• Title/Summary/Keyword: Nursing Record Improvement

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Incidence of Falls and Risk Factors of Falls in Inpatients (입원환자의 낙상 실태 및 위험요인 조사연구)

  • Yoon, Soo-Jin;Lee, Chun-Kyon;Jin, In-Sun;Kang, Jung-Gu
    • Quality Improvement in Health Care
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    • v.24 no.2
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    • pp.2-14
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    • 2018
  • Purpose: The objective of this study was to report the incidence of falls in hospitals and analyze the risk factors for falls. Methods: This study used data on 1,216 patients who experienced falls from 2015 to 2017 during their hospitalization. The data was collected from the falls incident reports and patient' electronic medical record of hospital. Data were analyzed with descriptive statistics using Chi-square test, Fisher's exact test and multiple Poisson regression analysis with the SAS 9.4 Results: The incidence of falls was 1.38 per 1,000 patients days (2015), 1.81 per 1,000patients days (2016) and 1.99 per 1,000patients days (2017). The incidence of injury caused by falls (level III~V) was 0.05 per 1,000patients days (2015), 0.04 per 1,000patients days (2016) and 0.06 per 1,000patients days (2017). The largest number of falls occurred during night shift (42.5%), specifically in the patients' room (70.8%), and medical unit (66.0%). Average age of fallers was 69.1 years and 61.7% of them were older than 71 years. CCI and the patient's department have statistically significant differences in injury or injury levels from falls, but the integrated nursing care services had no significant difference in injury or injury levels from falls. Conclusion: The result of this study can be used as a reference for establishing a fall prevention strategy for hospitalized patients by presenting index values such as the fall rate.

Study on the Awareness, Satisfaction and Job Stress of Nurses using EMR System (EMR System을 이용하는 간호사의 인식도, 만족도와 직무스트레스에 관한 연구)

  • Oh, Jae-Woo;Han, Jin-Sook;Moon, Young-Sook
    • Journal of Digital Convergence
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    • v.10 no.8
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    • pp.257-264
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    • 2012
  • This study was conducted to arrange the basic data for the ways to operate the effective nursing programs and reduce job stress by grasping the awareness, satisfaction and job stress of the nurses due to the introduction of EMR(EMR : Electronic Medical Record) system and clarifying the relationship among them. Methods: Of the hospitals which introduced EMR, the study was conducted for 356 nurses who used EMR in a university hospital in D city and the data was collected from June 1 to June 30. The collected data was analyzed with real number, percentage, T-test, ANOVA, and Pearson correlation coefficient. Results: The results of the study above, it could be certified that the higher the satisfaction and awareness of the users of EMR were, the more the job stress of them decreased. Therefore, the qualitative nursing should be provided to the patients by reducing job stress with the improvement of the awareness and satisfaction of the nurses of EMR, and shortening the time in keeping the records of patients, in order to enhance the satisfaction of EMR, there should be a proper management, such as a regular EMR education, and there must be the ways to reduce the job stress of the nurses and strengthen the satisfaction of EMR.

Hospital-Acquired Pressure Injury: Clinical Characteristics and Outcomes in Critical Care

  • Hyun, Sookyung;Moffatt-Bruce, Susan;Newton, Cheryl;Hixon, Brenda
    • International Journal of Advanced Culture Technology
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    • v.7 no.2
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    • pp.28-33
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    • 2019
  • Electronic health records (EHRs) enable us to use and re-use electronic data for various multiple purposes, such as public reporting, quality improvement, and patient outcomes research. Current hospital-acquired pressure injury (HAPI) risk assessment instruments have not been specifically developed for intensive care unit (ICU) patients and showed false positive rates in this specific populations. Previous research studies report a number of risk factors; however, it is still not clear what factors influence ICU HAPI in this population. As part of a larger research study, we performed an exploratory analysis by using a large electronic health record data. The aims of this study were to compare characteristics of patients who developed HAPIs during their ICU stay with those who did not, and to determine whether the two groups were different in the aspects of length of ICU stay, discharge disposition, and discharge destinations. We conducted chi-square test and t-test for group comparison. Association was examined by using bivariate analyses. Pearson correlation coefficients were used to examine correlation between LOS and number of medications. Our findings suggest a number of consistent and potentially modifiable risk factors, such as sedation, feeding tubes, and the number of medications administered. The mortality of the HAPI group was significantly higher than the non-HAPI group in our data. Discharge disposition was significantly different between the groups. 67% of the HAPI group transferred to intermediate or long-term care hospitals whereas 57.7% of the non-HAPI group went home after discharge. Awareness of these risk factors can lead to clinical interventions that can be preventative in the ICU setting.

A Study on the Factors Affecting Self-Regulation Program for Hypertensives (본태성 고혈압환자를 위한 자기조절 프로그램 관련요인 연구)

  • Park, Young-Im
    • Research in Community and Public Health Nursing
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    • v.6 no.2
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    • pp.234-249
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    • 1995
  • Essential hypertension, one of the leading primary cause of death in Korea, is a typical chronic disease requiring adequate and continuous management. Though these hypertensives need to maintain desirable health practice by themselves for their life time, many previous studies indicated that most of the essential hypertensives have no specific symptoms and thus, reluctant to follow appropriate medical regimens causing the condition further aggravated and complicated. Thus the comprehensive self-regulation program was conducted as a nursing intervention on the promotion self-care 'performance and improvement in physical parameters of hypertensives. For this purpose, a one group quasi -experimental research with pre and post test design was used. And the whole program was carried out from October, 1993 to February, 1994. Self-regulation program was consisted with group education on hypertension and self-care, self-regulation including the blood pressure self-monitoring and recording, recording of daily self-care activities, and encouraging and reinforcing self-efficacy through verbal persuation and enactive attainment. The subjects were asked to measure their own blood pressure by themselves twice per day and to record blood pressure and the daily self-care performance according to the instructions provided during the whole period of 9 weeks. The data was analyzed by experimental stages: the first week, the fifth week, and the ninth week since the experimental imput began. Data were analyzed by the SPSS PC+ program with paired t -test and F-test, and multiple correlation to determine the variables affecting the effect of program. The results were as follows : 1) Subjects in J company were significantly lower diastolic blood pressure than K company after the program (t=2.39, p=.024). Level of cholesterol was significant difference according to position(t=2.23, p=.034), family history (t=-2.66, p=.013), diagnosis duration, and career(t=2.88, p=.055). Perceived self-efficacy was more significantly increased among the group with family history(t=-3.00, p=.013). 2) Before the program, there were significant positive correlation among the variables: internal-LOC and self-efficacy(r=.3952, p=.015), external-LOC and barriers (r=.6515, p=.000), chance-LOC and Barriers(r=.4133, p=.012). However there were significant negative correlation between internal-LOC and barriers (r=-.3236, p=.041, external-LOC and self -efficacy(r=-.3517, p=.028), self-efficacy and barriers(r=-.6654, p=.000). 3) There were significant relationships between changes in self - care performance and self-efficacy at 5th week (r=.5313, p=.001) and changes in self-efficacy at 9th week(r=.4586, p=.005). 4) After the program, internal health locus of control and perceived benefits showed significant correlation(r=.5673, p=.001, but perceived barriers was negative correlation with perceived self-efficacy (t=-4242, p=.01). From the above results, it can be concluded that the self-regulation program is an effective nursing strategy through the change of variables to promote self-care performance of hypertensives and to increase the self-efficacy. Thus this program can be recommended in the management of the hypertensives in workplaces and community settings.

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An Effect of the Self-Regulation Program for Hypertensives -Synthesis & testing of Orem and Bandura's theory- (본태성 고혈압 환자의 자가간호증진을 위한 자기조절 프로그램 효과 -Orem이론과 Bandura이론의 합성과 검증-)

  • Park, Young-Im;Hong, Yeo-Shin
    • Research in Community and Public Health Nursing
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    • v.5 no.2
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    • pp.109-129
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    • 1994
  • Chronic health problems has become a major concern and challenge to the health care professionals today. Especially hypertension, one of the leading primary cause of death in Korea, is a typical chronic disease requiring adequate and continuous management. Though these hypertensives need to maintain desirable health practice by themselves for their life time, many previous studies indicated that most of the essential hypertensives have no specific symptoms and thus, reluctant to follow appropriate medical regimens causing the condition further aggravated and complicated. Self-care is an essential factor that keeps chronic patients in control of their health and wellness. Thus this study was conducted to identify the effect of the comprehensive self-regulation program as a nursing intervention on the promotion self-care performance and improvement in physical parameters of hypertensives. For this purpose, a one group quasi-experimental research with pre and post test design was used. The subjects of the study was consisted of thirty persons with mild or moderate essential hypertension from two companies in Cheong-ju city. The whole program was carried out from October, 1993 to February, 1994. The self-regulation program was consisted with group education on hypertension and self-care, self-regulation including the blood pressure self-monitoring and recording, recording of daily self-care activities, and encouraging and reinforcing self-efficacy through verbal persuation and enactive attainment. The subjects were asked to measure their own blood pressure by themselves twice per day and to record blood pressure and the daily self-care performance according to the instructions provided during the whole period of 9 weeks. The instruments used for data collection in this study were as follows : 1) Instruments used for measuring the knowledge about hypertension, multiple health locus of control, and perceived benifits and barriers were adapted from previous studies and modified by author to be fit for the subjects. 2) Self-efficacy scale and self-care performance record were developed by the author. 3) Physiological parameters included systolic / diastolic blood pressure, body weight, level of blood cholesterol, and 24hour ambulatory blood pressure. The post-experimental Cronbach's Alpha as the reliability test of scales were 0.703-0.897, an appropriate level of confidence. The effect of the program was analyzed by experimental stages ; the first week, the fifth week, and the ninth week since the experimental imput began. Data were analyzed by the SPSS PC+ program with paired t-test and t-test, repeated measure ANOVA, and pearson's correlation to de termine the effect of program. The results were as follows : 1) After the self-regulation program, scores on knowledge(t=-2.41, p=.011), perceived self-efficacy (F=5.60, p=.001), self-care performance(F=22.31, p=.0001) were significantly higher than those before the program. 2) After the program, both systolic and diastolic blood pressure were significantly lower than those before the program(F=10.89 -13.11, p=.0001). However in 24hour ambulatory blood pressure, systolic mean pressure was nearly significantly lower, but not in diastolic mean pressure. 3) After the program, the body weight was significant decresed(t=5.53, p=.0001), but the blood cholesterol level was not decreased significantly except in those cases with higher cholesterol level. 4) There were significant relationships between changes in self-care performance and diastolic pressure at 1st week (r=.3389, p=.033) and changes in self-care performance and systolic pressure at 9th week(r=.3651, p=.024). 5) There were significant relationship between perceived self-efficacy and self-care performance at 5th week(r=.5313, p=.001) and 9th week (r=.3026, p=.052). 6) After the program, internal health locus of control and perceived benefits did not show significant change, but perceived barriers was significantly lower than those before the program (t=3.57, p=.0001). From the above results, it can be concluded that 1) The self-regulation program is an effective nursing strategy to promote self-care performance of hypertensives and to lower the blood pressure. Thus this program can be recommended in the management of the hypertensives in workplaces and community settings. 2) The synthesis of Orem's self-care theory and Bandura's self-regulation & self-efficacy theory in this study was proved to enhance explanation and prediction of the change of self-care behavior. Thus the result of the study would contribute in development of the self-care theory and an expansion of practice-theory.

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The Effects on Knowledge and Attitudes of Smoking by Preventive Education for the Fifth Grade Student in Elementary School (흡연예방교육이 5학년 초등학생의 흡연에 대한 지식과 태도에 미치는 효과)

  • Lee Mi Kyung;Moon Hee Ja
    • Journal of Korean Public Health Nursing
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    • v.16 no.2
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    • pp.388-399
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    • 2002
  • This study would tend to clarify effects on knowledge and attitudes of smoking by preventive education for the fifth grade student in elementary school. It would also hope to contribute to activate smoking preventive education, improvement of health quality for the young and reduce school children's misdeeds. One hundred and sixty-eight school children, the fifth grade student in K city's elementary school have been gathered as testees and divided into two groups : 84 in an experimental group and other 84 in a group for comparison.. Data has been collected between 27th November, 2001 and 8th February, 2002 and methods, which were based on literature study, have been developed by myself and used after reliability test. The process has been formed in this order - pre-survey, experiment (smoking preventive education), the first post-survey and the second post-survey. The pre-survey was to fill the questionnaire and the post survey has done with the same way in 2 and 9 weeks later. The smoking preventive education has been carried out 4 times and the time for each experiment was 40 minutes. The collected data has been analysed by the purpose into $\chi^2-test$, t-test,. F-test, Duncan multiple range test with SPSS. The results of study would be as follows 1. The rate of smoking experience is $17.3\%$ and the biggest motive $(75\%)$ is curiosity. Also $5.4\%$ of respondents reply to have friends smoking a little. 2. The first hypothesis - the group with smoking preventive education would have much knowledge about smoking than comparison group - would be supported with statistical data (t=-3.329, p=.000). 3. The second hypothesis - the group with smoking preventive education would show higher attitude than the other group - would also be backed by statistically meaningful difference (t=-3.856, p=.000). 4. The variables of extent for smoking knowledge would be school record and the variables of extent for smoking attitude is friends' smoking, parents' reaction, experience until now and plan from now on.

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A Study on the agreement of Principal Diagnosis (주상병 일치도에 관한 연구 -1개 중소병원을 중심으로-)

  • Seo, Young-Suk;Kim, Yoo-Mi;Nam, Moon-Hee;Kang, Sung-Hong;Lim, Ji-Hye
    • Quality Improvement in Health Care
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    • v.15 no.1
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    • pp.123-133
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    • 2009
  • Background : The principal diagnosis has been used in many different fields such as hospital statistics, medical research, insurance claim, national health statistics and so on. Some principal diagnoses have a relatively low level of reliability in the medium-sized hospitals. The purpose of this study is to identify the reliability level of principal diagnoses and to suggest ways to improve reliability of the principal diagnosis. Method : Data were collected from a medium-sized hospital located in Pusan. The discharge summaries on 323 patients who were discharged in January, 2008 and the outpatient summaries on 251 patients who visited the hospital on March 28, 2008 were collected, and descriptive analysis was performed using SPSS version 12.0K. Result : The findings are the followings: (1) the diagnostic consistency rate between medical records and doctors' was 92.0%; (2) the diagnostic consistency rate between medical records and insurance claims was 86.1%; (3) the diagnostic consistency rate between doctors' diagnoses and insurance claims was 80.2%. The evidence seems to indicate that some principal diagnoses have reliability problems in the medium-sized hospitals. Conclusion : The results of this study suggest the followings: (1) employees should be trained and supervision of hospital activities are needed; (2) network systems should be constructed for each department; (3) professions need to be fostered (4) doctors' awareness of medical records should be changed.

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Analyzing Health Information Technology and Electronic Medical Record System-Related Patient Safety Incidents Using Data from the Korea Patient Safety Reporting and Learning System (환자안전보고학습시스템 자료를 활용한 의료정보기술 및 전자의무기록시스템 관련 환자안전사건 분석)

  • Cho, Dan Bi;Lee, Yu-Ra;Lee, Won;Lee, Eu Sun;Lee, Jae-Ho
    • Quality Improvement in Health Care
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    • v.27 no.2
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    • pp.57-72
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    • 2021
  • Purpose: At present, there are a variety of serious patient safety incidents related to problems in health information technology (HIT), specifically involving electronic medical records (EMRs). This emphasizes the need for an enhanced electronic medical record system (EMRS). As such, this study analyzed both the nature of and potential to prevent incidents associated with HIT/EMRS based on data from the Korea Patient Safety Reporting and Learning System (KOPS). Methods: This study analyzed patient safety incidents submitted to KOPS between August 2016 and December 2019. HIT keywords were used to extract HIT/EMRS incidents. Each case was reviewed to confirm whether the contributing factors were related to HIT/EMRS (HIT/EMRS-related incidents) and if the incident could have been prevented (HIT/EMRS-preventable incidents). The selected reports were summarized for general clarity (e.g., incident type, and degree of harm). Results: Of the 25,515 obtained reports, 2,664 incidents (10.4%) were HIT-related, while 2,525 (9.9%) were EMRS-related. HIT/EMRS-related incidents were the third largest type of incident followed by 'fall' and 'medication incidents.' More than 80% of HIT/EMRS-related incidents were medication-related, accounting for approximately one-third of the total number of medication incidents. Approximately 10% of HIT/EMRS-related incidents resulted in patient harm, with more than 94% of these deemed as preventable; further, sentinel events were wholly preventable. Conclusion: This study provides basic data for improving EMR use/safety standards based on real-world patient safety incidents. Such improvements entail the establishment of long-term plans, research, and incident analysis, thus ensuring a safe healthcare environment for patients and healthcare providers.

The Effects of Tai Chi Exercise on Physiologic, Psychological Functions, and Falls among Fall-Prone Elderly (태극운동이 낙상 위험 노인의 신체적, 심리적 기능 및 낙상발생에 미치는 효과)

  • Choi, Jung-Hyun;Moon, Jung-Soon;Sohng, Kyeong-Yae
    • Journal of muscle and joint health
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    • v.10 no.1
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    • pp.62-76
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    • 2003
  • This study was a quasi-experimental study of non-equivalent control group pretest and posttest design. The purpose of this study was to determine the effect of Tai Chi exercise program on physical functions, psychological functions, and fall among the fall-prone elderly. The data were collected from September 19, 2001 to January 31, 2002. The study, conducted at two facilities located in Kwang-ju, was targeted to the ambulatory aged 60 years or older who had at least one of the key fall risk factors. Experimental group participated in Tai Chi exercise for 40 minutes per one time and three times a week for 12weeks at an auditorium. Fifty nine fall-prone elderly were assigned to 12-week Tai Chi exercise program (n=29) and control group (n=30). They underwent tests of lower muscle strength, time for chair stand, balance, flexibility, depression, falls efficacy, fear of falling, and numbers of fall at the baseline and at the 12th week. Numbers of fall and fall injuries were monitored for 16 weeks(12-weeks intervention plus 4-week follow-up periods) using fall calendar. Each participant was given a calendar to record the numbers of fall per day for a month. The calendars were collected at the last week of each month. 1. Tai Chi exercisers showed significant improvement in the strength of knee flexors, and ankle dorsiflexors and plantarflexors compared to the control group. The experimental group had improvement in the strength of knee extensors while the control group did not, with no statistical significance. 2. Tai Chi exercisers reported positive change in the average time of chair stand as compared to the control group. 3. Tai Chi exercisers had significant improvement in flexibility as compared to the control group. 4. There was no significant difference in the depression between the two groups, even though the Tai Chi exercisers maintained depression score in the same level while the others were increased. 5. Tai Chi exercisers showed significant improvements in the falls efficacy as compared to the control group. The falls efficacy was significantly improved among the experimental group while the opposite was identified among the control group. 6. The experimental group reported the significant reduction of the fear of fall, whereas control group reported the opposite. 7. Of the 59 subjects for 16weeks(12weeks intervention period and 4weeks follow up), 9 (31.0%) of the 29 in exercise group and 15 (50%) of the 30 in the control group fell (relative risk=0.62. 95% CI 0.32-1.19), even with no statistical difference. The results suggest that the Tai Chi exercise program can improve the strength of knee flexors, ankle dorsiflexors and plantarflexors, chair stand. flexibility, falls efficacy, and fear of falling for the fall-prone elderly.

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Activity to reduce the record missing for nursing care charge (간호수가 누락률 감소활동)

  • Kim, Nan Ja;Lee, Yong Kyo;Kim, Hye Jin;Cheung, Ok Ju;Song, Nam Gyoung;Jun, Mi Sun
    • Quality Improvement in Health Care
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    • v.15 no.1
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    • pp.73-78
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    • 2009
  • 문제: 오늘날 간호사는 과거와 달리 현대적 보건의료 요구를 해결할 수 있는 체계적인 이론과 기술을 습득하도록 훈련된 고급 전문 인력이고, 간호행위를 생산하기 위해서는 서비스의 생산원가 뿐만 아니라 전문 인력으로서의 훈련 및 유지비용 등도 투입되어야만 가능하게 함으로서 2008년 7월부터 시행한 중환자실 간호등급에 따른 간호수가 책정으로 인해 중환자실 내에서 이루어지고 있는 많은 간호행위 중 수가를 받을 수 있는 부분이 생기게 되었고 간호행위의 중요성과 더불어 간호를 시행 후 받을 수 있는 수가에 대한 간호사들의 입력에 대한 의무도 늘어나게 되었다. 이에 빈번히 누락되고 있는 간호수가 관리를 통한 경제적 손실을 방지해야 할 필요성을 느껴 개선활동을 하고자 한다. 목적: 2008년 7월부터 시행한 중환자실 간호등급에 따른 간호수가 책정으로 인해 중환자실내에서 이루어지고 있는 간호 행위의 중요성을 인식하고 구체적인 문제 분석과 간호 현장에서의 개선안을 도출함으로써 경제적 손실을 방지할 수 있는 간호수가 누락률을 감소시키고자 함이다. 의료기관: 대구파티마병원 내과 중환자실. 질 향상 활동: 업무개선의 방법으로 환자 개인별 간호수가 입력 누락 방지 체크 리스트 사용 및 처방 전달 시스템의 간호수가 재입력 화면을 이용하여 입력의 용이성 도모하였고 입력된 간호수가를 처방 전달 시스템 간호수가 조회 프로그램을 이용해 익일 누락여부를 매일 모니터링 하였다. 교육 및 홍보활동으로는 간호수가 입력누락 방지를 위한 간호수가 입력 지침을 제작하여 전체간호사는 년 2회, 신규간호사는 개별 교육을 실시하였으며, 월별 간호수가 누락통계를 실명 공고 하여 간호수가 다 빈도 누락 간호사는 추가 개별교육을 실시하였다. 개선효과: 간호수가 입력 프로세스 개선을 통해 간호수가 평균 누락률이 개선 전 6.5%, 개선 후 1.2%로 5.3%의 누락 감소율을 보였으며 역치 5%를 달성하였고 간호수가 누락금액은 개선 전 2,992,752원, 개선 후 590,787원으로 2,401,965원의 누락 효과 비용을 구할 수 있었다. 본 QA활동으로 중환자실 간호수가 전산입력에 대한 체계적인 교육부재와 신규간호사들의 잦은 전산누락이 있어왔으나 표준화 된 체크리스트 지침과 입력확인 작업으로 전산입력 누락률이 감소하는 효과를 가져왔다. 추후 심평원 청구 작업을 하는 부서와 연계되어 실제 청구 누락률에 대한 비교와 간호사 근무연수와 간호수가 입력 누락률에 대한 상관관계 조사를 제언 해 본다.

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