Pediatric Informatics: Computer Applications in Child Health (Health ...

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86 W.H. Drummond et al. 8.2.2 Formative Evaluation of the QI Initiative’s Results After it became apparent that the protocol implementation had failed, an analysis of the process was conducted and revealed multiple problems: 1. High Work Load: The new, more stringent oxygen saturation limits created more monitor alarms, requiring the staff to adjust supplemental oxygen more frequently, adding additional workload for already busy nurses. A high patient census and many labile patients, whose saturations always fluctuate, further magnified the staff work load. 2. Lack of “Buy-in”: Several influential staff members did not believe in the protocol’s premises. Maintaining oxygen saturation in a more narrow range was not seen as beneficial to patients’ outcome, so the required titration of oxygen was considered a useless chore. Some staff members were unsure if all babies would benefit from this protocol or only smaller premature infants. 3. Regulations: Pressured to save time in order to comply with work-hour rules, 14 residents quickly learned to ignore the time-consuming titration protocol steps and reverted to increasing the oxygen to 100% at the beginning of a desaturation episode, leaving the nurse or respiratory therapist to titrate the FiO 2 back down. 4. Ambiguity: Users were unclear if this protocol applied to all patients or if there were legitimate exceptions. The resulting confusion led to inconsistent protocol application and measurement errors. 15 5. Negative Impact of Hospital IT: One of the major obstacles discovered in the course of the failure analysis, was the impact of a newly implemented respiratory therapy clinical documentation system designed entirely for adult patient care. This system was designed in response to a JCAHO mandate, and required the respiratory therapists (RT) to document their work using a remote computer terminal – effectively pulling the RT away from the patient bedside for extended periods of time. The reporting system added a significant documentation burden. The time spent documenting could be more than twice as long as the actual patient encounter. This HIT system effectively interrupted RTs’ workflow, increased their work load, and made it impossible for them to aid in the implementation of the care optimization protocol. 6. Workflow and Layout: NICU B had been recently renovated, modernized, and enlarged, using a custom architectural design focused on solving lighting, noise, and privacy problems. Sound dampening walls, floors and translucent partitions were used to quiet the environment and to create visual and auditory privacy between the bed spaces (Fig. 8.3). Nurses in the new cubicles could not see, or hear, much of what was happening elsewhere in NICU B. The new bed space arrangement was very different from the former layout of the NICU B (Fig. 8.4), and from the layout of NICU A. Both NICU A and the previous design of the NICU B had a floor plan that aligned the beds in rows along counters, about 4 ft apart. While noisy and very unpleasant for parents, visual and auditory access to all the bed spaces was excellent with the previous design.
8 Complexity in Healthcare Information Technology Systems 87 Fig. 8.3 The renovated NICU B has partial visual and auditory isolation of the staff and parents who are in the semi-closed bed spaces. At the time of the picture, the unit is 100% occupied. Note the acoustically dampening, translucent partition above the headwall and the muted south-facing exterior window in the upper right corner. The space in the view contains 7 caregivers, 11 babies, and 2 parents Fig. 8.4 Previous configuration of NICU B. The space is open, without any noise damping designs. All patients are visually accessible from any location in the room. Providers are easily visible
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Health Informatics (formerly Comput
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Editors Christoph U. Lehmann George
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vi Series Preface changes to both t
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viii Foreword This text will prove
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x Preface financial investment and
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How to Use This book This book is t
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xvi Contents 9 Pediatric Care, Safe
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xviii Contents Part VII A Vision an
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xx Contributors Donna M. D’Alessa
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xxii Contributors Christoph U. Lehm
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xxiv Contributors Mark M. Simonian,
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4 G.R. Kim pharmacy, medical educat
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6 K.B. Johnson and G.R. Kim Deaths
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8 K.B. Johnson and G.R. Kim 2.4.1 I
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10 K.B. Johnson and G.R. Kim 2.4.3
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12 K.B. Johnson and G.R. Kim Educat
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14 K.B. Johnson and G.R. Kim 2.6 Co
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Chapter 3 Core Pediatric Data Kevin
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3 Core Pediatric Data 21 3.3 Pediat
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3 Core Pediatric Data 23 3.6 Pediat
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Chapter 4 Neonatal Care and Data De
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4 Neonatal Care and Data 27 Essenti
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4 Neonatal Care and Data 29 4.3 The
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138 D.M. D’Alessandro 4. Case ser
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140 D.M. D’Alessandro Ontario, BC
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142 D.M. D’Alessandro Table 10.1
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144 D.M. D’Alessandro Children ar
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146 D.M. D’Alessandro 17. Ely JW,
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Chapter 11 Clinical Practice Guidel
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11 Clinical Practice Guidelines: Su
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162 M.J. Feldman in patients withou
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164 M.J. Feldman The art of medicin
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166 M.J. Feldman important design g
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168 M.J. Feldman Incorrect or missi
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170 M.J. Feldman Fig. 12.4 GIDEON D
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172 M.J. Feldman system or etiology
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174 M.J. Feldman ED-12: “Practica
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176 M.J. Feldman Fig. 12.7 DXplain:
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178 M.J. Feldman For GIDEON: Rabies
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180 M.J. Feldman KB on infectious d
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182 M.J. Feldman 4. Johnson KB, Fel
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Chapter 13 Managing Pediatric Knowl
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13 Managing Pediatric Knowledge Res
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Chapter 14 Supporting Continuing Pe
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14 Supporting Continuing Pediatric
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14 Supporting Continuing Pediatric
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Chapter 15 Pediatric Care Coordinat
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15 Pediatric Care Coordination: The
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Chapter 16 Prioritizing Pediatric I
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16 Prioritizing Pediatric Investmen
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Chapter 17 Aligning Pediatric Ambul
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17 Aligning Pediatric Ambulatory Ne
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258 G.R. Kim and C.U. Lehmann Elect
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260 G.R. Kim and C.U. Lehmann 18.2.
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262 G.R. Kim and C.U. Lehmann There
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264 G.R. Kim and C.U. Lehmann 13. C
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266 K.B. Johnson and C.G.M. Weigle
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280 C. Sable et al. computer for la
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282 C. Sable et al. Table 20.3 Tele
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284 C. Sable et al. without increas
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286 C. Sable et al. Fig. 20.1b Wash
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288 C. Sable et al. prior to case d
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290 C. Sable et al. presence of con
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292 C. Sable et al. 17. Sable C, Ro
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294 A.E. Zuckerman and G.R. Kim 21.
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296 A.E. Zuckerman and G.R. Kim �
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Chapter 22 Privacy Issues David M.N
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22 Privacy Issues 305 22.3 Pediatri
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22 Privacy Issues 307 patient must
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22 Privacy Issues 309 and receipt o
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Chapter 23 Electronic Mail in Pedia
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23 Electronic Mail in Pediatric Pra
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Chapter 24 Information Management b
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24 Information Management by Patien
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Chapter 25 Overview of Pediatric In
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25 Overview of Pediatric Inpatient
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Chapter 26 Prescribing/Ordering: Co
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26 Prescribing/Ordering: Computeriz
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346 S.H. Mitchell et al. 27.2.1 Med
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348 S.H. Mitchell et al. context of
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350 S.H. Mitchell et al. 27.3.3.1 C
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352 S.H. Mitchell et al. challenges
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354 S.H. Mitchell et al. work round
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Chapter 28 Medication Administratio
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28 Medication Administration and In
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Chapter 29 Understanding and Preven
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29 Understanding and Preventing Err
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386 D.C. Stockwell and A.D. Slonim
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400 J.H. Schneider a number of prob
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402 J.H. Schneider on governance, u
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404 J.H. Schneider 31.6.1 Data Rele
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406 J.H. Schneider Understanding op
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408 J.H. Schneider of this componen
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410 J.H. Schneider Table 31.1 (cont
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412 J.H. Schneider References 1. Am
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Chapter 32 Developing Pediatric Dat
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32 Developing Pediatric Data Standa
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430 G.R. Kim and S.T. Rosenbloom Co
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432 G.R. Kim and S.T. Rosenbloom No
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434 G.R. Kim and S.T. Rosenbloom pr
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436 G.R. Kim and S.T. Rosenbloom ab
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Chapter 34 Pediatric Research and I
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34 Pediatric Research and Informati
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Chapter 35 The Moving Picture of Pe
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35 The Moving Picture of Pediatric
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470 G.R. Kim and K.B. Johnson Cente
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472 G.R. Kim and K.B. Johnson 36.4
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Index A 2006 AAP recommendations on
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Index 477 psychological data, 45 se
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Index 479 High frequency flow inter
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Index 481 O Online Mendelian Inheri
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Index 483 Standards development org
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