The Computerized OMAHA System in Microsoft Office Excel. (PDF ...

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Nursing Informatics 2014 K. Saranto et al. (Eds.) © 2014 The authors and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License. doi:10.3233/978-1-61499-415-2-310

The Computerized OMAHA System in Microsoft Office Excel Xiaobin LAI a , Frances K. Y. WONG a,, Peiqiang ZHANG b, Carenx W. Y. LEUNG c, Lai H. LEE c, Jessica S. Y. WONG c, Yim F. LO c, Shirley S. Y. CHING a,1 a School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China b Suning Appliance Company Limited, Beijing, China c

Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China Abstract. The OMAHA System was adopted as the documentation system in an interventional study. To systematically record client care and facilitate data analysis, two Office Excel files were developed. The first Excel file (File A) was designed to record problems, care procedure, and outcomes for individual clients according to the OMAHA System. It was used by the intervention nurses in the study. The second Excel file (File B) was the summary of all clients that had been automatically extracted from File A. Data in File B can be analyzed directly in Excel or imported in PASW for further analysis. Both files have four parts to record basic information and the three parts of the OMAHA System. The computerized OMAHA System simplified the documentation procedure and facilitated the management and analysis of data. Keywords. documentation system, computerization.

Introduction Increasing attention is being paid to the documentation of nursing care. A computerized documentation system is important to simplify recording procedures and facilitate the management and analysis of data. It is also a good starting point for analyzing nursing activities from a quantitative perspective. Such an analysis can help nursing professionals identify essential and effective interventions for clients. A randomized controlled trial was developed to examine the effectiveness of a nurse-led care program for cancer patients receiving chemotherapy. The nurse-led care program examined in the study consisted of a pre-chemotherapy nurse consultation and several telephone follow-ups that were delivered by three intervention nurses. To document the problems, nursing care, and outcomes of the intervention group, the OMAHA system was adopted as the documentation system. The OMAHA system is one of the most popular documentation systems in the nursing discipline. Due to the popularity, there are some commercial computer software are available [1]. However, the software is expensive for a student project. Although paper-based recording chart is also available, it is time-consuming and 1

Corresponding Author: Shirley S. Y. CHING, School of Nursing, the Hong Kong Polytechnic University, Hong Kong, China; E-mail: [email protected].

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environment-unfriendly. In addition, it may be difficult for the researchers to analyze nursing intervention in the study. A more efficient and economical documentation method is needed. Hence, two Office Excel files for the OMAHA System were developed in the study.

1. The OMAHA System and the Excel files The OMAHA system is a comprehensive classification designed to generate meaningful data following documentation of client care [2]. It consists of three parts: the Problem Classification Scheme, the Intervention Scheme, and the Problem Rating Scale for Outcomes. The three parts provide a structure to document client needs, describe practitioner interventions, and measure client outcomes [2]. The two Office Excel files for the OMAHA System were named as File A and File B. File A was designed for individual clients. File B was a summary of all clients’ data. Both files comprised four parts. File A was used by the intervention nurses, which was saved in a laptop particularly for the study. The intervention nurses could use File A to review the client’s previous condition before each intervention session and document the client care after each session. File B was used by the researchers for data analysis. 2. File A: Individual client documentation 2.1. Part I of File A: Record sheet of basic information Among the four parts of File A, the first part is a record sheet of basic information (Figure 1). Two types of information were recorded: i) client’s demographic and clinical characteristics; ii) information of each intervention session, such as date of the session, the serial number of the session, and the nature of the session (face-to-face consultation or telephone follow-up).

Figure 1. Record sheet of basic information.

2.2. Part II of File A: Record sheet of problems and outcomes The second part aimed to record the Problem Classification Scheme and the Problem Rating Scale for Outcomes of the OMAHA System (Figure 2). All of the 42 OMAHA problems in the Problem Classification Scheme were included. Each problem has its own corresponding outcome rating scale that is evaluated from three aspects:

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knowledge (K), behavior (B), and status (S). There are a few blank rows under each problem to record the problem in a chronological manner.

Figure 2. Record sheet of problems and outcomes.

2.3. Part III of File A: Record sheets of interventions This part was used to record the Intervention Scheme of the OMAHA System in detail. Multiple Excel sheets were included in this part. Common intervention items for each problem were listed in one Excel sheet (Figure 3). The intervention nurses could click on the intervention items that they used in each intervention session.

Figure 3. Record sheets of interventions.

2.4. Part IV of File A: Summary sheet for individual clients This last part of File A is a semi-automatic summary of the previous three parts (Figure 4). The average KBS scores of the existing problems before and after the intervention were listed on this sheet. The total number of intervention sessions and the average duration were also calculated. The client’s problems before and after the intervention were presented in this sheet as well.

Figure 4. Summary sheet for individual clients.

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3. File B: Group summary of all clients File B is a summary of all clients’ data. Visual Basic for Applications (VBA) program was developed in File B to extract data automatically from File A. The file can be used directly or imported to Predictive Analytics Software (PASW) for data analysis. There are four parts in File B as well. 3.1. Part I of File B: Summary of basic information The first part of File B is the summary of part I of File A (Figure 5). The total number of intervention sessions, the nature of each session, the duration of each session, and the symptom grading results in each session were presented.

Figure 5. Summary of basic information.

3.2. Part II of File B: Summary of KBS outcomes of clients Both part II and part III of File B summarized the Problem Rating Scale for Outcomes of the OMAHA System. Part II summarized the outcomes from client perspective aiming to compare the changes of clients before and after the intervention; while Part III recorded the outcomes from problem perspective. In Part II of File B, the number of problems and the average KBS scores before and after the intervention of each client were listed (Figure 6).

Figure 6. Summary of KBS outcomes of clients.

3.3. Part III of File B: Summary of KBS outcomes of problems Part III of File B is another summary of the KBS scores of each existing OMAHA problem, aiming to analyze the KBS changes of each OMAHA problem over (Figure 7). The KBS scores of each problem at each intervention session were summarized in this sheet. 3.4. Part IV of File B: Summary of interventions for problems The last part of File B comprised several record sheets, aiming to analyze the Intervention Scheme of the OMAHA System. The intervention details of each

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OMAHA problem were extracted from File A. The frequency of each intervention item used in the study was included in this part (Figure 8). Through this part, the most commonly used intervention items for each problem can be identified. This part is under revision at this stage.

Figure 7. Summary of KBS outcomes of problems

Figure 8. Summary of interventions for problems.

4. Conclusion Computerized recording system can enhance the efficiency of the documentation procedure and simplify the management and analysis of data. Comparing with commercial software and paper-based record charts for the OMAHA System, these Excel files have both benefits and disadvantages. Developing nursing documentation files in Excel is relatively easy and affordable since it is widely used. For research projects, especially students’ projects, it may be an economical choice. These files can be used in other research projects. Similar Excel files may be tailored-made for other research projects as well. However, the functions in these Excel files may not be as perfect and stable as those in commercial software. Continuous improvement of the two Excel file is needed.

References [1] The OMAHA System, http://omahasystem.org/links.html, retrieved 22/12/2013. [2] K.S. Martin, The OMAHA System: a key to practice, documentation, and information management, Elsevier Saunders, Missouri, 2005.