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Use of ICNP-based electronic nur sing documentation system for pr - - PowerPoint PPT Presentation

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Use of ICNP-based electronic nur sing documentation system for pr actice and research Hyeoun-Ae Park, PhD, RN Professor College of Nursing Seoul National University Brief history of ICNP in Korea 1997-2000: Translation of Alpha & Beta

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Use of ICNP-based electronic nur sing documentation system for pr actice and research

Hyeoun-Ae Park, PhD, RN Professor College of Nursing Seoul National University

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Brief history of ICNP in Korea

  • 1997-2000: Translation of Alpha & Beta versions
  • 2000-2001: Development of extended Korean ICNP
  • 2001-2002: Development of a prototype ICNP-based electroni

c nursing record system

  • 2003: Implementation of electronic nursing documentation sys

tem at Bundang Seoul National University Hospital

  • 2005-2006: National standardization of nursing statements
  • 2008-10: Translation of version 1.0 and version 2.0
  • 2011: Development of prototype electronic nursing documenta

tion system based on information model and clinical practice g uideline

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List of Korean Hospitals with ICNP- based ENR

  • Already implemented: Bundang SNU Hosp

ital, SNU Hospital, Boramae Hospital, Asa n Medical Center, KyungHee Hospital, Cat holic Medical Center, Dongsan Medical Ce nter

  • Under development: National Cancer Cent

er, Ilsan Hospital, Army Hospital

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Use of ICNP-based ENR for P ractice

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Seoul National University Bundang Hospit al

Number of beds: 1003 Number of outpatients per day: 3615 Number of nurses: 845

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Catalogues

A catalogue item A catalogue ite m A catalogue it em A catalogue i tem A catalogue item A catalogue item A catalogu e item A catalogue item A catalogue ite m A catalogue it em A catalogue i tem A catalogue item A catalogue item A catalogu e item A catalogue item A catalogue ite m A catalogue it em A catalogue i tem A catalogue item A catalogue item A catalogu e item A catalogue item A catalogue ite m A catalogue it em A catalogue i tem A catalogue item A catalogue item A catalogu e item

Nursing Sta tements Extended Kor ean ICNP

Relationship between ICNP Concepts, State ments, Catalogues and Patient Records

Statement A Statement B Statement C Statement D Statement E Statement F Statement G

Patient Records

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Components of Electronic Nur sing Record System

Ext Extended ve vers rsion

  • f I

ICNP Standard rd n nurs rsing data d dictionary ry

Terminology Server

Population o

  • f

sta statements tements I Identification o

  • f

new c w concept

EMR System

El Electro ronic P Patient Re Record rds

Store re Re Retri rieve ve U UIs f for D r Data En Entry ry

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Narrative Nursing Documentation System

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Narrative Statements and Catalogues at Bundang SNUH

  • Number of narrative statements

– About 9,000

  • Catalogues

– 21 common catalogues: ADT, vital sign, eliminatio n, nutrition and diet, activity and rest, medication, pain, transfusion, bleeding, emergency care, sym ptom management, respiratory care, skin care, I/ O, and etc. – 38 nursing unit specific catalogues: Each nursing unit has about 15 different catalogues

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Use of data collected with ICN P-based ENR for research

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1st Study

  • Research question: Is there any difference in terms of quantity

and quality of nursing documentation before and after implem entation of ENR?

  • Method: 20 open heart surgery patients’ paper-based nursing

records and another 20 open heart surgery patients’ electronic nursing records were analyzed according to the nursing proc ess and compared in terms of quantity and quality of documen tation.

  • Result: After the implementation of electronic nursing record s

ystem, quantity of nursing records (2.5 times) and the pattern

  • f nursing records following the nursing process have been in

creased and granularity of nursing records has been improved .

  • J Kor Soc Med Informatics 2009;15(1):83-91
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2nd Study

  • Research question: Are there any gaps between r

equired nursing care time based on patient classifi cation and actual nursing care time based on nurs e staffing level?

  • Methods: We reviewed the nursing records of 124,

416 patients discharged from 2005 to 2007 to ide ntify the gaps in nursing care time.

  • Results: The pediatric and geriatric units showed r

elatively high staffing needs and the trends of und erstaffing over time.

  • Comput Inform Nurs. 2011 Jul;29(7):419-26.
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0.5 1 1.5 2 2.5 3 3.5 Pediatric ¡nursing ¡ Women's ¡health Surgical ¡nursing Orthopedic ¡& ¡ rehabilitation ¡ nursing ¡ Medical ¡nursing Psychiatric ¡ nursing ¡ Geriatric ¡nursing ¡ 2005 2006 2007

F=16.42** F=23.54** F=9.26** F=5.22* F=4.54* F=7.88* F=2.37

Comparison of Gaps between Required Nursing Care Time based on Patient Classification and St atus Quo

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3rd Study

  • Research questions: Can we estimate pressure ulcer incidenc

e? Are there any practice variations in the nursing intervention provided for preventive pressure-ulcer care to patients with pr essure ulcers or at risk of pressure ulcers? Is there any differe nce in nursing interventions in relation to the patients' medical problems and the characteristics of the nurses who cared for t hem?

  • The narrative nursing notes of 427 intensive-care patients wh
  • were discharged in 2007 were analyzed. The frequencies of

five nursing interventions for pressure-ulcer prevention were c

  • mpared between pressure-ulcer and pressure-ulcer risk grou

ps, as were the characteristics of the nurses who were treatin g the patients in these two groups. Nursing interventions for pr essure-ulcer prevention were also assessed relative to the pat ients' medical problems.

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3rd Study (Cont’d)

  • Results: The overall incidence of pressure ulcers was 15.0%. Positio

n change was the most popular nursing intervention provided for pre ssure-ulcer prevention in both the pressure-ulcer and at-risk groups, followed by skin care. There was a statistically significant tendency t

  • ward a greater frequency of providing skin care and nutritional care

in the at-risk group than in the pressure-ulcer group. There was no statistically significant difference in the mean frequencies of nursing i nterventions relative to the patients' medical problems in the pressur e-ulcer group. However, frequencies of nursing interventions did diff er significantly between patients with neurological problems and tho se with other medical problems in the at-risk group. Analysis of the n urses' characteristics revealed that more nursing interventions were documented by those who were younger, less experienced, and mor e educated. Pressure-ulcer prevention care was provided at frequen cies much lower than the recommended guidelines.

  • Int J Med Inform. 2011 Jan;80(1):47-55.
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Variations in Nursing Activities related t

  • Pressure Ulcers

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Pediatric ¡nursing ¡ Women's ¡health Surgical ¡nursing Orthopedic ¡& ¡rehabilitation ¡ nursing ¡ Medical ¡nursing Geriatric ¡nursing ¡ Intensive-­‑care ¡nursing Sensory/mobility ¡assessment Nutritional ¡assessment Ulcer ¡wound ¡care Exercise Position ¡change Skin ¡assessment Use ¡of ¡devices

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4th Study

  • Research question: Can we estimate the incidence of adverse

drug events (ADEs) and the frequency and the duration of na usea by analyzing narrative nursing statements documented i n standardized terminology-based electronic nursing records.

  • Methods: 156,339 narrative nursing statements documented o

ver 3320 days were reviewed for 487 admissions of cancer pa tients who were treated with cisplatin at a tertiary hospital bet ween July 1 and December 31, 2009. Narrative nursing state ments with the terms “adverse drug reaction,” “allergy,” “hyper sensitivity,” and other ADEs associated with cisplatin describe d in the prescription information approved by the Korea Food and Drug Administration were analyzed. In addition, the chara cteristics of one of the ADEs, nausea, were examined further.

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4th Research (Cont’d)

  • Results: Narrative statements documenting the presence or a

bsence of an “adverse drug reaction,” “allergy,” and “hypersen sitivity” were found in 162 (33.3%) of the nursing records of th e 487 patients. Narrative statements documenting the presenc e or absence of ADEs due to cisplatin were found in 476 (97.7 %) of the nursing records. At least 1 ADE was noted in 258 of the 487 patients (53.0%). The presence of nausea was docum ented in 214 (43.9%) of the 487 patients’ nursing records; the mean duration of this nausea was 5.17 days.

  • Conclusion: ADEs can be monitored by using narrative nursin

g statements documented in standardized terminology-based electronic nursing records.

  • Adverse-Drug-Event Surveillance Using Narrative Statements

in Electronic Nursing Records, IJMI (under review)

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Next Generation Electronic Nursing Records System

§ Generating nursing statements based data element models § Developing nursing catalogues based on Clinical Practice Guidelines

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Detailed Clinical Model

  • Data element model consisted of enti

ty-attribute-value triplet

  • Entity: Focus or core concept of data

element

  • Attribute: Qualifier or modifier neede

d to describe characteristics of entity in more detail

  • Value: Possible instances of attribute

to realize characteristics of element

  • Optionality: Indicate if attribute is opti
  • nal or mandatory to describe an ele

ment

  • Data type: type of value an attribute

can take

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Example of DCM: Labour pain

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Labour pain

Duration

2 Datatype: REAL Optionality: mandatory

Interval Occurence Rhythm Severity

5 Datatype: REAL Optionality: mandatory Unit: sec Unit: sec 20110807_1315 Datatype: TS Optionality: optional regular Datatype: SC Optionality: optional severe Datatype: SC Optionality: optional

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Table View of DCM of Labour Pain

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Generating Narrative Statements from DCM

From Simple statements To complex statements

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Clinical Practice Guideline

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Recommendation Detailed Recommendation Observations on Presentation in S uspected Labour physical observation 체온을 측정한다. 맥박을 모니터한다. uterine contractions 자궁수축을 확인한다. labour pain 진통의 양상을 사정한다. 활력징후를 측정한다. backache 요통 양상을 확인한다. 요통을 줄일 수 있는 비약물적 요법을 교육한다. vaginal loss 양수파막 여부를 확인한다. 질 분비물의 양상을 모니터한다. fetal wellbeing 태아 심박동수를 모니터한다. 부모에게 태아 움직임을 확인할 수 있도록 교육한다.

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Selection of Narrative Statements for Guideli ne-based Catalogue

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UI of Guideline-based Electronic Nursing Do cumentation System

Narratives Detailed Recomme ndations Catalogue Fol ders

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Thank you

Hyeoun-Ae Park hapark@snu.ac.kr