ABSTRACT
This article explores the use of a cognitive information-processing structure, mental models, to assess an organizational management change to shared leadership (SL). The purpose of this study was to describe the mental models of critical care nurses after the implementation of an SL management model. Scenarios based on daily clinical situations and measuring three SL concepts (empowerment, accountability, and partnership in decision making) were posed to critical care nurses in personal interviews. By using this evaluation methodology, nurse administrators can determine to what extent a new management change has been incorporated into daily nursing practice and in what areas to target further education and resources.
Subject(s)
Critical Care , Leadership , Specialties, Nursing , Decision Making , Evaluation Studies as Topic , Humans , Models, Nursing , Nursing Methodology ResearchABSTRACT
Complementary nursing was developed in response to the need for maintaining high quality care while controlling health care costs. The complementary nurse provides comprehensive management of complex patients through an entire episode of an acute illness, to transition them back to a prehospital state through interdisciplinary discharge planning. In this article, the authors describe the process used in developing and implementing this new integrated role of acute care case management. The article contains role responsibilities, communication tools, and lessons learned from experience.
Subject(s)
Acute Disease/nursing , Case Management/organization & administration , Delivery of Health Care, Integrated/organization & administration , Episode of Care , Models, Nursing , Humans , Job Description , Patient Care Team , Patient DischargeABSTRACT
Complementary nursing is an acute care case management delivery system developed to maintain high quality care while controlling health care costs. In this article, the authors describe results of a multi-method evaluation of complementary nursing. Patient, staff, ancillary department, physician, and administration responses were positive and indicated that the program improved the quality and coordination of patient care. Readmissions and direct costs decreased, and there was growth in nursing expertise. The development and implementation of the Complementary Nursing Program was described in Part I of this article, appearing in the September/October 1997 issue of Nursing Case Management.
Subject(s)
Acute Disease/nursing , Case Management/organization & administration , Episode of Care , Managed Care Programs/organization & administration , Models, Nursing , Aged , Continuity of Patient Care , Delivery of Health Care, Integrated , Female , Humans , Male , Middle Aged , Nursing Evaluation Research , Program EvaluationABSTRACT
Clinical paths are being developed in response to the current push to decrease healthcare costs while maintaining high quality care. Literature supports clinical path evaluation results, but few articles address a systematic evaluation process. The purpose of this article is to present a five-step evaluation model that can be followed in determining the effectiveness of clinical paths. The goal of the evaluation process is to provide reliable information and to translate the information into changes in healthcare. The article contains a graphic representation of the model, an explanation of each step, and activities to be performed.
Subject(s)
Critical Pathways/standards , Models, Organizational , Outcome and Process Assessment, Health Care/organization & administration , Program Evaluation/methods , HumansABSTRACT
This study was undertaken to evaluate the accuracy of technicians checking unit dose carts as compared with pharmacists checking unit dose carts. The final (after check) fill in both arms of the study was evaluated for accuracy on the same five criteria: 1) correct drug, 2) correct dose, 3) correct dosage form, 4) correct quantity, and 5) expiration date. In the technician arm, 7571 doses were checked with 10 errors, giving a 99.76% (1 error in 420) accuracy. In the pharmacist arm of the study, 3116 doses were checked with 34 total errors, giving a 98.91% (1 error in 92) accuracy. The results of this study indicate that technicians would have as high if not a higher accuracy rate than pharmacists. Using pharmacy technicians in this role should continue the same level of care by maintaining a high accuracy in medication dispensing and provide greater economic benefit to the organization by using technical rather than professional personnel.
Subject(s)
Medication Systems, Hospital/standards , Pharmacy Service, Hospital/standards , Quality Assurance, Health Care/statistics & numerical data , Hospital Bed Capacity, 300 to 499 , Humans , Iowa , Pharmaceutical Preparations/administration & dosage , Pharmacists/standards , Pharmacy Service, Hospital/organization & administration , Pharmacy Technicians/standardsABSTRACT
The process used in preparing this administrative report provided the means of documenting departmental support of technician task expansion, cost benefits, increased availability of professional time, and the need for a dynamic department. Some of the benefits to St. Luke's Regional Medical Center and its Pharmacy Department were an increase in technician job satisfaction, improved quality of patient care attributable to the increased scope of pharmacy service, and up to 8554 hours per year of professional time available for more clinically oriented responsibilities. If technician turnover were decreased by half, technician pricing errors eliminated, and technicians assumed the identified technical tasks, potential monetary benefits could be as much as +116,900 per year. The departmental cost of implementing these recommendations would be an additional 4.16 technician FTEs, and the professional time for training, supervising, and coordinating technicians and functions. These recommendations were well received by pharmacy administration, and the committee was asked to develop a list of priorities and an implementation plan for administrative approval.
