Lecture Notes in Medical Informatics Vol. 1: Medical Informatics Europe 78. Proceedings 1978. Edited by J. Anderson. XI, 822 pages. 1978. Vol. 2: D. Fenna, S. Abrahamsson, S. O. L06w and H. Peterson, The Stockholm County Medical Information System. VI, 163 pages. 1978. Vol. 3: Long-Term Studies on Side-Effects of Contraception - State and Planning. Symposium 1977. Edited by U. Kellhammer and K. Oberla. VI, 240 pages. 1978. Vol. 4: Clinical Trials in 'Early' Breast Cancer. Proceedings 1978. Edited by H. R Scheurlen, G. Weckesser and I. Armbruster. VI, 283 pages. 1979. Vol. 5: Medical Informatics Berlin 1979. Proceedings 1979. Edited by B. Barber, F. Gremy, K. Oberla and G. Wagner. XXIII, 970 pages. 1979. Vol. 6: Health Care Technology Evaluation. Proceedings, 1978. Edited by J. Goldman. VII. 118 pages. 1979. Vol. 7: Technology and Health: Man and his World. Proceedings, 1978. Edited by G. Wagner, P. L. Reichertz and E. Mase. VI, 243 pages. 1980. 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XX, 938 pages. 1982. Vol. 17: Biomedical Images and Computers. Proceedings, 1980. Edited by J. Sklansky and J.-C. Bisconte. VII, 332 pages. 1982. Vo1.18: D.P Pretschner, Engymetry and Personal Computing in Nuclear Medicine. V, 129 pages. 1982. Vol. 19: R L. Blum, Discovery and Representation of Causal Relationships from a Large Time-Oriented Clinical Database: The RX Project. XIX, 242 pages. 1982. Vol. 20: S. Biefang, W. Kopcke, M.A. Schreiber, Manual for the Planning and Implementation ofTherapeutic Studies. V, 100 pages. 1983. Vol. 21: Influence of Economic Instability on Health. Proceedings, 1981. Edited by J. John, D. Schwefel, and H. Zollner. VIII, 528 pages. 1983. Vol. 22: Objective Medical Decision-making; Systems Approach in Acute Disease. Pro ceedings, 1983. Edited by J. E. W. Beneken and S. M. Lavelle. VIII, 243 pages. 1983. Lecture Notes in Medical Informatics Edited by O. Rienhoff and D.A.B. Lindberg 41 James P. Turley Susan K. Newbold (Eds.) Nursing Informatics '91 Pre-Conference Proceedings Springer-Verlag Berlin Heidelberg New York London-Pans Tokyo Hong Kong Barcelona Budapest Editors James P. Turley Project Director Community Nursing Minimum Data Set Melbourne, Victoria, Australia and Associate Professor University of Texas Health Science Center Houston, Texas, USA Susan K. Newbold Health Application Specialist IBM Australia Ltd. Melbourne, Victoria, Australia and IBM Bethesda, Maryland, USA ISBN-13: 978-3-540-53881-3 e-ISBN-13: 978-3-642-95656-0 001: 10.1007/978-3-642-95656-0 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its current version, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1991 2127/3140-543210 - Printed on acid-free paper FOREWORD The Fourth International "Nursing Informatics '91" Preconference sessions held in Melbourne Australia on the 12th and 13th April 1991 hosted by the Nursing Computer Group, Victoria Inc. (N.C.G.V.) and I.M.I.A. Working Group 8. The aims of both the International Committee and the N.C.G.V.are to provide our Nursing Colleagues nationally and internationally with access to a wide range of information about computers awareness literacy ,and, the sharing of experiences. As technology advances and nurses understand their particular practice setting needs, progress in the area of nursing informatics will be an expanding arena for Industry and knowledge. Papers such as those presented here will contribute greatly to the dissemination of todays knowledge base and hopefully assist in our expansion as we move toward the year 2000. The vision and subsequent motivation of hosting an International Informatics Meeting is that a few very dedicated nurses can encourage their colleagues to approach this newly defined specialty with openness and enthusiasm. If nurses are not able to attend these sessions the papers presented here demonstrate care and commitment to the learning opportunities afforded nurses in Australia and Internationally. It is my opinion that awareness, followed by knowledge of a specialty, even one so new and dynamic as Informatics is the primary legacy that the hosts can give to the country that supports an International Conference. I would like to envisage the time when conference forums not only saluted the presenters but encouraged the host country nurse participants to learn first hand from the "experienced". These forums should disseminate their findings to address nursing informatics as a whole and the unique needs of the host country. The profession would still be able to take informatics to the edge and involve nurses in nursing informatics. The future does require participation in decision making and nurses at all levels of competency and knowledge should be part of the "team". This text owes much to the contributing authors and to the excellent editing of Jim Turley and Susan Newbold, to them all thank-you. The Nursing Computer Group Victoria (Inc.) Australia has been honoured to be part of the international nursing informatics community and the N.C.G.V. knows they have in a small way contributed to the expanding knowledge of the use of computers and information science. Joan Edgecumbe President Nursing Computer Group Victoria (Inc.) PREFACE These articles are the Proceedings of the Pre-Conference Workshops held prior to the Fourth International Conference on Nursing Use of Computers and Information Science. The Conference is more commonly known as Nursing Informatics '91. Nursing Infomatics '91 was held in Melbourne, Australia, 12-13 April, 1991. The Conference attracted those interested in Nursing and Computers from all over the world. The authors are thanked for their dedication to furthering the use of computers in Nursing and to sharing their views, opinions, successes, and failures so that others might learn. The ultimate goal is that clients receive improved nursing care as a result of the introduction of computers to the health care environment. Some editing has taken place with the articles, but it was the intention of the editors to retain the author's style and flavor. The papers offer a wide variety of opinions and experiences from a set of individuals from all over the world--from the Americas, Europe, and the host-country, Australia. The Pre-Conference Workshops provided in-depth coverage of important subjects including systems for use in critical care, bedside terminals, standards and minimum data sets, working with computer programmers, automated nursing documentation, computers and information technology in nurse education and training, system implementation and evaluation, and career planning. One workshop provided the opportunity to personally review educational software whilst one workshop aimed to introduce nurses with little prior knowledge to the use of computers and information science. The planning for the Pre-Conference Workshops started approximately one year prior to the actual Conference and those committee members are herein recognised for their efforts. The Pre-Conference Workshop Committee follows: Joan Edgecumbe, Convener Barbara Carter Phil Eltringham Anita Griffin John Hinterreiter Sally Mizrahi Susan Newbold Martin Owen Kate Stanistreet Peter Torokfalvy James Turley We must also thank the corporate sponsors of the Pre-Conference Workshops: Arthur Andersen & Co. HCS Australia Hewlett Packard (Asia & Australia) Ltd. IBM Australia, Ltd. Marquette Electronics, Inc., U.S.A. McDonnell Douglas Information Systems (Australia) Pty Ltd. Others who gave special assistance to the Pre-Conference include: Nancy J. Gantz, Judith Ronald, Penny Baxter, Kathleen A. McCormick, Rita D. Zielstorf, Kathryn J. Hannah, Christine Bolwell, Betsy S. Hersher and ICL Corporation. James P. Turley, Susan K. Newbold, editors. CONTENTS I. BEDSIDE TERMINALS 1 -- Participation Of Nurses In The Development Of A Computerized Bedside Charting System Sherri Dorken, Gordon Tait, Janet Brophy 1 2 -- The Development And Implementation Of A Computerized Bedside Based Nurse Documentation System Carol Robinson 5 3 -- A US Developed Nursing System - Will It Work In Australia? Dianne Ayres 6 4 -- Vision On Bedside Nursing Information Systems H.B.J. Nieman, A.R. Bakker 15 5 -- Bedside 90 -- A New Concept In Information Handling At The Ward Solveig Engdahl, Cecilia Sjoblom, Uif Bergman, Staffan Bergqvist, Berit Jansson, Christine Lindberg, Gert Ljungkvist, Ingrid Robling, Per Salomonsson, Bo Sundin 24 6 -- Point Of Care Terminals: A Blessing Or A Curse? Judith Shamian, Betty Hagen, Ruth Brenner, Philip Lohman 26 II. INTRODUCTION TO THE USE OF COMPUTERS AND INFORMATION SCIENCE 7 -- An Introduction To Basic Computer Concepts Lidia Mayner 31 8 -- Role Of The Nurse In Implementing Nursing Information Systems Rita Axford 35 VI 9 -- Using Computers In Nurse Education, Staff Development And Patient Education Bill McGuiness 43 10 -- Changing Stereotypes A.C. Lynn Zelmer 51 11 -- Future Developments In Information Technology: Potential Impact On Nursing And Patient Care Carol Ingrid Bradburn 62 III. STANDARDS AND MINIMUM DATA SETS 12 -- Network Based Healthcare Computing Applications Samuel Schultz /I 70 13 -- The Challenges Of Developing The Challenges Of Developing A National Minimum Data Set In A Changing World Maggie J. Wheeller 72 14 -- Development Of The National Minimum Data Set For Institutional Health Services Manoa Renwick 82 15 -- Standardized, Comparable, Essential Data Available Through The Nursing Minimum Data Set Harriet H. Werley, Jane S. Leske 95 16 -- Community Nursing Minimum Data Set - Australia James P. Turley 107 17 -- Developing Criteria And Guidelines For Nursing Documentation Margareta Ehnfors, Anna Ehrenberg, Ingrid Thorell -Ekstrand 117 VII IV. SYSTEMS SUPPORTING NURSING PRACTICE 18 -- Data Protection In Nursing Informatics; Balancing Privacy Aspects And Shared Use Elly Pluyter 125 19 -- Development Of A Nursing Information System: Keys To Success P.R.B. Heemskerk - Van Holtz, H.B.J. Nieman, E.S.P. Pluyter- Wenting, W. Roelofs 127 20 -- Quality Assurance And An Automated Health Care Record Mary Ann Lubno 139 21 -- The Role Of Nursing In Computer Automated O.R. Systems: Bridging The Gap From Technology To Implementation Donna Prokopczak 145 22 -- How To Harness The Power Of Information Technology To Benefit Patient Care Barbara Palmer 151 23 -- Nursing Benefits Realization: Effective Nursing Information Management Systems Charlotte A. Weaver 158 V. COMPUTERS AND INFORMATION TECHNOLOGY IN NURSING EDUCATION AND TRAINING 24 -- Computers And Information Technology In Nurse Education - The English Experience. Paula M. Procter 163 1 -- Participation Of Nurses In The Development Of A Computerized Bedside Charting System Sherri Dorken, Gordon Tait, Janet Brophy INTRODUCTION Nurses in an eighteen bed multi-disciplinary Paediatric Intensive Care Unit (PICU) have helped to develop a bedside computer system which automatically records the patient's physiological variables such as heart rate, blood pressure, and respiratory rate from the bedside monitor on a minute to minute basis and graphically displays this information on a bedside microcomputer. The graphic display of this detailed information facilitates the astute observation of patterns and trends in the patient's physiological status (Figure 1). ==== .. Adm:i.:. =TII",:k -P-lIl:i" ,nl. ,A"" """,. IIl:lP U."" DIDAkl:", &"2: IlOE .... DHN ( .. _) ~: 9" Doous ;.ILU: 4 1 ;'-4U6-91;) ;- "~~ W = ~ 2C:Sr;JI ~~ol~t=:::: DI.i)IIIIU &"C1ntrDl I 135 Sal.,." Tmnd ) :: ( II:llrUJr.IT ] '~I;'J~ UUUU~~ ScrDIl DI.plI11U [t--12 lin ) ::!IJ _ ' , t I ,t , ( 1211 ... ->] ...... 2"5a" ~: _: :- .... ;~ ~ ( lIJh y ) ~-_. F - . •••••T ••••• • ••• 100 S""nT. .....I I~ C1211ftT ~ F laa ( "1.111 'ren" ) EID :i 1 ~ II ~D I~ :.. :.. {g :La :b :!a. ( 1"1.,1l Tr.,nd ) 11:ro eQn9 :,2<1S0 5~c11.Tu! -oi.,..t. .h." so. 0 _! .... .&P...,Jj. :' H!!MEELRER" I EaINRRcEJH5 oIoO::~~ FI"Uu ~f\Ql td.o c1 ~ !I.OO no IU PJ:: eeNNEERRRRII ~~"n IO:~ I"U Rote ~ PJ: atERR I I:QRn 10,30 Ii,., o...l &,j' !!HERR I aRcEH 10:80 lilT! In PJ: HELEn EIUWlI 20:10 "c~\a\1 noell1en IBO.O .g ..... PJ: HELEn~1i ~ ~ Figure 1: Physiological status 2 This system will eliminate the routine task of manually recording patient data while it improves the accuracy, legibility and completeness of documentation and provides a more detailed record of the patient's physiological status than is possible with a manual charting system. The system also functions as an information resource for nurses and physicians with features such as automatic calculation of resuscitation drug dosages based on the patient's weight, as well as a database of on-line drug information specific to the paediatric intensive care setting. Nursing care plans, and unit specific policies and procedures will be added to the system in the near future. Nursing interactions with the computer include entering "manual points" for trends that are not being recorded on the patient's monitor, indicating the patient's ventilator rate, and documenting stat and prn medications and "significant event" notes such as pacing, intubation, extubation, to OR, from OR, etc. (See Figure 2). CUlT1Int Nuh Time 0(;:25 Item time 06:25 lIL.J....u.J - :l1i?I'mln til Eignific ..n t E~8nh Ngb Oplign& Nole o I"Iendale~s.tht.11Gt "S ed. SIgn In ~ 01'1:27 PB~.moker-AV Sequenllal Pec,ng Q o SIgn Out IIntl~ lotln o SOB Prugruss Neh COnllDt Intub.tad - 5el Progruse " 061 o E~luboled - See PrDgrng Neurological o Pa~1 mak9r-AY!feQUenl ial Aelplratory o Poclmoker-.Iltnol Pocing o Aelulcltatlo ~ pe~lmeker-""entrlcul.r Pe o lllInlplDntation P8Cim81<9r-Sen~lng In MIIUllaneOUI o (ll~mm'e ) All Drug_ DI t: Repeat Drug~ Repeat Drug I DUIIlI! Repeat Drugl (DIICOntlnUI!~ J ( Autamlnoph. . n IIIiU mg pr ) [!!<!, lI~p'!a' Dnl ~ it I I ( niH"nliDulI d J ( R~I'I'III O'ul,l!l2: ) [~~t Rp'p~ut OrulJ !l'21 ( D'~ Wflt'IIU~ II J ( Il'!p".l Dm!) ,i. ..~ ) [! !<!, U~p'!a' DnlS it~ I I [Cuntinua Figure 2: General screen.