The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital

Abstract

BackgroundIntensive care information systems (ICIS) are continuously evolving to meet the ever changing information needs of intensive care units (ICUs), providing the backbone for a safe, intelligent and efficient patient care environment. Although beneficial for the international advancement in building smart environments to transform ICU services, knowledge about the contemporary development of ICIS worldwide, their usage and impacts is limited. This study aimed to fill this knowledge gap by researching the development and implementation of an ICIS in a Chinese hospital, nurses’ use of the system, and the impact of system use on critical care nursing processes and outcomes.MethodsThis descriptive case study was conducted in a 14-bed Respiratory ICU in a tertiary hospital in Beijing. Participative design was the method used for ICU nurses, hospital IT department and a software company to collaboratively research and develop the ICIS. Focus group discussions were conducted to understand the subjective perceptions of the nurses toward the ICIS. Nursing documentation time and quality were compared before and after system implementation. ICU nursing performance was extracted from the annual nursing performance data collected by the hospital.ResultsA participative design process was followed by the nurses in the ICU, the hospital IT staff and the software engineers in the company to develop and implement a highly useful ICIS. Nursing documentation was fully digitized and was significantly improved in quality and efficiency. The wrong data, missing data items and calculation errors were significantly reduced. Nurses spent more time on direct patient care after the introduction of the ICIS. The accuracy and efficiency of medication administration was also improved. The outcome was improvement in ward nursing performance as measured by ward management, routine nursing practices, disinfection and isolation, infection rate and mortality rate.ConclusionsNurses in this ICU unit in China actively participated in the ICIS development and fully used the system to document care. Introduction of the ICIS led to significant improvement in quality and efficiency in nursing documentation, medication order transcription and administration. It allowed nurses to spend more time with patients to improve quality of care. These led to improvement in overall nursing performance. Further study should investigate how the ICIS system contributes to the improvement in decision making of ICU nurses and intensivists.

Analyzing Research Fronts in Medical Informatics Field Based on Topic Model and Life Cycle Theory

“…This requires the implementation of effective and optimized querying systems (T22) [33] in order to reduce the computational complexity of handling these data. In addition, evaluation of health information system (T31) focuses on the quality management and evaluation of the system,such as those on the effect on health services [34,35].…”

Workflow for Intensive Care Unit Nurses: A Time and Motion Study

“…Our results also showed that the amount of time spent by nurses in each of the nursing activities differed among different ICU departments; nevertheless, a general assessment showed that from the highest to lowest, the order for timeconsumption of the six types of nursing activities is as follows: direct nursing care > nursing documentation > communication > indirect nursing care > personal affairs > miscellaneous affairs. Regarding nursing documentation time-consumption, when compared to manual documentation, the application of an intensive care information system was shown to significantly shorten the time spent by nurses on documentation procedures from 3.8 to 2.05 hr in a 12-hr period (Qin et al, 2017). However, in our study, registered nurses still had to spend a great deal of time on documentation, especially during the night shift, which is consistent with those of a Brazilian study on ICUs (Kakushi & Evora, 2014).…”

Midwifery and Nursing Strategies to protect against COVID-19 During the Third Trimester of Pregnancy

“…As not all pregnant women with clinically confirmed COVID-19 presented with fever or other clinical symptoms, it was essential to maintain a high degree of vigilance and follow strict hygiene, disinfection, and isolation protocols when caring for the women ( Moore and Rendall, 2014 , Qin et al., 2017 ). All the procedures described in this paper are based on best practice.…”