Presented by Dr Chris Hendry Director, New Zealand Institute of Community Health Care

1. Health IT Innovation In Practice
Informing and Improving Community
Nursing Care Through Access to Data.
Dr Chris Hendry
Director
NZICHC
www.nzichc.org.nz

2. Transforming our health care system:
10 priorities (NHS 2013)
1. Active support for self-
management
2. Primary prevention
(population focused)
3. Secondary prevention
(patient focused)
4. Managing Ambulatory Care
Sensitive conditions
(Diabetes, heart failure, asthma etc.)
5. Care co-ordination.
6. Integrating services to meet
mental and physical health needs.
7. Primary care management of
end of life care.
8. Medication management
9. Managing elective activity
10. Managing urgent and
emergency activity.

3. Secondary use of EHR information
• Audit of the ‘system’
– Terminology/definitions
– Information pathways
– Information gaps
– Identification of training needs
• Functioning of the service(s)
– Service overview
– Service impact and outcomes
– Service development priorities

4. Reason for Admission Total clients
Requesting rest home care at home 41
Requesting hospital care at home 12
Previous service unable to meet increased needs 12
Previous service unable to meet long term needs 4
Total 69
Analysis of information entered for the
Nurse Maude TotalCare Service.

5. Ethnicity Total clients %
European
59 88.1%
Maori 4 6.0%
Pacific Peoples 1 1.5%
Other 1 1.5%
Not documented 2 3.0%
Total 67 100.0%
Patients profile.

6. Omaha System Problems Total Clients % of Clients
Personal care 60 89.6%
Neuro-musculo-skeletal function 54 80.6%
Urinary function 50 74.6%
Physical activity 49 73.1%
Medication regime 48 71.6%
Health care supervision 46 68.7%
Nutrition 45 67.2%
Pain 40 59.7%
Cognition 38 56.7%
Skin 38 56.7%
Bowel function 35 52.2%
Service needs

7. Score Knowledge Behaviour
Status
(Wellbeing)
1 no knowledge
not appropriate
behaviour
extreme
signs/symptoms
2
minimal
knowledge
rarely appropriate
behaviour
severe
signs/symptoms
3 basic knowledge
inconsistently
appropriate behaviour
moderate
signs/symptoms
4
adequate
knowledge
usually appropriate
behaviour
minimal
signs/symptoms
5
superior
knowledge
consistently
appropriate behaviour
no signs/symptoms
Use of OMAHA system to identify level of dependency

8. Score
(Omaha KBS Classification)
Knowledge Behaviour Status
(Wellbeing)
1 22 3 18
2 152 16 77
3 188 138 321
4 194 366 139
5 2 35 3
Average score 3.00 3.74 3.06
Median score 3 4 3
Use of OMAHA system to identify level of dependency

9. Polypharmacy
0
1
2
3
4
5
6
7
8
9
10
3 4 5 6 7 8 9 10 11 12 13 14 15 16 >16
Numberofclients
Number of medications per client
The majority of patients (60%) had eight or more medications prescribed.

10. Alerts & Hazard
Name Total Clients % of Clients
Falls risk 58 86.6%
Drug allergy 31 46.3%
Lives alone 31 46.3%
Cognitive ability 27 40.3%
Hearing impaired 28 41.8%
Other 104
Risk assessment

11. Score Pain
Count Of
clients
Percentag
e of
clients
Unknow
n Unknown 1 1.5%
1 I have no pain or discomfort 29 43.3%
2
I have moderate pain or
discomfort 36 53.7%
3
I have extreme pain or
discomfort 1 1.5%
Total 67 100.0%
Standardised tools: EuroQOL

12. Barthel Index – 33% independent
EuroQOL 65% scored 13 or higher =
health impacting quality of life
0
5
10
15
20
25
30
35
<4 4-7 8-11 12-15 16-20
Numberofclients
Barthel Score on admission
<4 = totally dependent
4-7 = very dependent
8-11 = partially dependent
12-15 = needs minimal help with ADLs
16-20 = independent
0
2
4
6
8
10
12
14
16
6 7 8 9 10 11 12 13 14 15 16 17
Numberofclients
EuroQOL Total Score (functional categories) at or near
admission
Good health Intermediate Severe difficulties
Standardised tools: Barthel & EuroQOL

13. 0
2
4
6
8
10
12
12 13 14 15 16 17 18 19 20 21 22
Numberofpatients
Total Braden Score at or near admission
Higher risk
Lower risk
Standardised tools: Risk of pressure injury

14. Geriatric Depression Score
on admission
Count of clients
0-9 (normal) 7
10-19 (mildly depressed) 4
20-30 (severely depressed) 2
Total 13
Standardised tools: Geriatric Depression Score

15. Omaha System Intervention
Interventions
(n=2593)
Percentage of
Interventions
signs/symptoms-physical 376 14.5%
dressing change/wound care 369 14.2%
communication 276 10.6%
nursing care 248 9.6%
continuity of care 228 8.8%
medication administration 206 8.0%
bladder care 193 7.5%
medication coordination/ordering 179 7.0%
medical/dental care 178 7.0%
dietary management 174 6.5%
bowel care 166 6.0%
Service activities

16. Progress during the service

17. Acute Inpatient event LOS
Before TC During TC Difference
7.81 5.72 2.09
ED presentations
Number
Before During
86 33
Average visits per
day
0.24 0.21
Impact of the service

19. • Claire Willemsen (Nurse Maude Nurse Manager)
• Lynn Vandertie (Institute Data analyst)
• Sheree East (Nurse Maude Director of Nursing)