Wednesday, December 13, 2006

The sad state of home care nursing

Where are the research reports that involve home care?

Home care is the sector touted, in every report on the future of healthcare in Canada, as fundamental to the future of the system, a sector that must grow in order to manage the increased complexity that the system will generate.

Given the present and envisioned future of home care, the sector should be a beehive of research activity, and we should have a research report or a report of an innovation in virtually every issue of this journal. The development of leaders is critical for this sector to respond to the enormous opportunities and challenges facing it.

Because home care is not covered by the Canada Health Act, different provinces use a variety of funding and delivery models. The Canadian Home Care Human Resources Study (2003) reports that between 8,600 and 9,700 registered nurses (depending on who is counting) are employed in home care; 29% of them work for private, for-profit agencies. Many receive no fringe benefits such as vacation, sick leave or pensions, and their salaries are lower than those of nurses working in other sectors (Canadian Home Care Human Resources Study 2003).

Home care nursing has a long and proud history in Canada. It needs great leadership to stimulate the development of innovations and research to put information into the hands of decision-makers.

Read the complete editorial here:

Dorothy Pringle, PhD
Editor-in-Chief, Canadian Journal of Nursing Leadership

Tips to navigate healthcare

"Tell the doctor why you are taking notes! You will discover that note-taking is a major theme of this book, yet we had never considered the doctor's interpretation of the patient taking notes. Since we have interviewed several physicians, we now know it is good practice to explain to the doctor up front why you are doing this. The doctor may think that you are creating a record in case he or she messes up. Explain clearly that you may need to go somewhere else and it may be helpful to have a record of what this visit yields."

This "tip" comes from "Navigating Canada's Health Care" a new book by Michael Decter and Francesca Grosso. They have including some good tax advice. So read this before you design your tax return.

And why ask the doctor? Take advice from Erma Bombeck: "Seize the moment. Remember all those women on the 'Titanic' who waved off the dessert cart."

Give us some humorous advice. Share the moment

Monday, December 11, 2006

. . . the effect on patients of knowing nurses only by their first names

I have a number of questions about the effect on patients of knowing nurses only by their first names. First, does it matter, and if it does, how is mattering manifest? Are patients as comfortable providing personal details or seeking information from Sue as they are from Sue Smith? Are they more comfortable? Do patients hold different expectations of nurses when they know only their first name, as opposed to knowing their full name? Is it appropriate in some patient care environments but not others? Second, what is behind this trend to using first names only in nursing? Is it a safety issue? Has it anything to do with nurses' status within the healthcare team? Was it planned, or did it just happen? Finally, are we compromising any aspect of our professionalism by using our first names only? Do we know the answers to these questions? Should we?

Dorothy Pringle, PhD and editor in chief of the Canadian Journal of Nursing Leadership.

Canada needs to invest $300 per Canadian for new information technology if we are to reduce ‘wait times’ in our healthcare system

The Commonwealth Fund asked 6,000 primary care doctors in seven industrialized countries about their use of information technologies (IT) to support primary care. Canada did not fare well. In fact, only 23 percent of Canadian doctors said they use electronic medical records (EMRs), compared with overwhelming majorities of doctors in the Netherlands (98%), New Zealand (92%), the U.K. (89%), and Australia (79%).

Right now, few of Canada’s family physicians are able to electronically order tests and prescriptions, access patient test results and hospital records on-line, or share health records electronically with other clinicians outside their practice. Canada has the lowest usage of computerized alerts on dangerous drug interactions and automated reminders for follow-up or preventive care. Other countries moved to address this sooner and we’re clearly lagging behind.

A staggering 68 percent of specialists receive no patient information for referred patients on their first visit. Patients with chronic illness regularly visit emergency rooms in hospitals that have no record of their medications or medical history. In addition, the lack of an integrated electronic health record significantly impedes the capacity of physicians to work in integrated multi-disciplinary teams. Unproductive appointments, repeat tests, unnecessary hospitalizations and uncoordinated care – the cycle of inefficiency ripples through the system, impacting access to services and wait times. Much worse, anywhere between 9,000 and 24,000 Canadians die each year from health system errors, much of it caused by preventable adverse drug events.

We must strengthen our commitment and accelerate the pace of implementation if we are to play catch-up with other countries who commenced their investment some 15 years ago.

This is the clear message from our healthcare community – from the Patient Safety Institute to the Canadian Medical Association to countless clinical bodies and hospital associations – and now reinforced in the Commonwealth Fund study. Echoing this sentiment, the Health Council of Canada recently stated that if we don’t modernize the management of patient information, all other activities for health care renewal will stall. Given that one of our key renewal efforts underway today is to improve wait-times and patient access to timely care, we clearly need to accelerate our efforts to tackle this national priority.

In addition to finishing what Infoway and its partners have started, our renewed commitment must provide a secure, comprehensive electronic health record for every Canadian, introduce electronic records in physician offices and computerized prescribing in hospitals. Our approach must also empower patients (and in particular, chronic-care patients) by giving them the tools to promote self-care and to access wait-times information on-line.

It is estimated that a one-time investment of about $300 per Canadian will be needed to fully implement the necessary systems. This investment will provide estimated savings and benefits to Canada’s health care system of approximately $6 billion each year once fully implemented. However, in terms of the lives that can be saved, the service improvements that will be delivered and patient empowerment, the benefits are priceless.

This material taken from an editorial commentary by:

Brian Postl, MD was Canada’s Federal Advisor on Wait Times and CEO of the Winnipeg Regional Health Authority. He is also a member of the Board of Directors at Canada Health Infoway.

Richard Alvarez is the CEO of Canada Health Infoway, a not-for-profit corporation responsible for accelerating the introduction of electronic health record systems to all Canadians.