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PubMedDate not supplied

Implementation of a variety of computerized bedside nursing information systems in 17 New Jersey hospitals.

This article examines issues of implementing nursing information computer systems in 17 hospitals in New Jersey and the initial effects of such systems as perceived by users. Unlike previous studies that examined the effects of one system in one hospital, this study examines the effects of several major systems in a variety of settings. Many of the hospitals experienced major delays or other problems with implementation; the hospitals in which timely implementation occurred were the ones that had purchased a commercially available stand-alone nursing system and did not try to develop interfaces or do extensive development. While these hospitals did meet with difficulties and needed some software customization, the problems were not so severe as to impede timely implementation. On the other hand, most of the hospitals that had major delays had planned more ambitious projects. These hospitals either required development work with vendors or were implementing a nursing information system while simultaneously putting in place a hospital system. Initial staff impressions of the effects of the system were positive; nursing department staffs reported that they liked the nursing systems. They said that documentation was better (more readable, complete, and timely) and they also believed that care was improved because the computer prompted nurses on what to look for and what to do. Support for these systems from hospital administration, outside of nursing, was cautious and based primarily on cost/benefit results.

Attitude of Health Personnel↗

PubMed1994

Implementation of guidelines for preoperative laboratory investigations in patients scheduled to undergo elective surgery.

OBJECTIVE: To assess the impact on preoperative laboratory investigations in elective surgery after the implementation of guidelines for ordering such tests. DESIGN: A retrospective chart audit. SETTING: A university teaching hospital. PATIENTS: The charts of 903 patients who underwent an elective surgical procedure from each surgical specialty except cardiovascular and thoracic. INTERVENTIONS: Implementation of guidelines for preoperative laboratory investigations. MAIN OUTCOME MEASURES: Impact on the preoperative use of laboratory investigations after implementation of the guidelines as well as patient morbidity and mortality. RESULTS: The mean number of preoperative laboratory investigations done per patient decreased from 4.65 before implementation of the guidelines to 4.18 after (p < 0.001). There was no apparent adverse impact on patient morbidity or mortality. CONCLUSION: Implementation of guidelines for preoperative laboratory investigations for elective surgery resulted in a reduction in the number of tests without adverse impact on patient morbidity or mortality.

Blood Chemical Analysis↗

PubMed1994

[Study of home nursing care needs and implementation of self care of chronically ill patients].

This study was done to gather the basic information needed to identify how the home nursing care needs and implementation of self care is being carried out for chronically ill patients. The subjects of the study were 294 from chronically ill patients in a general hospital, a university hospital and seven primary health care center and the data was collected by a nurses, public health nurse practitioners using questionnaires from July 30 to September 30, 1993. The data were analyzed using percentage, mean, and T-test, ANOVA. Our objectives were to understand basic nursing information general characteristics, implementation of self care, home nursing care needs, implementation of self care depend on general characteristics. The results of the study were as follows 1) General characteristics of subjects. The majority of subjects are female (54.8%); 66.7% of residence are fishing and agrarian villages. 20.1% of disease are neurologic system (backache, neuralgia, HIVD, C.V.A). 2) Environmental offord reveals high point in implementation of self care (2.76 +/- 1.37); 3) B.P check reveals high percentage in home nursing care needs. (84.7%); 4) Implementation of self care depend on general characteristics reveals significantly different by sex*, educational level**, monthly income**, number of family*, disease*, and reason of untreatment** (* < 0.05, ** < 0.01). In conclusion the study requires efforts of nurse practitioners, and the support of useful resources by government.

Adult↗

PubMed1993

Managing the implementation of a pharmacy information system.

The stages by which a pharmacy information system should be implemented are described. Implementation can be divided into three stages. The first stage is preimplementation, during which the hardware vendor installs and configures the operating system, the software is installed, the site is prepared, files are built, policies and procedures are modified or written, staff members are trained, functions or programs are tested, and supplies are purchased. The second stage is implementation, in which the new system becomes operational and is expanded. There are four basic implementation strategies: abrupt switchover, parallel conversion, conversion of one location at a time, and conversion of functions or modules in stages. The final stage is postimplementation, which consists of testing of the system, acceptance or rejection of the system, and the institution of quality control procedures. The acceptance criteria should be developed before the system is purchased. It is important to involve the pharmacy staff and other hospital departments in the planning for an information system. Careful management before, during, and after the implementation of a new pharmacy information system is essential to a smooth and timely conversion.

Clinical Pharmacy Information Systems↗

PubMed1995

A model for adapting clinical guidelines for electronic implementation in primary care.

Medical informaticians who seek to implement clinical guidelines by computer must be aware of a significant gap that exists between guideline development and utilization. In order to be effective, guideline recommendations must be followed by clinicians; in order for clinicians to follow willingly, they must agree with the guidelines. This paper presents a model process for building consensus among clinicians that can be used to obtain support for guideline recommendations prior to their electronic implementation. This approach involves initial presentation of the guidelines by a specialist, iterative cycles of surveying clinicians' opinions about the guidelines and revising the guidelines, supervision of the process by a practice opinion leader, and final group discussion of the revised guidelines to reach consensus. This model was successfully used to adapt guidelines for the continuing care of patients with diabetes mellitus that were subsequently implemented electronically with broad support of the primary care clinicians using them. The model minimized the need for lengthy group discussion by surveying individuals' attitudes and working through a practice opinion leader to gain consensus support for the guidelines. An efficient approach for developing support for guidelines among practitioners will facilitate the electronic implementation of guidelines and lead to enhanced compliance with guidelines after implementation.

Delphi Technique↗

PubMedDate not supplied

Outcomes system implementation for subacute care.

The emergence of subacute care, seen as a cost-effective alternative to other, more expensive settings, is an important option for case managers. The current, rapid growth of subacute care, the diversity of subacute programs, the differences in patient types, and the lack of consistent standards to define subacute care illustrate the critical need for the case manager's role in balancing quality and cost. The lack of solid clinical outcomes data for patients treated in subacute care make it difficult for case managers to assess quality. Outcomes data, as a measurable dimension of quality, may include clinical effectiveness measures, associated costs, and patient/family satisfaction. Outcomes data can be used as a tool by the case manager to facilitate the coordination of patient care. Although there is an increased consumer interest in outcomes across all health care modalities, there is limited outcomes research available to document the efficacy of subacute care. As the pressure increases for outcomes data on subacute care by consumers and payers, efforts toward facility implementation of outcomes systems to assess subacute care are growing. The unique challenges to outcomes implementation in a skilled nursing facility-based setting are discussed, and strategies for successful implementation are presented. Basic subacute outcomes implementation issues of organizational support, staff participation, and data collection are reviewed. Ideas for case management involvement with facility implementation are discussed.

Case Management↗

PubMedDate not supplied

Implementation of NANDA nursing diagnoses online. North American Nursing Diagnosis Association.

The authors describe the online implementation of the standardized nursing language of the North American Nursing Diagnosis Association (NANDA) nursing diagnoses at one 250-bed community hospital located in Chicago. A brief description of NANDA nursing diagnoses is provided along with a discussion of issues regarding implementation of these nursing diagnoses in a clinical information system. This system did not support online documentation of patient problems, therefore the challenge was to add documentation of patient problems to the system's software. This article focuses on the design and implementation of the nursing diagnoses computer screens, rather than focusing on the two problems we encountered during implementation--appropriate use of nursing diagnoses and the fit of nursing diagnoses with nursing interventions. Yet, the lessons learned in designing and implementing NANDA nursing diagnoses online may help others.

Chicago↗

PubMed2004

[Public health, prevention and federalism: insights from the implementation of the federal law on health insurance].

OBJECTIVES: In 1996, the new Swiss law on health care insurance (KVG) introduced the coverage of certain preventive measures. This provided an opportunity to include research-based public health issues in federal health policy. The present article examines the problems with which the realization of those goals in a Federalist health care system with strong cantonal autonomy as it is found in Switzerland was confronted. METHOD: Comparative qualitative case studies design (vaccination of school age children and screening-mammography). RESULTS: Switzerland's federalist health care system strongly hinders the realisation of the Confederation's public health goals. Prevention falls into the cantons' autonomy and the federal KVG (Krankenversicherungsgesetz; Health insurance law) only regulates the coverage of the services provided, but does not contain any instruments to assure implementation in consistency with the policy goals. Under those circumstances, conflicts of interest between the implementing actors, varying cantonal preferences, and scarce resources block the implementation of public health goals. CONCLUSIONS: The results imply stronger leadership of the Confederation in prevention policy and an improved consideration of implementation aspects in approving new measures to obligatory insurance coverage.

Adult↗

PubMed2005

Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence.

BACKGROUND: The process of returning disabled workers to work presents numerous challenges. In spite of the growing evidence regarding work disability prevention, little uptake of this evidence has been observed. One reason for limited dissemination of evidence is the complexity of the problem, as it is subject to multiple legal, administrative, social, political, and cultural challenges. PURPOSE AND METHODS: A literature review and collection of experts' opinion is presented, on the current evidence for work disability prevention, and barriers to evidence implementation. Recommendations are presented for enhancing implementation of research results. CONCLUSION: The current evidence regarding work disability prevention shows that some clinical interventions (advice to return to modified work and graded activity programs) and some non-clinical interventions (at a service and policy/community level but not at a practice level) are effective in reducing work absenteeism. Implementation of evidence in work disability is a major challenge because intervention recommendations are often imprecise and not yet practical for immediate use, many barriers exist, and many stakeholders are involved. Future studies should involve all relevant stakeholders and aim at developing new strategies that are effective, efficient, and have a potential for successful implementation. These studies should be based upon a clearer conceptualization of the broader context and inter-relationships that determine return to work outcomes.

Attitude to Health↗

PubMed1983

The effects of implementation problems on certificate of need decisions in Illinois.

There has been a lack of appreciation of the complexities of implementing certificate of need (CON) programs and, further, the effects of those implementation problems on the program's effectiveness. This study describes implementation problems and presents some evidence of their impact on approval rates in one state. Start-up phase problems included non-reviewable projects, exempted projects and pre-emptive actions by the hospitals to avoid the regulations. It is estimated that these problems raised the program's approval rate by 12 percent and resulted in approximately +310 million of capital costs and an unknown increase in operating costs. Two problems of continuing implementation are identified. The first concerns the availability and specification of the standards and criteria for project review. The second problem is the lack of significant compliance mechanisms. The Reagan administration has made massive cuts in support for health planning and CON programs. The rationale for these cuts is based on the belief that CON has not been effective in reducing the escalation of hospital costs. This article indicates some of the reasons for its impotence.

Certificate of Need↗

PubMed2006

A method for implementation of nutritional therapy in hospitals.

BACKGROUND AND AIMS: Many barriers make implementation of nutritional therapy difficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different departments could improve nutritional treatment within selected quality goals based on the ESPEN screening guidelines. METHODS: The project was carried out as a continuous quality improvement project. Four different specialities participated in the study with a nutrition team of both doctors, nurses, and a dietician, and included the following methods: (1) Pre-measurement: assessment of quality goals prior to study including the use of screening of nutritional risk (NRS-2002), whether a nutrition plan was made, and monitoring was documented in the records. (2) INTERVENTION: multidisciplinary meeting for the ward staff using a PC-based meeting system for detecting barriers in the department concerning nutrition, elaboration of an action plan and implementation of the plan. (3) Re-measurement: as in (1) based on information from records and patient interviews, and an evaluation based on focus group interview with the staff. Patients who gave informed consent to participate in the study (>14 years) were included consecutively. Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson chi(2) test for nominative data. P values <0.05 were considered significant. The study was performed in accordance with the Research Ethics Committee. RESULTS: In this study 141/122 patients were included before/after the implementation period with a mean weight loss within the last 3 months of 6.2 and 5.2 kg, respectively. Before the study we found that BMI was not measured. More than half of the patients had a weight loss within the last 3 months, and 40% had a weight loss during hospitalization, and this was not documented in the records. About 75% had a food intake less than normal within the last week, and nearly one-third were at a severe nutritional risk, and only 33% of these had a nutrition plan, and 18% a plan for monitoring. Barriers concerning nutrition included low priority, no focus, no routine or established procedures, and insufficient knowledge, lack of quality and choice of menus, and lack of support from general manager of the hospital. The staff introduced individually targeted procedures including assigning of responsibility, a nutrition record, electronic calculator of energy intake, upgrading of the dieticians and special diets, communication, and educational programs. A great consistency existed between barriers for targeted nutrition effort and ideas for improvement of the quality goals between the different departments. Quality assessment after study showed an overall significant improvement of the selected quality goals. CONCLUSION: The introduction of a new method for implementation of nutritional therapy according to ESPEN screening guidelines seems to improve nutritional therapy in hospitals. The method included assessment of quality goals, identification of barriers and individual targeted plans for each department followed by an evaluation process. The model has to be refined further with relevant clinical endpoints.

Aged↗

PubMed2006

Factors influencing implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas.

The purpose of this research was to evaluate factors influencing the implementation of the Coordinated Approach to Child Health (CATCH) Eat Smart School Nutrition Program in Texas using data from the CATCH dissemination study. A mail survey was sent to school foodservice personnel (N = 213) who attended a CATCH training from August 2000 through January 2002. A response rate of 40% (n = 85) was achieved. The mean score for the percentage of CATCH Eat Smart guidelines implemented was 80.44. Multivariate linear regression analysis revealed that, after adjusting for age and number of years employed in school foodservice, the following factors were significantly associated with the percentage of CATCH Eat Smart guidelines implemented: utility of CATCH and CATCH Eat Smart in meeting requirements for Coordinated School Health Programs (P = 0.006), school foodservice personnel's satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.008), utility of CATCH in facilitating interschool communication about children's health (P = 0.019), and perceived student satisfaction with food made using the CATCH Eat Smart guidelines (P = 0.046). These results suggest that dissemination approaches for Coordinated School Health Programs should focus on ways to enhance program satisfaction, be consistent with legislated mandates, and increase interschool staff communication to increase program implementation by school foodservice personnel.

Adolescent↗

PubMed2003

Possibilities and barriers in the implementation of a preconceptional screening programme for cystic fibrosis carriers: a focus group study.

OBJECTIVE: This qualitative study aimed to explore possibilities and barriers in the implementation of a nationwide preconceptional cystic fibrosis (CF) carrier screening programme. METHODS: Sessions were held with two focus groups of CF patients and CF relatives, one focus group of people from the target population (couples planning a pregnancy), and two focus groups of potential providers (general practitioners (GPs) and municipal health service workers). RESULTS: Important barriers in the implementation of a preconceptional CF carrier screening programme included the problem of reaching the target population, the heavy workload of GPs, the limited public knowledge about CF in general, and the absence of a preconceptional consultation setting. In general, there was a positive attitude among the participants towards CF carrier screening. CONCLUSION: This study revealed some important barriers in the implementation of CF carrier screening programmes. More research is needed to specify and quantify the importance of the various barriers. Eventually, different intervention strategies should be included in an implementation plan to overcome the most important barriers in the organization and execution of screening.

Adult↗

PubMed2000

Implementing evidence-based recommendations for health care: a roundtable comparing European and American experiences.

BACKGROUND: A roundtable held October 5-6 1999, in Maidstone, Kent, United Kingdom, was convened to identify current strategies and ongoing challenges in implementing evidence-based practice guidelines in health care. Despite numerous new medical research findings for improving health care and despite the dissemination of many practice guidelines, the recommendations from these efforts are not being uniformly adopted. Overuse, underuse, and misuse plague the practice of medicine today. IMPLEMENTING GUIDELINES: Multiple implementation strategies are more likely to succeed that a single implementation method; local selection and adaptation of guidelines are critical; and reminders, educational outreach (for prescribing), and interactive educational workshops are generally effective. EXPERIENCE IN EUROPE: In most countries, guideline development has progressed from consensus conference, to evidence-based statements, and finally to evidence-based guidelines that also consider cost-effectiveness. Guideline development is the most advanced in The Netherlands, where physicians have coordinated their efforts with the government to achieve more uniformity than is found elsewhere. EXPERIENCE IN THE UNITED STATES: Designing systems that will facilitate change--not changing physician behavior--should be the focus. The concern for effecting improvement in health care is now more acute because of the increased attention being given to medical errors and patient safety. SUMMARY STATEMENT: Multifaceted approaches are clearly the most important method for improving care. Such approaches may include many improvement methods, none of which work well alone most of the time or any of the time.

Accreditation↗

PubMed1997

Implementing assertive community treatment programs in rural settings.

The authors present a controlled evaluation of a rural adaptation of the assertive community treatment (ACT) model for clients with serious and persistent mental illness (SPMI). Four community mental health settings adopted an ACT model, while a fifth site blended ACT principles with those of the Rhinelander model, another approach to case management for persons with SPMI. A broad array of client and system outcomes were evaluated at 6, 12, and 24 months into the intervention. Twelve-month findings alerted us to potential problems in implementing the treatment model in study year 1; the implementation was qualitatively evaluated and weaknesses were addressed at the beginning of the second treatment year. Small, positive findings at 24 months suggested that the mid-study course correction may have had an impact. We present these findings along with descriptive data on the challenges of implementing complex services models. We give particular attention to describing implementation barriers to mental health services provision that are uniquely rural.

Adult↗

PubMed2004

Implementation of the JACIE standards for a haematopoietic progenitor cell transplantation programme: a cost analysis.

The purpose of the present project was to analyse the costs incurred by the implementation of JACIE standards at a University Hospital with 1000 beds, performing some 40 autologous transplants per year. The cost analysis was performed on the basis of a prospective assessment of the time spent by all staff members involved with the implementation over a 14-month period of the quality management system (QMS) required by the JACIE standards. Two physicians worked on JACIE Section A (management=82 h), one physician and two nurses for section Ba (clinical unit adults=125.75 h), two physicians and three nurses for section Bp (clinical unit paediatrics=206 h), one physician, two nurses and one technician for section C (progenitor cell collection facility=105.75 h), and one physician and two technicians for section D (progenitor cell processing facility=426 h). The total time spent on the project amounted to 945.5 h with a total salary cost of \[euro]150 000. We concluded that implementation of the JACIE standards was accomplished within a 14-month period with a financial impact of approximately \[euro]150 000. The impact on quality parameters (eg clinical and laboratory end points, side effects) on HPC transplantation will be assessed in a second report after the first year of practical implementation.

Academic Medical Centers↗

PubMed2003

Spinal cord injury providers' perceptions of barriers to implementing selected clinical practice guideline recommendations.

BACKGROUND/OBJECTIVE: Twelve focus groups were conducted at 6 Department of Veterans Affairs (DVA) Spinal Cord Injury (SCI) Centers. The purpose of these focus groups was to identify provider-perceived barriers to implementing selected recommendations of two clinical practice guidelines (CPGs)--Prevention of Thromboembolism in Spinal Cord Injury and Management of Neurogenic Bowel in Adults With Spinal Cord Injury--at their sites. METHODS: A total of 75 SCI direct-care staff (including physicians, nurses, dieticians, rehabilitation therapists, psychologists, and social workers) participated in the focus groups, which were conducted by trained focus group facilitators. Woolfs framework was used to classify perceived barriers into 1 of 4 categories: (a) lack of knowledge, (b) lack of agreement, (c) lack of ability, or (d) lack of systematic reminders for implementation. The "lack of ability" category was further expanded to reflect which specific aspect of the environment was seen as the obstacle: (a) patient, (b) provider, (c) SCI unit, (d) hospital or medical center, or (e) non-Veterans Affairs (VA) hospital setting. RESULTS: Providers disagreed with the recommendation to reinstitute prophylaxis in patients with nonacute SCI to prevent deep vein thrombosis and identified a number of system-level problems with providing appropriate prophylaxis. Providers identified patient reluctance to changing their bowel programs and difficulties in documenting changes in the patients' bowel program as obstacles to implementing the neurogenic bowel CPG. CONCLUSION: Based on this feedback, interventions were developed to address provider-perceived barriers. These interventions were implemented at 6 Veterans Affairs SCI Centers.

Adult↗

PubMed1995

Implementation of guidelines on stroke prevention.

The aim of the present paper was to study the implementation of new medical knowledge. We investigated whether Danish doctors have implemented new national guidelines for oral anticoagulation of atrial fibrillation. An anonymous questionnaire with six standardized case stories was sent to 315 general practitioners in the county of Viborg and Ringkøbing, 79 heads of departments of medicine and cardiology, and 20 heads of departments of neuromedicine across the country. The answers showed that the Danish doctors recommended anticoagulant therapy only to a low extent for this group of patients despite the guidelines and the scientific evidence. The reasons for not choosing anticoagulant therapy were lack of knowledge concerning risk of stroke associated with the disease, worries about the disadvantages of the treatment, and lack of knowledge of its benefits. It is concluded that despite solid scientific documentation and an intensive implementation process of guidelines, issued by well-known respected colleagues in a small homogeneous country as Denmark (5 million inhabitants), knowledge of new research findings varies greatly and is generally limited. To obtain optimal use of new research findings, a powerful implementation effort must be recommended and the study reveals a need for a closer link between research and post-graduate education.

Aged↗