Care administration systems

Whilst perhaps and over simplification, in general the ability of the systan to influence care and therefore the potential risk to patients increases down the list. Nevertheless one should not assume that just because a system seems to fit a specific class then a particular approach to risk management is warranted or can be or justified. The level of analytical rigour and need for risk reduction depends entirely on a particular system s potential to adversely impact care irrespective of how one might choose to classify it. 

These systems are associated with the running and operation of the healthcare service. Often the applications are not specific to health and sometimes they are general tools which have been configured for use in a healthcare setting. Typical systems are those which support business functions such as  

Payroll and Human Resources Staff rostering Finance management Billing Complaints 

In the main systems of this nature do not influence care sufficiently to introduce any significant clinical risk (or at least to influence care is not part of their intended purpose). Where dependencies are likely to exist it would appropriate to consider clinical risk - otherwise the focus of any analysis will be on the business. As such most countries choose not to regulate these kinds of application in healthcare. 

Note though that it is nearly always possible through inference to derive scenarios where failures of these systems could eventually compromise patient care. For example, errors in staff rostering could contribute to a service being understaffed which could then lead to an adverse outcome. Generally the harm causality pathway in these cases is tenuous or convoluted. There is sufficient human intellect embedded within the business processes to catch potential problans long before they realistically affect care. In other words any hazards are simply not credible in the real world or would fall into a category where risk reduction would not be justified by the effort required. 

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Care administration systems deal with the practical organisation of care delivery but stop short of capturing and delivering the information on which clinical decisions are made. 

Care administration systems have the capability to more directly influence the provision of and access to care. Their lack of ability to affect clinical decision making in no way precludes them from being safety-related. In fact significant risk can exist in relying on these system to manage care delivery. For example, suppose a system fails to create appointment letters at the appropriate time such that patients... 

Depending on the type of ester used, losses of vitamin A by binding to the administration systems can be considerable and complicate the interpretation of the study results (91). Special emphasis should be put on delivering adequate doses and the photoprotection of vitamin A, when this active is employed in neonatal care. The effect of phototherapy radiation on vitamin A photostability, present in TPN admixtures, has been investigated (92). The addition of Intralipid fat emulsion to TPN admixtures significantly reduces losses of vitamin A (Fig. 10). 

It is essential that clinicians and health care delivery systems (including administrators, insurers, and purchasers) institutionalize the consistent identification, documentation, and treatment of every tobacco user who is seen in a health care setting. 

Managing reference data can be particularly troublesome when two or more systems are merged for example when two local systems are being replaced by a single alternative and there is a need to preserve historical cliifical data. Each system is likely to have its own reference data and, particularly over time, it is common for these datasets to have similar purposes but with different content. For example, a Patient Administration System may have five different options for Admission type whilst the Electronic Health Record may have seven different options for that same field. Whilst it might be possible to live with this discrepancy on a day-to-day basis, the situation suddenly becomes very complex when it is necessary to merge the two datasets. Any proposed solutions need a careful safety assessment. 

Key operational components of an information technology plan include provision for maintenance of current systems. Software maintenance costs alone can typically run from 18 to 22 percent of software list prices and the qualified human resources necessary to support installed systems. Typically, information technologies in health care systems are either undeiihinded or place an unreasonable emphasis on administrative systems. An allocation of iq) to 6 percent of the annual operating budget for information systems is not unrealistic. A summary of contemporary infoimation systems is included in the Table 37.3. 

TABLE 37.3 Examples of Contemporary Health Care Information Systems Required for Clinical and Administrative Purposes... 

For example, Karnataka state in South India has experimented quite substantially with health care insurance systems (demand) and new pharmaceutical stocking and distribution practices (delivery). Although quite progressive in this regard, it has no deliberate state or urban administrative mechanisms to test the integration regularly. 

Macbeth, G. (1993). Collaboration can be elusive Vii inia s experience in developing an interagency system of care. Administration and Policy in Mental Health, 20, 259-282. 

The calculation setup screens list a good selection of the options that are most widely used. However, it is not a complete list. The user also chooses which queue to use on the remote machine and can set queue resource limits. All of this is turned into a script with queue commands and the job input file. The user can edit this script manually before it is run. Once the job is submitted, the inputs are transferred to the server machine, the job is run and the results can be sent back to the local machine. The server can be configured to work with an NQS queue system. The system administrator and users have a reasonable amount of control in configuring how the jobs are run and where files are stored. The administrator should look carefully at this configuration and must consider where results will be sent in the case of a failed job or network outage. 

Educating the Patient and Family If lypressin or desmopressin is to be used in the form of a nasal spray or is to be instilled intranasally usingthe nasal tube delivery system, the nurse demonstrates the technique of instillation (see Fhtient and Family Teaching Checklist Self-Adnrinistering Nasal Vasopressin). The nurse includes illustrated patient instructions with the drug and reviews them with the patient. If possible, the nurse lias the patient demonstrate the technique of administration. The nurse should discuss the need to take the drug only as directed by the primary health care provider. The patient should not increase the dosage (ie, the number or frequency of sprays) unless advised to do so by the primary health care provider. 

The Vaccine Adverse Event Reporting System (VAERS) is a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS collects and analyzes information from reports of adverse reactions after immunization. Anyone can report to VAERS, and reports are sent in by vaccine manufacturers, health care providers, and vaccine recipients and their parents or guardians. An example of the VAERS and instructions for completing the form are found in Appendix F. Any clinically significant adverse event that occurs after the administration of any vaccine should be reported. Individuals are encouraged to provide the information on the form even if the individual is uncertain if the event was related to the... 

The nurse reviews the results of all laboratory tests at the time they are reported. The primary health care provider is notified of the results before the administration of successive doses of an antineoplastic drug. If these tests indicate a severe depressant effect on the bone marrow or other test abnormalities, the primary health care provider may reduce the next drug dose or temporarily stop chemotherapy to allow the affected body systems to recover. 

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