Transcript Nursing Informatics Research Network

Kia Ora from
Nouvelle-Zélande
The Omaha System Partnership:
Nursing Informatics Research Network
Kay Poulsen
Help4U, New Zealand
Omaha System in NZ
• HINZ November 2009
“To ensure that correct decision making occurs at
the right time, at the right place, and that services
provided are at the right level in a consistent,
coordinated way, this clinical information must be
valid, reliable, but most of all present”.
Brent McGrath (1960 – 2010)
Changing the way nurses and allied health professionals document and communicate
care in community clinical practice : a community care clinical data set.
Omaha System
• Holistic evaluation of problems in the setting of a
person’s life
– Individual, family or community level
– Potential problems & health promotion
• Multi-dimensional perspective using simple framework
– Omaha System is the A, B, C that enables us to write War
and Peace
• Measure the impact of interventions on consumer
awareness and consumer engagement as well as
clinical outcomes.
– Knowledge, Behaviour, Status outcome ratings
A Community Care Solution
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Omaha System
CADITM data dictionary
Project GAIN
PLAIN WORDSTM taxonomy
IT architecture
International partnerships
Life Interrupted…
4.35am, 4 September 2010
Delivering the vision
• HINZ, November 2010 – Sheree East
“The key thing is, understanding the landscape
in which you are operating is constantly shifting.
And when the ground shifts beneath you –
systems need to be flexible and sustainable.
“We are now ready to embark upon the trial and
implementation of the dataset using 21st century
documentation and communication technology”
Transforming Clinical Practice through Terminology
12.51pm, 22 February 2011
Help4U
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A health navigation and consumer advocacy service
Linked student welfare division with existing agencies
Commenced coordinating suburban welfare enquiries
Earthquake services A-Z
The lightbulb project / winter care parcels project
Operation Suburbs
In the suburbs
• 2000 portaloos
• 27,500 chemical toilets
• 400 disposal tanks
Problems encountered
Interventions
The Aftermath: impact on health
services
Loss of:
• 100 tertiary care hospital beds (17%)
• 600 residential care beds
• 122 non-government community health groups
and counting…..
June 2011
Entrer (enter)…Omaha System
• TotalCare service
– Hospital in the Home
• Nurse Practitioner service
– Older Persons’ Health
• Help4U service
– Family health centre care coordination
• AESOP clinical documentation tool
• New Zealand Omaha System User Group
Start and Chart…
©2012 Help4U Holdings Ltd
Preliminary Comparison:
Nurse Practitioner Service and
TotalCare Service
• The Nurse Practitioner Service served 11
patients (27% male, 36.4% living alone)
• Average age 86.6 years, with an average of 6.1
problems per patient (67 total problems)
• Have been referred by general practitioner for
more frequent in-home visits
• The TotalCare service served 37 patients (27%
male, 56.8% living alone)
• Average age 84.8 years, with an average of
10.0 problems per patient (371 total
problems)
• Have been identified as requiring residential
care, but there is no bed
Of the 9 top problems, 5 are physiological and 4 are health related behaviors.
Comparison of Problems (n > 20)
Neuro-musculo-skeletal function
30
7
Personal care
28
2
Health care supervision
27
3
Urinary function
23
2
Pain
4
Physical activity
NPS
22
2
Medication regimen
21
4
Vision
20
5
Skin
16
7
0
TC
23
5
10
15
20
25
30
35
*Behavior is significantly higher for TC (differences for
knowledge and status are not significant)
Comparison of Baseline
Knowledge, Behaviour, and Status Ratings
5
4.5
4
3.72
3.32
3.5
3.02
3
3.00
3.05
2.76
TC
2.5
2
1.5
1
Knowledge
NPS
Behaviour
Status
Baseline assessments for all problems:
Individual/Family/Community Level
232
Individual
34
70
Family
Community
4
TC
NPS
5
0
64
Missing
29
0
50
100
150
200
250
Next Steps
• Omaha System Partnership Care Plans
– Diabetes
– Wound Management
– Homecare
• Post discharge care coordination research
• Streamlining and integration to care process
• TotalCare Evaluation
– “The service appears to have achieved what it was
set up for with only 25% of those eventually
admitted to resthomes and only 1 to hospital. Six
patients ended up dying in their own homes”.
Quake ‘Swarms’
(3,400 > mag 3; > 11,000 in total, in 21 months)
Questions
Acknowledgements
Sheree East, RN, DoN
Nurse Maude, Christchurch NZ
Karen A. Monsen, PhD, RN
University Of Minnesota, Minneapolis, MN, USA
Amy B. Lytton, MS, RN
St. Paul-Ramsey County Public Health, MN, USA
Sara Avery
Massey University, Nursing Programme
Wellington, NZ
Ashleigh Peck
CPIT School of Midwifery
Christchurch, NZ