Eija Kivekäs

Impacts of structuring nursing records: a systematic review

AIM The study aims to describe the impacts of different data structuring methods used in nursing records or care plans. This systematic review examines what kinds of structuring methods have been evaluated and the effects of data structures on healthcare input, processes and outcomes in previous studies. MATERIALS AND METHODS Retrieval from 15 databases yielded 143 papers. Based on Population (Participants), Intervention, Comparators, Outcomes elements and exclusion and inclusion criteria, the search produced 61 studies. A data extraction tool and analysis for empirical articles were used to classify the data referring to the study aim. Thirty-eight studies were included in the final analysis. FINDINGS The study design most often used was a single measurement without any control. The studies were conducted mostly in secondary or tertiary care in institutional care contexts. The standards used in documentation were nursing classifications or the nursing process model in clinical use. The use of standardised nursing language (SNL) increased descriptions of nursing interventions and outcomes supporting daily care, and improving patient safety and information reuse. DISCUSSION The nursing process model and classifications are used internationally as nursing data structures in nursing records and care plans. The use of SNL revealed various positive impacts. Unexpected outcomes were most often related to lack of resources. LIMITATIONS Indexing of SNL studies has not been consistent. That might cause bias in database retrieval, and important articles may be lacking. The study design of the studies analysed varied widely. Further, the time frame of papers was quite long, causing confusion in descriptions of nursing data structures. CONCLUSION The value of SNL is proven by its support of daily workflow, delivery of nursing care and data reuse. This facilitates continuity of care, thus contributing to patient safety. Nurses need more education and managerial support in order to be able to benefit from SNL.

Evaluation of Intravenous Medication Errors with Infusion Pumps

This paper presents the key issues of the use of intravenous infusion pumps to be able to further develop strategies that will improve patient safety and prevent medication errors. The study was conducted in four wards in a Finnish tertiary hospital. These units included medical intensive care unit, surgical intensive care unit, general medical unit and general surgical ward. Multi-disciplinary team, nurses and pharmacists, performed observations (N=492) on the units. The results indicated that errors were rated as A – B in the NCC MERP harm index. Lack of patient identification bands on some units and inadequate allergy documentation appeared as risk factors. Furthermore medication processes varied within the units especially in administering and documenting. In spite of the Electronic Patient Record system, several overlapping documentation forms were in use. Through this prevalence study, violation errors of hospital policy were found that could potentially place patients at risk.