Computerized clinical pathways (care plans): piloting a strategy to enhance quality patient care.
ABSTRACT Having paper and electronic documentation can interfere with staff communication and workflow. In this 950-bed multicampus acute healthcare network in the southeastern United States, paper pathways did not clearly demonstrate multidisciplinary documentation and involvement in the plan of care. The majority of documentation was computerized, but clinical pathways remained in the paper chart. Limited literature findings, incomplete pathway documentation, and nurse dissatisfaction with cumbersome documentation processes created the impetus for this practice change. DESCRIPTION OF THE PROJECT/INNOVATION: To provide a sound basis for transitioning the pathways into the electronic medical record, a pilot was conducted on 1 medical-surgical department using 1 computerized pathway. Outcomes were measured utilizing pathway documentation audits and staff perception surveys. PROJECT OUTCOMES: Pilot results revealed improvements in pathway documentation and staff satisfaction with use of the computerized pathway. There was a 69% increase in the documentation of barriers to patient progression/utilization of the problem list, 10% increase in documentation of patient medication teaching, and 31% increase in documentation by ancillary staff using the computerized pathway. According to the survey results, staff perceived that the computerized pathway was a more useful tool in (1) prompting them to educate the patient (36% increase compared with paper); (2) communicating pertinent patient information during shift report (34% increase compared with paper); and (3) documenting barriers to patient progression (30% increase in comparison to paper). Based on these results, approval was obtained from health network administrators to move forward with system-wide implementation.
In order for clinical pathways to be effective, patient-centered communication tools, they must be easily accessible, be utilized by all health team members, and complement day-to-day workflow. Piloting innovative practice changes helps to garnish buy-in and support from all levels of the healthcare team.
Automation provides a first step to easier accessibility and linkage of pathways to other pertinent information and multidisciplinary patient care processes. Computerized pathways may be an impetus for healthcare providers to view automation as a key step to improving multidisciplinary care delivery and patient care quality.
Conference Paper: Mining Clinical Pathway Using Clustering and Rule Induction[Show abstract] [Hide abstract]
ABSTRACT: This paper proposes maintenance and construction of clinical pathway by using data on histories of nursing orders. The methods consist of three process. First, data on counting sum of executed orders are extracted from hospital informaton system. Then, clustering is applied to the data and the labels for grouping are obtained. By using the labels, rule induction is applied, and classification power of each attribute is estimated. The attributes are sorted by an index of classification power, the original table is decomposed into sub tables. Clustering, rule induction and table decomposition methods are applied to the sub tables in a recursive way. The method was applied to a dataset whose patients had an operation of cataract a. The results show that the reuse of stored data will give a powerful tool for maintenance of clinical pathway, which can be viewed as data-oriented management of nursing schedule.Proceedings of the 2013 IEEE International Conference on Systems, Man, and Cybernetics; 10/2013
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ABSTRACT: Cognitive and functional impairments are leading predictors of poor outcomes in hospitalized older adults. This study reports adoption rates of 9 Assessing Care of Vulnerable Elders quality indicators in a sample of US hospitals (N = 128). Chief nursing officers were surveyed using a 6-point scale (no activity to full implementation) for each Assessing Care of Vulnerable Elders quality indicator. Adoption rates were low, highlighting the need for greater efforts to heighten awareness among senior executives and nursing leaders.Journal of nursing care quality 04/2014; 29(4). DOI:10.1097/NCQ.0000000000000061 · 1.09 Impact Factor
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ABSTRACT: Computerized clinical guidelines are frequently used to translate research into evidence-based behavioral practices and to improve patient outcomes. The purpose of this integrative review is to summarize the factors influencing nurses' use of computerized clinical guidelines and the effects of nurses' use of computerized clinical guidelines on patient safety improvements in hospitals. The Embase, Medline Complete, and Cochrane databases were searched for relevant literature published from 2000 to January 2013. The matrix method was used, and a total of 16 papers were included in the final review. The studies were assessed for quality with the Critical Appraisal Skills Program. The studies focused on nurses' adherence to guidelines and on improved patient care and patient outcomes as benefits of using computerized clinical guidelines. The nurses' use of computerized clinical guidelines demonstrated improvements in care processes; however, the evidence for an effect of computerized clinical guidelines on patient safety remains limited. © The Author(s) 2015.Western Journal of Nursing Research 03/2015; DOI:10.1177/0193945915577430 · 1.38 Impact Factor