Workflow analysis to identify the opportunities for improving information management and nurses' work efficiency in palliative care

Transcription

1 University of Wollongong Research Online University of Wollongong Thesis Collection University of Wollongong Thesis Collections 2005 Workflow analysis to identify the opportunities for improving information management and nurses' work efficiency in palliative care Shaohui Ma University of Wollongong Recommended Citation Ma, Shaohui, Workflow analysis to identify the opportunities for improving information management and nurses' work efficiency in palliative care, M.Info.Tech. thesis, School of Information Technology and Computer Science, University of Wollongong, Research Online is the open access institutional repository for the University of Wollongong. For further information contact the UOW Library:

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3 Workflow Analysis to Identify the Opportunities for Improving Information Management and Nurses Work Efficiency in Palliative Care A thesis submitted in fulfilment of the requirements for the award of the degree Master of Information and Communication Technology (Research) From University of Wollongong By Shaohui MA School of Information Technology and Computer Science 2005

4 Dedicated to my parents and my sister

5 CERTIFICATION I, Shaohui Ma, hereby declare that this thesis, submitted in fulfilment of the requirement for the award of Master of Information and Communication Technology by Research, in the School of Information Technology and Computer Science, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualifications at any other academic institution. Shaohui Ma 28/03/2005

6 List of Publication Ma, S., Yu, P, and Alcock, C., Workflow Analysis, an Important Tool for Identifying Opportunities for ICT Adoption in Palliative Care Ward, Proceedings of HIC 2004 Conference, Brisbane, July i

7 Abstract As a means to identify the appropriate opportunities for an organisation to apply Information and Communication Technologies (ICT) to streamline its process, workflow analysis is the essential first step in achieving better process management and efficiency. The purpose of this research is to understand, through workflow analysis, the step-by-step process of tasks completed by nurses in a palliative care ward and a community healthcare centre. This understanding will contribute to the accurate identification of appropriate opportunities for applications of ICT that fit the nurses relevant task requirements, and will improve work efficiency of the nurses involved in palliative care. The literature review gives the general concepts of the research and background information about both palliative care and optional applications of ICT. The materials are gathered via the Internet and library. This research is conducted in the palliative care ward at Port Kembla Hospital and the community healthcare centre of the Illawarra region. The major data collecting methods are interview and observation conducted in the ward and the community healthcare centre. These data collecting methods have advantages and characteristics of qualitative research methodology that benefited this research project. The direct outcome of this research is a set of workflow analysis diagrams covering the major procedures of the nurses daily practice. Through analysing these workflow diagrams, this thesis describes the situations for the potential applications of ICT, the ii

8 use of the applications, and the benefits of implementing these applications. After the description and discussion in this thesis, the chosen ICT applications are Personal Digital Assistants (PDAs), wireless technology, scanner and barcode systems, as well as an advanced database system. The adoption of these applications has the potential to improve the management of medical information, and the work efficiency and effectiveness of the nurses daily practice, and benefit the palliative care patients and their families. iii

9 Acknowledgements The research work presented in this thesis was conducted under the supervision of Dr Ping Yu and Associate Professor Carole Alcock, who took the position as my cosupervisor. I express overwhelming gratitude to them. Without their enthusiastic guidance, generous help and encouragement, particularly Dr Ping Yu, I could not have finished this research project. I would like to thank Dr Frank Formby, Ms Janice Jensen, and the nurses of the Palliative Care Unit at Port Kembla Hospital, as well as Ms Jacinda Ramage of the Community Healthcare Centre at Piccadilli Centre and nurses of Warilla Community Healthcare Centre for their patience and generous help. Without them, I could not have gathered adequate information for this research. Finally, I would like to thank my family and my wife for the numerous ways in which they have supported me during the course of this research project. iv

10 Table of Contents List of Publication...i Abstract...ii Acknowledgements...iv List of Figures...ix List of Tables...x Chapter 1: Introduction...1 Chapter 2: Literature Review Introduction Palliative Care Workflow Technology Workflow Background Information on Workflow Management Systems Workflow and Information Technology Applications in Healthcare Examples of Applicable Information and Communication Technologies Hand-held Equipment Access to the medical information E-Prescribing Electronic Medical Record Security Limitations Section Summary Wireless Technology Scanner and Barcode Systems Chapter Summary...28 Chapter 3: Methodology Introduction Conducting the Research What is the Research About? Ethics Considerations Experiment Site Method and Approach Exploratory Study...34 v

11 The Library Resources The Internet Descriptive Study Data Collection Method Qualitative or Quantitative Method? Interview Observation Justification of Research Method Analysing the Data Research Plan Chapter Summary...43 Chapter 4: Results Introduction Nurses workflow in the ward Morning Shift Handover Stock Check (Figure 4.1 a) Check Pumps (Figure 4.1 b) Morning Pill Round Morphine Round (Figure 4.1 c) Handover with Nurse Manager and Resident Doctor Prepare the Documents (Figure 4.1 d) Update the Medical Notes (Figure 4.1 e) Prepare the Lunch Pill Round (Figure 4.1 f) Other Activities Afternoon Shift Handover Stock Check (Figure 4.2 a) Check Pump and Mattress (Figure 4.2 b) Morphine Round (Figure 4.2 c) Pill Round Check the Stock with Pharmacist (Figure 4.2 d) Check the Patient s Figures (Figure 4.2 e) Extra Medicine (Figure 4.2 f) Update the Notes (Figure 4.2 g) Other Activities Night Shift Handover Stock Check (Figure 4.3 a) Check Medication Charts (Figure 4.2 b) Prepare the Pills (Figure 4.2 c) Update the Notes (Figure 4.2 d) Other Activities Admission Notification (Figure 4.4 a) Admission...62 vi

12 Checking (Figure 4.4 b, Figure 4.4 c, Figure 4.4 d and Figure e) Deterioration Check the patient (Figure 4.5 a and Figure 4.5 b) Update the Notes (Figure 4.5 c) Death Check the Patient Death Prepare the Document (Figure 4.6 a) Other activities Summary Community Health First Visit Checking for Referrals (Figure 4.7 a) Occupational Check (Figure 4.7 b) First Visit Update the Data (Figure 4.7 c) Other Activities Follow-on Visit Before Follow-on Visit (Figure 4.8 a) Follow-on Visit the Client Update the Data (Figure 4.8 b) Summary Issues Identified through Investigations Current Medical Database The Information Captured in the Current Database Work Practice Might Be Improved Nurses Mobility Reduce the Duplication of Nurses Tasks Chapter Summary...83 Chapter 5: Discussions and Recommendations Introduction Nurses Work Process That Has Potential to Be Improved Medication Related Processes Medical Records Related Processes Recommendations for The Usage of ICT to Improve The Inefficient Work Processes The Recommended Mechanism for Improving Information Management The Recommended Mechanism for Improving Efficiency Via The Integration of Personal Digital Assistants into Nursing Work Process The Recommended Mechanism for Improving Effectiveness and Saving time Via Integration of Scanner and Barcode Chapter Summary...96 Chapter 6: Conclusion...97 vii

13 References: Appendix 1 Appendix 2 Appendix 3 viii

14 List of Figures Figure 2.1 Workflow Reference Model Components & Interfaces (Hollingsworth 1995)...13 Figure 4.1 Nurses Work Process in Morning shift 46 Figure 4.2 Nurses Process in Afternoon Shift...52 Figure 4.3 Nurses Work Process in Night Shift 57 Figure 4.4 Nurses Work Process in Admission.61 Figure 4.5 Nurses Work Process in Deterioration.64 Figure 4.6 Nurses Work Process in Death 66 Figure 4.7 Nurses Work Process in First Visit.70 Figure 4.8 Nurses Work Process in Follow-on Visit 74 Figure 5.1 Nurses using PDAs to communicate with the medical database..93 Figure 5.2 The usage of scanner and barcode system in the Ward...94 ix

15 List of Tables Table 5.1 Database Structure of the Ward...78 Table 5.2 Database Structure of Community Healthcare Centre...79 x