real time information that favors the fulfillment of tasks in scheduled time. This tool is considered of great clinical importance for coordinated patient care because the visibility and availability of clinical information improves communication between professionals, streamlines workflow, and consequently accelerates shared decision making.

Fall Risk Assessment Through a Self-Service Terminal in the Outpatient Setting.

Health organizations aim to identify patients with high fall risk in the different attention scenarios in order to provide safety and quality care. In order to address this issue, we designed an assessment tool that surveys fall risk through three questions in self-service terminals in the outpatient setting. Our objectives in this article are to describe the implementation process. A cross sectional design was used for the pilot (between October and November 2018). The issued tickets rate with high fall risk (defined as 2/3 positive responses) was 34.3%. Some adjustments needed to be done because some patients did not have true risk criteria due to self-report. We conclude that this tool will allow quicker identification of patients with true high risk. Effective prevention strategies will be necessary to improve safety after risk fall identification.

Exploring Nurses' Perceptions and Expectations Toward a BCMA Implementation Using a Mobile App and Workstations as a Change Management Strategy.

The inclusion of new technologies in health, such as the 2D Codes scanning Drug Administration System (BCMA), has an impact on the perception of nurses, mainly changes in their workflow, and incorporation of mobile devices for patient care. The objective of this study is to know the perceptions and expectations of nurses regarding the implementation of BCMA. Qualitative research was conducted based on interviews with groups of nurses from different inpatient wards of the Hospital Italiano de Buenos Aires, with and without system implementation. The analysis of the interviews produced the categorization of information for future interventions and the need to create standard strategies for the effective continuity during the implementation of the project. Some determinants for the acceptance of the system by the nursing staff: the ease of use of the mobile station, the device, the nursing application and its usefulness, and high expectations about the new process.

Looking for the Best WOW: Understanding the Nurses' Needs.

The effective use of nurses' time for providing increasingly safe, efficient, and patient-centered care is a major concern for healthcare managers as well as for nurses themselves. Different solutions have been used aimed at improving those times by providing nurses with mobile and 'on wheels' alternatives for bedside care. Nevertheless, the selection of solutions is still a complicated organizational decision. This paper describes the evaluation of ergonomic characteristics of five local mobile carts for the bedside nursing care at Hospital Italiano de Buenos Aires. Cornell University's checklist was used for data collection according to five domains: car handling, work surface and data load, documents and screen reading, storage and dimensions, and energy and cleaning. Considering the scarcity of literature on needs for WOWs assessment, the findings of this paper represent a valuable approach to the requirements of nurses in real work environments and a support for decision-making based on nursing observations.

BarCode Medication Administration in ICU: Learning from Our Nurses.

Errors during drug administration stage represent a significant percentage of adverse events associated with health care. Its prevalence is higher in critical care units, due to vulnerable patient population, characteristics of intensive care as well as complexity of pharmacotherapy. Errors can occur at any stage of the medication cycle although they often occur during administration, so nurses' role in prevention is essential. The bar code medication administration (BCMA) technology increases patient safety by instituting control time, but a poorly designed system or a faulty implementation can lead to low utilization in future. This paper describes implementation, evaluation, detection of problems and search for their possible solutions of a BCMA system in the intensive care unit at Hospital Italiano de Buenos Aires.

Post-Implementation Study of a Nursing e-Chart: How Nurses Use Their Time.

Nursing documentation is a significant component of electronic health records nevertheless integrating a new chart into nursing activities required multiples strategies to ensure adherence. Current literature demonstrates that nurses spend part of their time performing activities no related with patients' direct care and sometimes even does not fall under their purview. Thus it is important to quantify the effect that a new system could have in the proportion of time dedicated to documentation. The objective of this work was to determine the time dedicated to different activities including those related to electronic documentation after the implementation of a renewed nurse chart in an Electronic Health Record at Hospital Italiano de Buenos Aires. An observational, cross sectional and work sampling study was performed. During the study 2396 observations were made in 3 wards. Nurses' activities included 36.09% of direct care, 28.9% of indirect care, 0.67% support tasks, 22.99% non related to patient tasks, 11.32% personal activities and documenting on EHR 17.43%. The comparison with the previous study shows indirect care activities decreased 12.28% and non-related to patients increased 11.85%. The results demonstrate that the new nurses' e-chart did not increase documentation time.

Score de alertas tempranas en una historia clínica electrónica / Early warning score in an electronic health record / Score de alerta precoce em um registro médico eletrônico

Reconhecer a deterioração clínica do paciente é um aspecto fundamental. A implementação de um sistema de alerta precoce ajuda enfermeiras para obter informação clínica no momento certo para identificar pacientes em risco de deterioração. um sistema de alerta precoce Reino Unido, imerso em registros médicos eletrônicos de Hospital Italiano de Buenos Aires usando o processo de cuidados de enfermagem implementado em 2014 para facilitar a pontuação e monitoramento, a fim de melhorar a segurança do paciente foi implementado.

Reconocer el deterioro clínico del paciente es un aspecto clave para la seguridad del mismo. La implementaciónde un sistema de alerta temprana ayuda a las enfermeras a obtener información clínica en el momento oportuno para identificar a los pacientes con riesgo de deterioro. Se implementó un score de alerta temprana desarrollado en el Reino Unido en la historia clínica electrónica del Hospital Italiano de Buenos Aires. El mismo fue incorporado al proceso de atención de enfermería implementado en la institución en el año 2014. El objetivo de este desarrollo fue facilitar la puntuación y vigilancia con el fin de mejorar la seguridad del paciente.

Nurses' expectations and perceptions of a redesigned Electronic Health Record.

When a new Electronic Health Record is implemented or modifications are made, the full acceptance by end users depends on their expectations and perceptions about the possible benefits and the potential impacts on care quality. The redesign of an electronic nurse chart should consider the inherent characteristics of nurses' practice and the variables that may influence the implementation and use of the new chart. In this study, a qualitative method evaluated nurses' expectations and perceptions about the implementation impacts of a redesigned nurse chart in an electronic health record at Hospital Italiano de Buenos Aires. Seventy-four nurses participated in three operative groups. Following ground theory, three analytic dimensions were found: impact at work, communication and chart quality. In addition, time was a recurrent topic. Nurses found it difficult to think positively if reduction in time of documentation was not assured.

The expectations of nurses about the implementation of a Barcoded Medication Administration System: a qualitative study.

The implementation of a health system like the Barcode Administration System (BCMA) often disrupts the workflow of nursing staff. Taking into account that system acceptance by nurses is one of the most important factors for successful implementation, this paper describes nurses' expectations regarding the introduction of BCMA. For this purpose, interviews were conducted with 18 nurses in different units of an academic medical center in Argentina. Analysis of the interviews produced six main themes. Among these themes two factors were identified as determinants for system acceptance: ease of use perceptions and usefulness.

Isolation of patients with vancomycin resistant enterococci (VRE): efficacy of an electronic alert system.

UNLABELLED: This study investigates the implementation of an alert system for the isolation of vancomycin resistant enterococci (VRE) colonized patients. Given the risk of admitting a patient colonized by VRE it is necessary to implement efficient isolation measures. An electronic alert system integrated into a health information system (HIS) could help with the detection of these patients and their isolation in proper units. OBJECTIVES: Determine the efficacy of an electronic alert system in improving the rate of properly isolation of patients colonized with VRE. METHODS: two consecutive series of admission in adults units of 67 patients that were infected or colonized with VRE were compared. The time period of the study was six months before the implementation of the alert system and six months post-implementation of the system. RESULTS: The proportion of admission with proper isolation of the patient in correct units increased 44% after the alert system implementation. CONCLUSION: The implementation of an alert system improved the proportion of properly isolated patients with VRE.

Implementación de un sistema de vigilancia activa de infecciones intrahospitalarias en una unidad de cuidados intensivos pediátrica / Implementation of an active saurveillance system of nosocomial infections in a pediatric intensive care unit

Introducción. La implementación de un sistema de vigilancia de infecciones hospitalarias constituye uno de los pilares de un programa de control de infecciones, sobre todo en las unidades de cuidados intensivos pediátricos (UCIP) donde se concentran los pacientes más vulnerables. Objetivos. Describir los resultados de la impleementación de un sistema de vigilancia activa de infecciones hospitalarias en una UCIP.Población, material y métodos. Desde septiembre de 2000, todas las infecciones nosocomiales se registraron mediante un sistema de vigilancia, implementado en la UCIP de un hospital universitario. De acuerdo con la metodología del Sistema Nacionalde Vigilancia de Infecciones Nosocomiales de EE.UU. (NNISS),1 la vigilancia se concentró en las infecciones asociadas a procedimientos invasivos.A partir de indicadores específicos se elaboraron gráficos estadísticos de control tipo U para evaluarla evolución temporal de estos indicadores y permitirla detección precoz de brotes. Los datos obtenidosse compararon con los informes del NNISS.Resultados. Hasta el 30 de noviembre de 2002 se registraron 112 infecciones en 1.682 pacientes (10,9 episodios c/1.000 días-paciente). Si bien las neumonías(13,1 episodios c/1.000 días-ventilador) y las infecciones urinarias (7,1 episodios c/1.000 días catéter urinario) estuvieron por encima del percenti lo 75 del NNISS, la evolución temporal de estos indicadores mostró una tendencia decreciente. Los gráficos de vigilancia expectante permitieron detectardos brotes de bacteriemias asociadas a catéter antes de finalizar el mes de vigilancia, los cuales fueron rápidamente controlados. Conclusiones. La utilización de indicadores apropiadosen combinación con gráficos estadísticos de control, permitió la comparación de nuestros datos con un estándar externo y la detección precoz debrotes, lo que facilitó una rápida implementación de las medidas de control.

Implementación de un sistema de vigilancia activa de infecciones intrahospitalarias en una unidad de cuidados intensivos pediátrica / Implementation of an active saurveillance system of nosocomial infections in a pediatric intensive care unit

Introducción. La implementación de un sistema de vigilancia de infecciones hospitalarias constituye uno de los pilares de un programa de control de infecciones, sobre todo en las unidades de cuidados intensivos pediátricos (UCIP) donde se concentran los pacientes más vulnerables. Objetivos. Describir los resultados de la impleementación de un sistema de vigilancia activa de infecciones hospitalarias en una UCIP.Población, material y métodos. Desde septiembre de 2000, todas las infecciones nosocomiales se registraron mediante un sistema de vigilancia, implementado en la UCIP de un hospital universitario. De acuerdo con la metodología del Sistema Nacionalde Vigilancia de Infecciones Nosocomiales de EE.UU. (NNISS),1 la vigilancia se concentró en las infecciones asociadas a procedimientos invasivos.A partir de indicadores específicos se elaboraron gráficos estadísticos de control tipo U para evaluarla evolución temporal de estos indicadores y permitirla detección precoz de brotes. Los datos obtenidosse compararon con los informes del NNISS.Resultados. Hasta el 30 de noviembre de 2002 se registraron 112 infecciones en 1.682 pacientes (10,9 episodios c/1.000 días-paciente). Si bien las neumonías(13,1 episodios c/1.000 días-ventilador) y las infecciones urinarias (7,1 episodios c/1.000 días catéter urinario) estuvieron por encima del percenti lo 75 del NNISS, la evolución temporal de estos indicadores mostró una tendencia decreciente. Los gráficos de vigilancia expectante permitieron detectardos brotes de bacteriemias asociadas a catéter antes de finalizar el mes de vigilancia, los cuales fueron rápidamente controlados. Conclusiones. La utilización de indicadores apropiadosen combinación con gráficos estadísticos de control, permitió la comparación de nuestros datos con un estándar externo y la detección precoz debrotes, lo que facilitó una rápida implementación de las medidas de control.(AU)

Assessing the impact of change in the organization of a technical support system for a health information systems (HIS).

OBJECTIVE: Evaluate the impact of the implementation of a new model of Help Desk and technical support in HIS users of the hospital. We carried an anonymous survey on a random sample of 150 users of the new system. The administrative staff (A), doctors (D) and nurses (N) were analysed by strata. We assessed the accessibility both to phone calls and through the institutional intranet; the understanding of the problems; the time taken to fully answer requests; and the degree of satisfaction concerning the change. The results showed that 94%, gained access through the intranet and that it was very satisfactory for the medical group (D80% vs A34% vs N8.7%). The different kinds of users were satisfied with the response time, above all the administrative stratum (A42% vs D38% vs N14%). All of them commented on their satisfaction with the change, above all, the doctors (D68% vs A46% vs N22%), who before this new implementation had expressed dissatisfaction with the old system. CONCLUSIONS: operational changes in the Help Desk contributed to improve how the service was perceived by its users; nevertheless both doctors and nurses required even faster response time.