The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital
Tóm tắt
Intensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses’ use of the system, and the impact of system use on critical care nursing processes and outcomes. This descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital. A participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate. Nurses in this ICU unit in China actively participated in the ICIS development and fully used the system to document care. Introduction of the ICIS led to significant improvement in quality and efficiency in nursing documentation, medication order transcription and administration. It allowed nurses to spend more time with patients to improve quality of care. These led to improvement in overall nursing performance. Further study should investigate how the ICIS system contributes to the improvement in decision making of ICU nurses and intensivists.
Tài liệu tham khảo
Leviss J. Hit or miss: lessons learned from health information technology implementations. 2nd ed. Chicago: AHIMA; 2010.
Heeks R. Health information systems: failure, success and improvisation. Int J Med Inform. 2006;75:125–37.
Nykänen P, Karimaa E. Success and failure factors in the regional health information system design process. Methods Inf Med. 2006;45(1):85–9.
Du B, Xi X, Chen D, Peng J. Clinical review: critical care medicine in mainland China. Crit Care. 2010;14(1):206.
Vincent J. Critical care - where have we been and where are we going? Crit Care. 2013;17:S2.
You L-m, Aiken LH, Sloane DM, Liu K, He G-p, Hu Y, et al. Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe. Int J Nurs Stud. 2013;50(2):154–61.
Choi J, Bakken S, Larson E, Du Y, Stone PW. Perceived nursing work environment of critical care nurses. Nurs Res. 2004;53(6):370-8.
Pickering BW, Litell JM, Herasevich V, Gajic O. Clinical review: the hospital of the future - building intelligent environments to facilitate safe and effective acute care delivery. Crit Care. 2012;16(2):220.
Mador RL, Shaw NT. The impact of a critical care information system (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature. Int J Med Inform. 2009;78(7):435–45.
Steurbaut K, Colpaert K, Van Hoecke S, Steurbaut S, Danneels C, Decruyenaere J, et al. Design and evaluation of a service oriented architecture for paperless ICU tarification. J Med Syst. 2012;36(3):1403–16.
Lapinsky SE, Holt D, Hallett D, Abdolell M, Adhikari NKJ. Survey of information technology in intensive care units in Ontario, Canada. BMC Med Inform Decis Making. 2008;8:5.
Vahedian-Azimi A, Ebadi A, Saadat S, Ahmadi F. Intelligence care: a nursing care strategy in respiratory intensive care unit. Iran Red Crescent Med J. 2015;17(11):e20551.
Bosman R, Rood E, Straaten HO, JVd S, Wester J, Zandstra D. Intensive care information system reduces documentation time of the nurses after cardiothoracic surgery. Intensive Care Med. 2003;29(1):83–90.
Hoekstra M, Vogelzang M, Drost JT, Janse M, Loef BG, van der Horst IC, et al. Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis. BMC Med Inform Decis Making. 2010;10(1):1–10.
Nyholm L, Lewén A, Früjd C, Howells T, Nilsson P, Enblad P. The use of nurse checklists in a bedside computer-based information system to focus on avoiding secondary insults in neurointensive care. ISRN Neurology. 2012;2012:1–7. doi:10.5402/2012/903954.
Conroy KM, Elliott D, Burrell AR. Testing the implementation of an electronic process-of-care checklist for use during morning medical rounds in a tertiary intensive care unit: a prospective before–after study. Ann Intensive Care. 2015;5(1):1–12.
Yusof MM. A case study evaluation of a critical care information system adoption using the socio-technical and fit approach. Int J Med Inform. 2015;84(7):486–99.
Shulman R, Singer M, Goldstone J, Bellingan G. Medication errors: a prospective cohort study of hand-written and computerised physician order entry in the intensive care unit. Crit Care. 2005;9(5):R516–R21.
Ammenwerth E, Shaw NT. Bad health informatics can kill - is evalaution the answer. Methods Inf Med. 2005;44:1–3.
Suchman L. Forward. In: Schuler D, Namioka A, editors. Participatory design: principles and practices. NJ: Lawrence Erlbaum; 1993. p. vii–x.
Greenbaum J, Kyny M. Design at work: cooperative design of computer systems. Hillsdale: Erlbaum; 1991.
Kensing F, Blomberg J. Participatory design: issues and concerns. Comput Supported Coop Work. 1998;7:167–85.
Spinuzzi C. The methodology of participatory desgin. Tech Commun. 2004;52(2):163–74.
Blomberg J, Suchman L, Trigg R. Back to work: renewing old agendas for change. In: Kyng M, Mathiassen L, editors. Computers and design in context. Cambridge: MIT Press; 1997. p. 201–38.
Kensing F. The trade unions influence on technological change. In: Briefs Uea, editors. Systems design for, with and by the users. North Holland: North-Holland Publishing Co. 1983.
Bødker S. Creating conditions for participation: conflicts and ressources in systems development. Hum Comput Interact. 1996;11(3):215–36.
Blomberg J, Suchman L, Trigg R. Reflections on a work-oriented design project. Hum Comput Interact. 1996;11(3):237–65.
Eriksson H, Penker M. Business modeling with UML – Business patterns at work. New York: John-Wiley & Sons. 2000.
Kensing F. Generation of visions in systems development – a supplement to the toolbox. In: Mathiassen L, editor. Systems design for human development and productivity: participation and beyond. Berlin: North-Holland Publishing Co; 1987. p. 285–301.
Grønbæk K, Kyng M, Mogensen P. Toward a cooperative experimental system development approach. In: Kyng M, Mathiassen L, editors. Computers and design in context. Cambridge: MIT Press; 1997. p. 201–38.
Carayon P, Cartmill R, Blosky MA, Brown R, Hackenberg M, Hoonakker P, et al. ICU nurses’ acceptance of electronic health records. J Am Med Inform Assoc. 2011;186:812–9.
Holden RJ, Karsh BT. The technology acceptance model: its past and its future in healthcare. J Biomed Inform. 2010;43:440–55.
Hayes B, Bonner A, Pryor J. Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature. J Nurs Manag. 2010;18(7):804–14.
Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med. 2010;362(18):1698–707.
Tissot E, Cornette C, Limat S, Mourand J-L, Becker M, Etievent J-P, et al. Observational study of potential risk factors of medication administration errors. Pharm World Sci. 2003;25(6):264–8.
Bates DW. Using information technology to reduce rates of medication errors in hospitals. BMJ. 2000;320(7237):788.
Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, et al. Nurses’ reports on hospital care in five countries. Health aff (Project Hope). 2001;20(3):43–53.
Lundgrén-Laine H, Kontio E, Perttilä J, Korvenranta H, Forsström J, Salanterä S. Managing daily intensive care activities: an observational study concerning ad hoc decision making of charge nurses and intensivists. Crit Care. 2011;15(4):1–10.
Sevdalis N, Brett SJ. Improving care by understanding the way we work: human factors and behavioural science in the context of intensive care. Crit Care. 2009;13(2):1–3.