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Informing and Improving Community Nursing Care Through Access to Data

Informing and Improving Community Nursing Care Through Access to Data



Presented by Dr Chris Hendry

Presented by Dr Chris Hendry
Director, New Zealand Institute of Community Health Care



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  • this slide shows some uptake of the TC service by 4 Maori and 1 Pacific person. Although the numbers are small there is some thinking that the TC service may meet the needs of this population due to its promotion of the person staying in their own home supported by family / whanau. 6% vs 1% in this age group of the general population
  • The next 2 slides come from the the Omaha system – this slide provides a high level description of the types of problems that clients have who are on the service (many have more than one problem) Knowing the overall problem picture for the population you are caring for provides many opportunities for developing services and improving careHearing 49.3%Social contact 47.8%Circulation 44.8%Vision 44.8%Digestion-hydration 40.3%Mental health 40.3%Respiration 38.8%Residence 25.4%
  • The majority of patients (60%) had eight or more medications prescribed.
  • Other includes in decreasing incidence: client behavior, 14, vision impaired 12, type 2 diabetes 10, nephrectomy (7), difficulty swallowing (6), respiratory problems (6), asthmatic (5), oxygen (5), allergy to food or material (3), animals present (3), poor dietary habits (3) etc.
  • We do EuroQual, Nottingham and barthel on admission. As part of the EuroQOL the patient is asked to categorize their pain.More than half (55%) recorded having moderate to extreme pain.
  • Risk of pressure injury is measured on admission
  • This assessment was completed for only a fraction of the population (<20%) – is it only administered to those that are thought to be depressed
  • PLEASE NOTE: This data might be significantly under-reported. The interventions are categorized in the “Progress Notes” section of the database which means that interventions that don’t warrant a progress note are not reported. I don’t think many of the SW interventions get reported since they are routine and without anything notableThe interventions the RNs undertake relate to the problems listed on the previous slide. There are a number of uses for this data – for one, we can see what the content of the role is and work out if we have the resources allocated correctly within the servicescreening procedures 2.9%skin care 2.4%mobility/transfers 2.4%coping skills 2.4%medication prescription 2.1%Safety 2.1%community supports, supplies, case management, and various aspects of symptom management.
  • This data is from the report completed last year and is a combination of DHB and NM data but might still be valid. We don’t have new data yet to analyseTC service has shortened the length of hospital stays and reduced the presentations to ED and inpatient length of stay by a significant amount

Informing and Improving Community Nursing Care Through Access to Data Informing and Improving Community Nursing Care Through Access to Data Presentation Transcript

  • Health IT Innovation In PracticeInforming and Improving CommunityNursing Care Through Access to Data.Dr Chris HendryDirectorNZICHCwww.nzichc.org.nz
  • Transforming our health care system:10 priorities (NHS 2013)1. Active support for self-management2. Primary prevention(population focused)3. Secondary prevention(patient focused)4. Managing Ambulatory CareSensitive conditions(Diabetes, heart failure, asthma etc.)5. Care co-ordination.6. Integrating services to meetmental and physical health needs.7. Primary care management ofend of life care.8. Medication management9. Managing elective activity10. Managing urgent andemergency activity.
  • Secondary use of EHR information• Audit of the ‘system’– Terminology/definitions– Information pathways– Information gaps– Identification of training needs• Functioning of the service(s)– Service overview– Service impact and outcomes– Service development priorities
  • Reason for Admission Total clientsRequesting rest home care at home 41Requesting hospital care at home 12Previous service unable to meet increased needs 12Previous service unable to meet long term needs 4Total 69Analysis of information entered for theNurse Maude TotalCare Service.
  • Ethnicity Total clients %European59 88.1%Maori 4 6.0%Pacific Peoples 1 1.5%Other 1 1.5%Not documented 2 3.0%Total 67 100.0%Patients profile.
  • Omaha System Problems Total Clients % of ClientsPersonal care 60 89.6%Neuro-musculo-skeletal function 54 80.6%Urinary function 50 74.6%Physical activity 49 73.1%Medication regime 48 71.6%Health care supervision 46 68.7%Nutrition 45 67.2%Pain 40 59.7%Cognition 38 56.7%Skin 38 56.7%Bowel function 35 52.2%Service needs
  • Score Knowledge BehaviourStatus(Wellbeing)1 no knowledgenot appropriatebehaviourextremesigns/symptoms2minimalknowledgerarely appropriatebehaviourseveresigns/symptoms3 basic knowledgeinconsistentlyappropriate behaviourmoderatesigns/symptoms4adequateknowledgeusually appropriatebehaviourminimalsigns/symptoms5superiorknowledgeconsistentlyappropriate behaviourno signs/symptomsUse of OMAHA system to identify level of dependency
  • Score(Omaha KBS Classification)Knowledge Behaviour Status(Wellbeing)1 22 3 182 152 16 773 188 138 3214 194 366 1395 2 35 3Average score 3.00 3.74 3.06Median score 3 4 3Use of OMAHA system to identify level of dependency
  • Polypharmacy0123456789103 4 5 6 7 8 9 10 11 12 13 14 15 16 >16NumberofclientsNumber of medications per clientThe majority of patients (60%) had eight or more medications prescribed.
  • Alerts & HazardName Total Clients % of ClientsFalls risk 58 86.6%Drug allergy 31 46.3%Lives alone 31 46.3%Cognitive ability 27 40.3%Hearing impaired 28 41.8%Other 104Risk assessment
  • Score PainCount OfclientsPercentage ofclientsUnknown Unknown 1 1.5%1 I have no pain or discomfort 29 43.3%2I have moderate pain ordiscomfort 36 53.7%3I have extreme pain ordiscomfort 1 1.5%Total 67 100.0%Standardised tools: EuroQOL
  • Barthel Index – 33% independentEuroQOL 65% scored 13 or higher =health impacting quality of life05101520253035<4 4-7 8-11 12-15 16-20NumberofclientsBarthel Score on admission<4 = totally dependent4-7 = very dependent8-11 = partially dependent12-15 = needs minimal help with ADLs16-20 = independent02468101214166 7 8 9 10 11 12 13 14 15 16 17NumberofclientsEuroQOL Total Score (functional categories) at or nearadmissionGood health Intermediate Severe difficultiesStandardised tools: Barthel & EuroQOL
  • 02468101212 13 14 15 16 17 18 19 20 21 22NumberofpatientsTotal Braden Score at or near admissionHigher riskLower riskStandardised tools: Risk of pressure injury
  • Geriatric Depression Scoreon admissionCount of clients0-9 (normal) 710-19 (mildly depressed) 420-30 (severely depressed) 2Total 13Standardised tools: Geriatric Depression Score
  • Omaha System InterventionInterventions(n=2593)Percentage ofInterventionssigns/symptoms-physical 376 14.5%dressing change/wound care 369 14.2%communication 276 10.6%nursing care 248 9.6%continuity of care 228 8.8%medication administration 206 8.0%bladder care 193 7.5%medication coordination/ordering 179 7.0%medical/dental care 178 7.0%dietary management 174 6.5%bowel care 166 6.0%Service activities
  • Progress during the service
  • Acute Inpatient event LOSBefore TC During TC Difference7.81 5.72 2.09ED presentationsNumberBefore During86 33Average visits perday0.24 0.21Impact of the service
  • • Claire Willemsen (Nurse Maude Nurse Manager)• Lynn Vandertie (Institute Data analyst)• Sheree East (Nurse Maude Director of Nursing)