The Nursing Specialist Group

Transcription

1 The Nursing Specialist Group Information Technology in Nursing Volume Issues for future nursing information systems: Delphi study results Heather Strachan, Borders Community Health Service NHS Trust Berwickshire, Scotland Abstract The second of three articles about a UK study which used the Delphi method to collect opinions on current and future nursing information systems (NIS). It identified that the advantages and disadvantages of existing NIS were consistent with those generally associated with computerisation. There were few examples of benefit from information usage. A computerised common patient record that communicated patient-focused information across departments. Institutions and disciplinary boundaries were identified as the top priority for the future. The initial questionnaire for the first round was returned by 29 of the 90 members of the BCS Nursing Specialist Group members contacted (32.2%). The second round questionnaire went to these 29 and 23 responded (79%) which amounted to 26% of the total sample. The majority of respondents related their answers to one speciality while a few addressed a number of specialities. Sixteen of the respondents referred to hospital nursing and all other specialities had four or less respondents. Only hospital nursing results could therefore be considered valid. All 23 respondents completed the section that related to issues required for successful usage of Nursing Information Systems (N1S). Results The top priorities for the development of existing and future hospital NIS are listed in Table 1. Overall four manual and nine computerised systems were reported to exist and eleven future computerised systems were identified. As well as those listed in Table 1, existing manual systems identified included Fostering, care planning, patient dependency, quality assurance and audit systems. Computerised systems included: patient administration; office automation; Fostering; theatre; pathology results reporting; accident and emergency. The future computerised NIS included: quality audit; patient held records (smart card); research database; critical pathways; decision

2 support/semi intelligent; links to GPs; ward management; and patient information. It was identified by a number of the respondents that many of the future N1S should be part of the computerised multidisciplinary, multiagency patient record the features of which are listed in Table 2. The comments made in round two of the survey are shown in italics and the level of agreement or disagreement with the potential advantages and disadvantages are displayed. Of the 145 advantages and disadvantages highlighted for both existing and future hospital NIS, 102 had a consensus of 80% or more. Of the sixty-eight issues required for successful usage of information systems: twenty-seven had a consensus of 100%; twenty-five of the issues had between 90% and 99% consensus; and ten issues had between 80% and 90% consensus. Only six of the issues had below 80% consensus, one of which produced a consensus of only 52%. Comments made by respondents in round two generally included additional benefits; a justification for disagreeing with an advantage, disadvantage or an issue; a concern or clarification. Comments were ignored if they stated the obvious or repeated the meaning of the statement. On a few occasions respondents commented that they did not have enough knowledge or experience of a particular system and therefore did not feel in a position to agree or disagree with the advantages or disadvantages. Very few statements were altered as respondents would not have an opportunity to review the changes. No third round was planned. Respondents comments were therefore displayed in italics in the final results, see Table 2 below.

3 Existing and future Nursing Information Systems The benefits of existing Hospital NIS were fairly numerous, however any positive effect of the 41 benefits identified would be considerably diminished by the 30 disadvantages. These advantages and disadvantages were consistent with those of computerisation in general. Advantages included: improved communication; improved availability and access to information; improved consistency and legibility of documentation; and saving time. Disadvantages of NIS The disadvantages identified were: initial set-up and training is time consuming and costly; lack of feedback of information; potential breaches in confidentiality and security. Advantages of NIS Few advantages from using information were expressed. Those that were identified were: more efficient management; cost effective use of resources; improved discharge planning; improved utilisation of bank and agency nurses. Information use Advantages and disadvantages that related to information usage tended to have the lowest consensus. They were usually disadvantages: lack of feedback of information; poor quality information; lack of ability to act on information; irrelevance of information to ward staff. It would appear that NIS have not yet reached the innovative and transformational stages outlined by Marion Ball and colleagues where information provides the major benefits., Our NIS have merely replaced existing manual systems. This may be why the acceptance of NIS has been so poor. 1 According to Phillips a lack of use of information by nurses is traditional and the reasons include: nurses use intuition rather than hard facts; information they collect has often been for the use of other disciplines; information has not always been of a high level or quality; nurses lack the basic understanding of how information can be used; nurses have been prepared to act on the instructions of others; nurses have been reluctant to initiate change. 3

4 Priorities for action Providing NIS that support patient focused information was identified as a top priority for both existing and future hospital NIS. This correlates with the information needs of nurses of which it is estimated that 49% is patient specific data. 4 Key features of the future patient record was integration of data with other systems; health care settings; and disciplines. These findings correlate with the Carty Delphi study which examined the information features necessary for future clinical N1S. (The Carty study was published after this research had commenced.) Carty's findings indicated that the items that generated the highest consensus were items that supported communication, patient specific data and a move towards patient care plans that cross disciplines as well as institutional lines. 5 A priority for future system development for hospital nurses was the development of two systems that already existed. These were the automatic Fostering system and an improved patient administration systems (PAS). Yet neither the Fostering system or PAS were in the top three priorities for existing systems that should be made more widely available. This may be because in their present form they are not considered to be achieving major benefits or meeting significant needs for nurses. The majority of computerised Fostering systems in use presently do not have the facility to generate the roster automatically. Of the few that are available, the actual benefits of automatically generated rosters are doubtful. Comments made by respondents identified that an automatically generated roster was: time consuming to review; that results were not always useable; and that the criteria and priorities required to generate an adequate roster were too complex. These findings have been recognised elsewhere. The traditional manual approach to Fostering while very flexible is labour intensive. Automated approaches either tend to over simplify the problem or, in trying to address all the problems inherent in every conceivable environment, exacerbate their complexity making them impractical and prohibitively expensive. 6 The main function of PAS is to support the recording of patient demographic and identification details. The improvement required to the PAS was to incorporate information needed to support contracting. This possibly reflects the increased amount of information required to support contracting and the resulting increase in the administrative burden. References 1. Ball M, Douglas J. Integrating nursing and informatics. In: Ball M, Hannah K, Gerdin Jelger U, Peterson H, eds, Nursing Informatics: Where Caring and Technology Meet. New York: Springer Verlag, 1988: Finnegan E. The Strategic Group for Nursing Information Systems research study into nursing information systems and its action plan for 1994/1995. In: Wright G, Eaves D, eds. Sharing Information - focusing on the patient. Weybridge: BJHC Books, 1994: Phillips M. Information technology can empower nurses. Information Technology in Nursing 1993; 5. 3: Coreoran-Perry S, Graves J. Supplemental-information-seeking behaviour of cardiovascular nurses. Research in Nursing and Health 1990; 13:

5 5. Carty B. Information features of clinical nursing information systems: A Delphi survey. In: Grobe S, Pluyter-Wenting E, eds, Nursing Informatics: An Overview for Nursing in a Technological Era.Amsterdam: Elsevier, 1994: Hardiker N. Duty Fostering in the primary nursing environment. Information Technology in Nursing 1992; 4. 4: 8-9.