The Impact of an Electronic Medication Administration Record (eMAR) and Computerized Physician Order Entry (CPOE) on Nurse Extender and Unit Clerk Staffing.

OBJECTIVE: The aim of this study is to describe the impact of the introduction of health information technology (HIT) on the utilization and payroll costs of nurse extenders and unit clerks in medicine and surgery units in a large regional health system. BACKGROUND: Long-term policy goals of HIT implementation are reported to include system-level reductions in labor costs, achieved through improved efficiency. METHODS: Using a retrospective cohort model, we analyzed how hours worked per patient day and staffing costs per patient day varied with the implementation of HIT over time at 2 different hospitals within a health system. RESULTS: Implementation of electronic medication administration records was not associated with significant changes in staffing or labor costs. Both labor hours and costs associated with nurse extenders and unit clerks were significantly reduced after the subsequent addition of computerized provider order entry. Simultaneously, units that did not implement any HIT experienced a significant increase in both labor hours and costs. CONCLUSION: Health information technology implementation in the inpatient setting is associated with significant savings in labor hours and costs in non-registered nursing roles.

Current beliefs and management strategies for treating infant colic.

INTRODUCTION: The purpose of this study was to describe the current beliefs about the etiology of colic as well as current management approaches used by pediatric health care providers. METHOD: An open-ended, short- answer survey concerning beliefs about the etiology and treatment of colic was conducted at major National Association of Pediatric Nurse Associates and Practitioners and American Academy of Pediatric meetings. The two groups of providers surveyed, pediatric nurse practitioners (PNPs) (n = 216) and pediatricians (n = 215), were similar in age and years of practice. RESULTS: PNPs were more likely to define colic as "excessive crying." No differences were found in the beliefs regarding etiology of colic. Pediatricians reported seeing more colicky infants per month. A strong relationship existed between etiology and primary treatment approach. Statistically significant differences were found between PNPs and pediatricians in approaches to management of colic. DISCUSSION: Colic remains a prevalent and mysterious malady, with a critical need for more evidence-based treatment protocols. Differences in approaches used by providers were found, with PNPs more likely to use behavioral and environmental approaches to treatment.

Sentinel lymph node mapping following neoadjuvant chemotherapy for breast cancer.

The purpose of this study was to evaluate the feasibility of sentinel lymph node mapping in patients undergoing neoadjuvant chemotherapy for breast carcinoma prior to lumpectomy or mastectomy and sentinel lymph node mapping followed by complete axillary dissection. A retrospective analysis of 14 patients from February 1998 to July 2000 with stage I to stage IIIB breast cancer diagnosed by core biopsy underwent neoadjuvant chemotherapy (doxorubicin/cyclophosphamide) prior to definitive surgery, including lumpectomy or mastectomy and sentinel lymph node mapping, followed by full axillary dissection. Thirteen of 14 patients had successful sentinel lymph node identification (93%), and all 14 underwent full axillary dissection. An average of 2.2 sentinel nodes and a median of 16 axillary lymph nodes (including sentinel nodes) were found per patient. Of the 13 patients in whom a sentinel lymph node was identified, 10 were positive for metastases (77%). Only 4 of the 10 had further axillary metastases (40%). Three patients had negative sentinel lymph nodes shown by hematoxylin and eosin and cytokeratin stainings and had no axillary metastases (0% false negative). The single patient in whom a sentinel lymph node could not be identified had stage IIIA disease with extensive lymphatic tumor emboli. Sentinel lymph node mapping is feasible in neoadjuvant chemotherapy breast cancer patients and can spare a significant number of patients the morbidity of full axillary dissection. Further study to evaluate sentinel lymph node mapping in this patient population is warranted.