Biomedical subjects
Publications and source records attributed to M M Mowry.
To maximize the potential benefits from automation in the nursing department, you must fully understand the work flow. With this understanding, and a concomitant understanding of automation strategies, the best fit of an information system into nursing practice can be developed.
The net effect of these features in an integrated system is that the pharmacist spends time more productively managing patient drug therapy, not the computer system. The patient's location and demographics, once entered, are immediately available in a clinically useful form. Information about medications, the patient's responses to them and all other clinical parameters is available in the pharmacy without leaving the pharmacy application, making the pharmacist more effective and efficient. Physicians' orders are qualified by the system as they are entered, minimizing the number of nonproductive encounters between the pharmacist and the physician. Medication orders arrive at the pharmacy in a more timely manner and with fewer problems. The pharmacy can, in turn, be more responsive, helping the patient receive medication that is timely, accurate and clinically appropriate. These benefits arise primarily as a by-product of the pharmacy being integrated into an information system environment in which data is easily and directly accessed and shared. The more closely the pharmacy and its information requirements are examined, the more important the integration component appears. Many of the above benefits are not achievable with a dedicated stand-alone pharmacy computer system; some are achievable with an interface to a stand-alone nursing-station based HIS. In the pharmacy, is to increase and flourish in its role as an important and integral part of the healthcare delivery team, then access by the pharmacist to all patient information, and access by other providers to information contributed by the pharmacy is a necessary requisite. Improvement inpatient care can be the only result of such enhanced interchange.
Integrated approaches to the delivery of patient care have the potential to do several things to alleviate potential problems resulting from the five changes discussed earlier. They bring physicians into a more active role with the largest group of employees in the hospital (nurses); giving them the opportunity to acquire a better appreciation of the objectives, goals, and constraints of other providers and of the institution as a whole. When nurses and other employees begin to appreciate the constraints placed on physicians by federal regulations and competition, mutual understandings are fostered. They lay a more solid foundation for good professional relationships between hospitals and IPAs and between hospital-based physicians and independent practitioners. They encourage the focus of all providers on quality patient care (at a price the community is willing to afford). They discourage the overlap of expensive services between providers and encourage planned growth for the community. They encourage collaborative practice at the bedside, at committee and board meetings, and throughout the community that can lead to the development of a new model of "health" care as opposed to "disease" care. Finally, they promote human understanding that encourages providers to recognize the appropriate professional (considering all the variables) for each role. Without such efforts, it appears that patient care quality will be the most likely aspect of health care to suffer in the future--a result against which all health care professionals should stridently guard.
In order to effectively evaluate hospital information systems today one must consider all aspects of the System, not simply the placement of terminals. A well designed system will be totally integrated via a single database, will support the concept of patient care management by exception, and will be bedside-based. Bedside-based data entry is a key aspect of a well designed system. The placement of terminals should support the work flow, not vice-versa. There are times when nurses and physicians will logically document at the nursing station, in the nurse's lounge, the physicians office, or a clinic; therefore, terminals should be located in these areas. However, the majority of care rendered is provided to the patient in a bed. Therefore, if computers are going to be support tools for clinical applications they must include data entry devices at the bedside. Results to date show this to have a uniformly positive effect on cost of care, quality of care and patient satisfaction.
The diagnosis related groupings (DRGs) prospective pricing reimbursement system is already affecting nursing service budgets and unit level staffing patterns. As cost containment pressures rise, nurse administrators have to seriously reexamine primary nursing as a viable care modality. This article discusses the compatibility of DRGs and primary nursing. Approaches to future research on measuring outcomes to assess the continued use of primary nursing are suggested.
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The assumption underlying diagnosis related group (DRG) reimbursement is that the prospective, diagnosis-determined rates reflect actual costs incurred during a hospital stay. The nursing component represents a significant percentage of the costs associated with a patient's hospital stay. However, a study of actual nursing labor costs for 240 acute care patients in five DRG categories showed that some DRGs vary in daily nursing labor costs up to 500% over the course of a patient's stay. For some DRGs, the patient's DRG classification is not an adequate measure for determining, assigning, or allocating nursing costs within the institution. Hospitals that do not track actual nursing costs risk unanticipated cost overruns for some diagnoses that may have a significant effect on hospital finances.