The Omaha System Partnership: Nursing Informatics Research Network

Kay PoulsenHelp4U, New Zealand

Kia Ora fromNouvelle-Zélande

Omaha System in NZ

• HINZ November 2009“To ensure that correct decision making occurs at

the right time, at the right place, and that services provided are at the right level in a consistent, coordinated way, this clinical information must be valid, reliable, but most of all present”.

Brent McGrath (1960 – 2010)

Changing the way nurses and allied health professionals document and communicate care in community clinical practice : a community care clinical data set.

Omaha System• Holistic evaluation of problems in the setting of a

person’s life– Individual, family or community level – Potential problems & health promotion

• Multi-dimensional perspective using simple framework– Omaha System is the A, B, C that enables us to write War

and Peace

• Measure the impact of interventions on consumer awareness and consumer engagement as well as clinical outcomes. – Knowledge, Behaviour, Status outcome ratings

A Community Care Solution

• Omaha System• CADITM data dictionary• Project GAIN • PLAIN WORDSTM taxonomy• IT architecture• International partnerships

Life Interrupted…

4.35am, 4 September 2010

• HINZ, November 2010 – Sheree East

“The key thing is, understanding the landscape in which you are operating is constantly shifting. And when the ground shifts beneath you – systems need to be flexible and sustainable.

“We are now ready to embark upon the trial and implementation of the dataset using 21st century documentation and communication technology”

Transforming Clinical Practice through Terminology

Delivering the vision

12.51pm, 22 February 2011

Help4U

• A health navigation and consumer advocacy service• Linked student welfare division with existing agencies• Commenced coordinating suburban welfare

enquiries• Earthquake services A-Z• The lightbulb project / winter care parcels project

Operation Suburbs

In the suburbs

• 2000 portaloos• 27,500 chemical toilets• 400 disposal tanks

Problems encountered

Interventions

The Aftermath: impact on health services

Loss of:•100 tertiary care hospital beds (17%)•600 residential care beds •122 non-government community health groups

and counting…..

June 2011

Entrer (enter)…Omaha System

• TotalCare service– Hospital in the Home

• Nurse Practitioner service– Older Persons’ Health

• Help4U service– Family health centre care coordination

• AESOP clinical documentation tool

• New Zealand Omaha System User Group

Start and Chart…

©2012 Help4U Holdings Ltd

Preliminary Comparison:Nurse Practitioner Service and TotalCare Service

• The Nurse Practitioner Service served 11 patients (27% male, 36.4% living alone)

• Average age 86.6 years, with an average of 6.1 problems per patient (67 total problems)

• Have been referred by general practitioner for more frequent in-home visits

• The TotalCare service served 37 patients (27% male, 56.8% living alone)

• Average age 84.8 years, with an average of 10.0 problems per patient (371 total problems)

• Have been identified as requiring residential care, but there is no bed

Comparison of Problems (n > 20)

7

5

4

2

4

2

3

2

7

16

20

21

22

23

23

27

28

30

0 5 10 15 20 25 30 35

Skin

Vision

Medication regimen

Physical activity

Pain

Urinary function

Health care supervision

Personal care

Neuro-musculo-skeletal function

TC

NPS

Of the 9 top problems, 5 are physiological and 4 are health related behaviors.

Comparison of Baseline Knowledge, Behaviour, and Status Ratings

2.763.00 3.053.02

3.72

3.32

1

1.5

2

2.5

3

3.5

4

4.5

5

Knowledge Behaviour Status

NPS

TC

*Behavior is significantly higher for TC (differences for knowledge and status are not significant)

29

0

4

34

64

5

70

232

0 50 100 150 200 250

Missing

Community

Family

Individual

TC

NPS

Baseline assessments for all problems: Individual/Family/Community Level

Next Steps• Omaha System Partnership Care Plans

– Diabetes– Wound Management– Homecare

• Post discharge care coordination research• Streamlining and integration to care process• TotalCare Evaluation

– “The service appears to have achieved what it was set up for with only 25% of those eventually admitted to resthomes and only 1 to hospital. Six patients ended up dying in their own homes”.

Quake ‘Swarms’ (3,400 > mag 3; > 11,000 in total, in 21 months)

Questions

Sheree East, RN, DoNNurse Maude, Christchurch NZKaren A. Monsen, PhD, RNUniversity Of Minnesota, Minneapolis, MN, USAAmy B. Lytton, MS, RNSt. Paul-Ramsey County Public Health, MN, USASara AveryMassey University, Nursing ProgrammeWellington, NZAshleigh PeckCPIT School of MidwiferyChristchurch, NZ

Acknowledgements