Take the leap from manual to on-line collection
Two-year data collection dream becomes a reality
CareOne, an affiliate of Memorial Medical Center in Savannah, GA, and its 40 branches started computerized data collection in April with a pilot project that will involve quality managers. By the end of the year, the company hopes to begin training field staff in the program.
"We will have much less in the way of limits in what we can do with our data,"says Sally Welsh, MSN, RN, CNAA, director of quality management at CareOne. "Now, we are only limited by time and imagination."
A rose is a rose, except . . . .
A year ago, CareOne started working in earnest toward computerized data collection. The first step was for each group including home health, nursing, infusion, and durable medical equipment (DME) to share the indicators they currently used. Welsh knew some major differences would have to be eliminated if CareOne was going to get the most out of a computerized system. "Home health benchmarked from branch to branch, but not with DME or infusion," she says. That made for some big differences in data collection tools.
In home health offices, 12 questions related to the patient satisfaction. In DME, none did. "We decided that there were five items common to all of the areas and started with that. Then each can add questions that meet their own needs." DME might add questions about whether the equipment was in good working order, but all would have questions on issues such as whether the patient was treated with respect.
In patient complaints, every branch was sending numbers to the corporate office, but they were using different forms. That, too, had to be changed. "We had to break complaints down by type of staff, by type of complaint. A lot of them just said that there were clinical complaints,’ but we didn’t know what that meant. We had to include questions that gave us more information," she says.
Computer system was the easy part
Instruction forms differed from branch to branch as well, so such things as "sentinel events" were defined differently depending on what branch was involved. "We had no definition of a major injury. Is it one where the person seeks care from a doctor or hospital, or one that requires care? We had to set up parameters that were the same for all of us," Welsh says.
Initially, the group compared what was considered major injury to make sure there was agreement. Quality nurses then conferred with staff. But, Welsh says, discussion on this matter continues.
Although it may seem daunting, Welsh says putting together a computer program has been perhaps the easiest part of the project. She met with the internal information systems personnel to determine what had to be done to create a good network. They needed to add modems and improve memory capabilities on the office computers. Then Welsh and the quality managers for each branch of CareOne met with the consultant who would design the data collection program.
Although aware that the Joint Commission on Accreditation of Healthcare Organizations has come out with a list of approved software vendors, Welsh says CareOne has not yet determined if it will seek approval for the new program. "We are still discussing that," she says.
"We told them what kinds of reports we wanted, what information we had now, and what information we would collect in the future," she recalls. For instance, if staff tracked an occurrence such as a fall, limited detail was available. "It was too time consuming to sort through too much detail," she explains. The new program will allow secondary coding to be included in reports, which should provide much more information.
She also requested portability between reports. "We wanted to be able to look at an occurrence report, identify sentinel events, and then create a sentinel report without having to input the information all over again."
Tracking by staff, patient
And she wanted automatic screen changes that would be triggered when certain information was input. If a patient had a positive culture for a urinary tract infection and had a Foley catheter, for example, she wanted the computer program to prompt staff to enter when and by whom the catheter was changed last. That entry would provide more information on infection control. "I wanted to be able to track by staff, by patient, and by how long until it is resolved. Before, we just looked at infection rates each month, not patient care over time. We never got to the resolution stage." (See sample infection control screens, inserted in this issue.)
The consultant provided a sample disk for Welsh and the quality staff to try. They made more suggestions, and after four such meetings, a program was completed. Total cost: less than $10,000.
Dual systems for a while
Training for quality managers and their secretaries started in late March. They will do trial runs on February data, although the nurses will continue to tally data manually until CareOne is sure the program works. "There are four quality managers, and they will have a lot of work for a while," Welsh says. "Before, all this used to be tallied at the branch level by the nurses."
Once the kinks are worked out, Welsh will start rotating in nurses for training. "This is going to give them more time," she says. "Some are worried because they don’t have computer skills, but that’s why we are spending so much time doing trial runs so that it can be as easy as possible. We know that we will get more and better data from this. Unless there is some huge glitch, I know that this will save time and money and will quickly pay for itself."
[Editor’s note: For more details, contact Sally Welsh, MSN, RN, CNAA, director of quality management, CareOne, 7135 Hodgson Memorial Drive, Suite 13, Savannah, GA 31406. Telephone: (912) 350-6448.]
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