Breakdown in informational continuity of care during hospitalization of older home-living patients: A case study

Olsen, Rose Mari; Skotnes, Liv Heidi; Enmarker, Ingela

doi:10.5334/ijic.1525

Cited by 20 publications

(41 citation statements)

References 48 publications

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“…The various ways in which information is gathered, stored and passed on between nurses and other caregivers differ across settings; these have changed over the last few decades due to the introduction of information and communication technology (ICT) and the electronic patient record (EPR) in health care (Meissner et al, ; Olsen, Hellzen, Skotnes, & Enmarker, ). Documentation is recognised as an important part of nursing and is mandated by Norwegian law (Keenan, Yakel, Tschannen, & Mandeville, ; Ministry of Health & Care Services, ).…”

Section: Introductionmentioning

confidence: 99%

Nurses' information practice in municipal health care—A web‐like landscape

Østensen

Bragstad

Hardiker

et al. 2019

Journal of Clinical Nursing

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Aim To uncover the characteristics of nurses' information practice in municipal health care and to address how, when and why various pieces of information are produced, shared and managed. Background Nursing documentation in the electronic patient record has repeatedly been found unsatisfactory. Little is known about how the information practice of nurses in municipal health care actually is borne out. In order to understand why nursing documentation continues to fail at living up to the expected requirements, a better understanding of nurses' information practice is needed. Design A qualitative observational field study. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods Empirical data were collected in three Norwegian municipalities through participant observations and individual interviews with 17 registered nurses on regular day shifts. The data were analysed through thematic content analysis. Results Nurses' information practice in municipal health care can be described as complex. The complexity is reflected in four themes that emerged from the data: (1) web of information sources, (2) knowing the patient and information redundancy, (3) asynchronous information practice and (4) compensatory workarounds. Conclusions The complex and asynchronous nature of nurses' information practice affected both how and when information was produced, recorded and shared. When available systems lacked functions the nurses wanted, they created compensatory workarounds. Although electronic patient record was an important part of their information practice, nurses in long‐term care often knew their patients well, which meant that a lot of information about the patients was in their heads, and that searching for information in the electronic patient record sometimes seemed redundant. Relevance to clinical practice This study provides contextual knowledge that might be valuable (a) in the further development of information systems tailored to meet nurses' information needs and (b) when studying patient safety in relation to nurses' information practice.

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Section: Introductionmentioning

confidence: 99%

Nurses' information practice in municipal health care—A web‐like landscape

Østensen

Bragstad

Hardiker

et al. 2019

Journal of Clinical Nursing

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“…Today's older adults in home health care settings have complex care needs, interact with multiple providers from different healthcare networks, and experience unmet information needs. Participants in the hospital to home health care transitions are particularly vulnerable to gaps in information due to the fragmented provider-centered communication patterns [2][3][4]. Personal health records have been shown to facilitate information sharing and support increased consumer engagement in other care settings [8,12,37].…”

Section: Resultsmentioning

confidence: 99%

“…Unfortunately, these challenges are seen across many care settings. For example, home health nurses, older adults, and informal caregivers have reported experiencing unmet information needs during the hospital to home health care transition [2][3][4]. This lack of information during the hospital to home health handoff can reduce home health provider's ability to provide evidence-based disease management in the home [4].…”

Section: Introductionmentioning

confidence: 99%

Assessing commercially available personal health records for home health

2016

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KeywordsPersonal health record, personal health records, home health nursing, qualitative research SummaryBackground: Home health nurses and clients experience unmet information needs when transitioning from hospital to home health. Personal health records (PHRs) support consumer-centered information management activities. Previous work has assessed PHRs associated with healthcare providers, but these systems leave home health nurses unable to access necessary information. Objectives: To evaluate the ability of publically available PHRs to accept, manage, and share information from a home health case study. Methods: Two researchers accessed the publically available PHRs on myPHR.com, and attempted to enter, manage, and share the case study data. We qualitatively described the PHR features, and identified gaps between the case study information and PHR functionality. Results: Eighteen PHRs were identified in our initial search. Seven systems met our inclusion criteria, and are included in this review. The PHRs were able to accept basic medical information. Gaps occurred when entering, managing, and/or sharing data from the acute care and home health episodes. The PHRs that were reviewed were unable to effectively manage the case study information. Therefore, increasing consumer health literacy through these systems may be difficult. The PHRs that we reviewed were also unable to electronically share their data. Conclusions:The gap between the existing functionality and the information needs from the case study may make these PHRs difficult to use for home health environments. Additional work is needed to increase the functionality of the PHR systems to better fit the data needs of home health clients.

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“…These gaps are created as a direct result of the inability to capture and exchange fall-related information electronically in the EHR or via Health Information Exchanges (HIEs) [45]. Without explicit attention to fall-related information, such gaps can also be influenced by clinicians' understanding of the scope and content of the information to be exchanged according to their discipline, context, and healthcare organization they work in [46].…”

Section: Discussionmentioning

confidence: 99%

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

Alhuwail

Koru

2016

Appl Clin Inform

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KeywordsHome health agencies, health information technology, quality of care, workflow, information management SummaryObjectives: To help manage the risk of falls in home care, this study aimed to (i) identify home care clinicians' information needs and how they manage missing or inaccurate data, (ii) identify problems that impact effectiveness and efficiency associated with retaining, exchanging, or processing information about fall risks in existing workflows and currently adopted health information technology (IT) solutions, and (iii) offer informatics-based recommendations to improve fall risk management interventions. Methods: A case study was carried out in a single not-for-profit suburban Medicare-certified home health agency with three branches. Qualitative data were collected over a six month period through observations, semi-structured interviews, and focus groups. The Framework method was used for analysis. Maximum variation sampling was adopted to recruit a diverse sample of clinicians. Results: Overall, the information needs for fall risk management were categorized into physiological, care delivery, educational, social, environmental, and administrative domains. Examples include a brief fall-related patient history, weight-bearing status, medications that affect balance, availability of caregivers at home, and the influence of patients' cultures on fall management interventions. The unavailability and inaccuracy of critical information related to fall risks can delay necessary therapeutic services aimed at reducing patients' risk for falling and thereby jeopardizing their safety. Currently adopted IT solutions did not adequately accommodate data related to fall risk management. Conclusion:The results highlight the essential information for fall risk management in home care. Home care workflows and health IT solutions must effectively and efficiently retain, exchange, and process information necessary for fall risk management. Interoperability and integration of the various health IT solutions to make data sharing accessible to all clinicians is critical for fall risk management. Findings from this study can help home health agencies better understand their information needs to manage fall risks. BackgroundHome healthcare, referred to as home care henceforth, is defined as episodic and intermittent secondary care services provided to home-bound patients in their homes. Serving mostly the elderly [1], home care involves skilled care services provided by nurses, physical therapists, occupational therapists, speech therapists, social workers, and home aides [2]. Home care is a critical component in the continuum of care for many patients who require recuperative and rehabilitative services after hospital discharges [3][4][5][6]. It enables patients to achieve better recovery, gain strength, regain functionality, and become independent more quickly [7]. Home care is an important component of the overall healthcare industry in the United States (US) with a projected increase in its utilization and expen...

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Breakdown in informational continuity of care during hospitalization of older home-living patients: A case study

Cited by 20 publications

References 48 publications

Nurses' information practice in municipal health care—A web‐like landscape

Nurses' information practice in municipal health care—A web‐like landscape

Assessing commercially available personal health records for home health

Identifying Home Care Clinicians’ Information Needs for Managing Fall Risks

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