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Recognition of the need to improve the quality of documentation as well as decrease the 'paperwork overload' provided the impetus for implementing a computerised care plan system at Grant Lodge in regional Victoria. The system has resulted in improvements to resident care plans and has optimised Resident Classification Scale (RCS) entitlements.
This case study is also a personal journey for Tineke Carr, a Registered Nurse (RN) and the Unit Manager who instigated this project, convinced management to fund it and led the transformation efforts.
Case Study Setting
Djerriwarrh Health Services provides community, acute and aged health care services to the Moorabool and Melton Shires in regional Victoria. Grant Lodge is a residential aged care facility (RACF) providing high level care for 30 residents. It is located on the Bacchus Marsh campus, sharing the infrastructure services with acute health care.
In 2001 Tineke Carr took up the position of Unit Manager of Grant Lodge. Being new to aged care, she was initially overwhelmed by all the paperwork. Tineke had recently attended the Nursing Informatics Conference in New Zealand where she gained exposure to the possibilities of applying information technology in nursing practice; but Grant Lodge had only one computer in the nursing office!
Care plans were developed by nursing staff utilising a proforma care plan. The proforma had a limited number of care issues and suitable interventions. The draft care plan was then sent to administration staff for typing. This resulted in a new resident not having a care plan for several weeks. As care needs for individual residents changed, the changes were hand written on the care plan, resulting in messy and illegible care plans.
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- Djerriwarrh Health Services participated in an external financial benchmarking exercise between 9 other aged care services of similar size. The report indicated that Grant Lodge had a less favourable resident profile (i.e. Resident Classification Scale (RCS) scores which give a lower financial return) than many peer RACFs.
- A visit from a review officer identified that there was insufficient evidence available to substantiate the RCS claims. This resulted in a resident's change of classification from category 2 to category 3
Having identified a need for improvement in the process and development of care plans, Tineke began to investigate several care planning software products. In addition to the requirements listed below, she wanted to ensure any software implemented would meet aged care standards, legislative and RCS requirements.
To find the most suitable product that would meet these criteria, Tineke searched the Internet and reviewed brochures she had received in the mail and collected at a conference. She visited a facility which had implemented a computerised financial package which included provision for care planning, however this facility had not implemented the care planning component. Once the most suitable product was identified (Software Workshop Aged Care), Tineke consulted with Grant Lodge's information technology (IT) support person to identify the technical requirements and associated costs.
A report was prepared and presented to management with specific recommendations. These recommendations included the software that would meet Grant Lodge's needs, hardware requirements, an implementation program and the potential benefits.
Once management approved the proposal, the implementation plan commenced. The software was purchased, installed on the server, and made available on the lone computer in Grant Lodge. The purchase of another computer took several months, but fortunately cabling had been installed previously.
Security and access was handled by Djerriwarrh Health Services' IT support person, in consultation with Tineke.
An education and training in-service session for nursing staff was held to provide a brief overview of the system and the anticipated benefits. Staff participated in a 3 hour 1:1 education session during which resident details were entered and a care plan developed.
The implementation process was over a three month period. During this time the majority of staff had completed the training, all residents' details had been entered on the computer and comprehensive care plans developed.
The following components were implemented:
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- The resident database stores information such as personal details, next of kin, billing details, medications, medical events and social, entertainment and activity profiles. From this information individual reports can be created, for example an individual resident's incident history or a facility wide incident event report for a particular period.
- The care plan component allows staff to easily create a personalised care plan from various templates, including a 'do-it-yourself' option. All goals and interventions can be personalised. Staff chose to print out the care plan to ensure it was readily available for nursing staff.
- The RCS assessment component is a special 'wizard' that calculates the RCS category depending on the care provided. Reports are available which provide statistical data related to the facility's RCS claims.
Grant Lodge now has a readily accessible resident database that keeps track of resident details including next of kin, medications, incidents, and activity profile.
Other benefits include:
- Individualised care plans which are comprehensive, easy to read and readily accessible.
- A computer in the nurses' station that can be accessed by all nursing staff.
- Individual and facility wide reports can be generated.
- Able to generate a hospital transfer form which is timely and accurate.
- Simplifies the 3 monthly review of the care plan with the resident / next of kin.
- The 'wizard' to assist in the RCS assessment of residents.
- All care provided is now documented enabling an RCS claim which is well supported with documentation.
- Presents a professional image.
- Increased computer literacy amongst nursing staff.
The following 'lessons learned' are from Tineke's experience of this process, as well as from her wide reading on the subject and discussions with her peers:
- Staff need to be inspired to see the benefits IT can produce for them.
- Identify your budget and specific information needs and match the software to suit.
- Staff education is essential.
Key Success Factor
A champion to initiate, lead and drive the project. In this case, Tineke was that person, in her role as Unit Manager.
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