Care Plans
EXCELCARE for Windows allows the definition of standard care plans that can be accessed from the Clinical Database and applied to a patient. Also care/therapy plans can be created from basic elements of care within the Clinical Database customized for the patient. The care plan can operate across an episode of care being defined at pre-admission, adjusted as required during the inpatient episode and then followed through the outpatient post-acute phase. Care Plans can be used across multiple episodes and in conjunction with a pathway, if appropriate. Since the care plan is also used as a documentation record, it becomes a necessary and vital part of the medical record.
Clinical Pathways
The EXCELCARE for Windows Clinical Pathways function enables your facility to define an interdisciplinary clinical pathway using your resources and staff available and then manage it dynamically on a patient. The clinical pathways guide clinicians to review clinical problems, goals and outcomes in a given time frame. Variance tracking is made easy and staff feedback on quality issues facilitated. Through the variance reporting function, users focus on significant variances from the defined standard. Variance analysis identifies for the clinicians the need for immediate action to correct a variance. Using this data, decisions can be made to adapt treatment protocols or standards as needed and serves for continuous quality improvement and effective utilization review. EXCELCARE is licensed by the Center for Case Management to automate the CareMap® process in the EXCELCARE software.
Quality Management - Outcomes Management
Case managers are assisted in the analysis of data by the many QM reports of concurrent patient outcomes. QM committees no longer have to depend only on retrospective data gathered through lengthy audit measures. The concurrent patient outcome data moves us to real time management of LOS, risks and costs. Quality Management allows your facility to define how and when patient outcomes should be reviewed. This function will then prompt your clinicians to enter the required data when appropriate so that an accurate record is created of patient progress against selected patient outcomes .All EXCELCARE care plans/pathways have outcomes included. They are readily available to the staff and facilitate the evaluation process. Outcome results can also be used to feed back into the development and maintenance of standards of care.
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Discharge Planning & Discharge Summaries
A concise record of all UOCs that were on a care plans utilized for a patient during the stay is printed at discharge or any time during the stay. The Discharge Summary is useful to review care with the patient or any other discipline that may follow the patient to another episode of care, i.e. LTC, Rehab, Home Care, etc.
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Most acuity collecting systems are subjective and labor intensive. In EXCELCARE, patient acuity is a by product of the care plan. It works this way-
Each intervention in a UOC is measured in three parameters: time, level of staff and frequency. These measurements are entered into the software database.
When a care plan is generated, the acuity is automatically gathered by the computer and reported in management reports. The information can also be sent top staff scheduling systems via an interface between the two software applications.
Staff / Cost Analysis
The cost/staff analysis function provides a tool for analyzing incurred and projected costs and staffing requirements in 'real' time based on actual therapy/care. Administrators require specific data to track the effectiveness and efficiency of therapy/care.
These data include the time/cost of patients' care as implemented by specific staff levels on a specific clinical area for a specified time period.
When the Clinical Database is built, the tools to prepare cost reports are tied dynamically to the therapy/care. The unique EXCELCARE methodology using the outcome-based standards of care enables managers to know the acuity of the patients by unit, shift, and level of staff. By having a more accurate picture of the exact therapy/care needed, managers can do more precise staffing and budgeting.
The analysis can be summarized by any combination of:
Your organization, i.e., agency/facility, department, clinical unit
and
Your cost factors, i.e., location, day, time period and staff type.
EXCELCARE for Windows can drill down into all time components that affect your real staffing needs by shift, giving an acuity picture of all your patients by individual patient. Staff placement for more effective therapy has never been more accurate.
The analysis also includes a projection of the level of staffing required for a future time period and location, based on the known requirements of the patients during that period.
The EXCELCARE product can enable administrators to more precisely identify the factors that increase as well as decrease the costs of care. After the significant factors are identified, strategies can be implemented to control costs yet provide the number and appropriate level of staff needed to ensure positive outcomes for patients.
Some of the different staff/cost components are: Direct time/cost Indirect time/cost Variable percent Fixed time Total required time/cost Actual time (if different from direct time in the database) Projected direct time/cost.
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Reports and Custom Reports
Reporting via Crystal Reports
EXCELCARE for Windows is able to provide reports with a specificity of data directly tied to the therapy/care provided by your interdisciplinary clinicians. This 'real time' data gives you a view of your clinical environment.
Along with the Care Plan, reports are available on the listings - i.e., diets, referral by staff member and location, task lists by due date/time, by events, operations by date, etc. Discharge summaries, acuity reports, DRG reports, case-mix, security reports showing user activity along with educational materials and letters can be printed or viewed.
Managers require specific data to track the effectiveness and efficiency of therapy/care. These data include quality of patient outcomes and the time/cost of an individual patient's therapy/care as implemented by a specific staff class in a specific program for a specified period of time. The EXCELCARE Clinical Database links all interventions to specific time periods, the specific staff class needed to implement each intervention, and to the outcomes of the therapy/care.
With EXCELCARE reports you can project staff resources (staff mix and time required for all clinicians) needed to provide the therapy/care needed for each patient. The acuity of each patient is clear; the placement of your staff can be more precise for the patients' 'real time' needs. The software calculates direct, indirect and total time required to provide therapy care by patient, by class of clinician, by unit and for a specified period of time.
The Cost of Care reports are used for managing resources. These reports contain data essential for budgeting and identifying scheduling patterns. Reports such as Required Time/Costs by Shift, Cost by Discharge, Patient Costs, Required and Actual Cost of Patient's Stay, Station Costs/Day, Monthly Diagnosis, and DRG Analysis - Daily and Length of Stay provide a clear picture of the use of staff resources to provide care based on direct, fixed indirect and variable percent.
EXCELCARE provides several formats for data collection for the evaluation of the quality of patient outcomes. Outcome Results Statistics Reports are available by Patient, by Comments by Patient, by Detail of the interventions/ observations, by Medical Diagnosis, and by Program. Pathway Variance Analysis Reports provide managers with the specific types of problems affecting the patient during their therapy/care.
Patient Master Listings
This handy report lists all patients on the unit, selected demographics and clinical information and the entire present plans of care for all patients. Staff finds the report useful in shift report, and updating/approval of care plans. It is not a part of the permanent medical record but a tool for staff in reporting and recording.
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Clinical Database Structure
The standards database is a collection of interventions/observations (forming Units of Care-UOC's) that are organized to reflect the way your facility delivers care to the patients. The purpose of having a Clinical Database is to define UOC's that reflect clinical practice and care delivery for patients. In this way, there is a measurable standard that everyone understands and works towards as interdisciplinary teams to achieve the best possible outcome for the patient.
The clinicians in a facility review, revise if necessary, and approve the UOC's on an ongoing basis. This database reflects the practice standard set by the organization. A database of UOC's are included with the software. (Sample UOC)
Unit of Care Sample
Unit Of Care (UOC) - INTUBATION
Interventions / Observations
1. Assess breath sounds q4h; prn.
2. Monitor pulse oximetry, q shift; prn.
3. Monitor ABG results prn.
4. Assist with equipment set up prn:
Selection of various sizes of Et tubes.
Selection of various sizes of blades for functioning laryngoscope.
Suction assembly.
Lubricant.
Syringe.
Stylet.
Resuscitation bag with mask.
End tidal CO2 monitor.
Tube holder or tape to secure tube.
Cetacaine spray + Lidocaine Topical Anesthesia (LTA) kit from pharmacy.
Protective equipment.
5. Place patient supine, neck hyperextended (dentures removed).
6. Hyper oxygenate with resuscitator bag & mask.
7. Medicate as ordered.
8. Assist physician with intubation.
9. Assess breath sounds & CO2 monitor in place to check for proper placement of ET tube.
10. Monitor chest x-ray prn.
11. Place on appropriate O2 delivery or vent as ordered.
12. Suction prn.
13. Refer to restraint policy, if necessary.
Goals / Outcomes
Has improved respiratory status.
Patient has no trauma during procedure.
Has adequate secretion removal.
ET tube is in proper position.
Integrity of ET tube is maintained.
Software Methodology
DEVELOPMENT OF THE CLINICAL KNOWLEDGE BASE
No longer can the clinical patient plan and documentation record just report on a single episode of treatment. The clinical record must be able to communicate the patient's interdisciplinary therapy/care over multiple episodes and through the total continuum of care. Never before has there been a greater need for a consistent framework within which to build a Clinical Knowledge Base that will be able to provide access to the vast number of procedures, activity sets, interventions/observations from each discipline linked to outcomes needed to develop patient plans.
EXCELCARE for Windows Patient Plan can be a combination of clinical pathways, care plans and customized interventions/observations developed through use of the Clinical Knowledge Base.
The unique, proprietary Clinical Knowledge Base designed by EXCELCARE, Inc. uses a theoretical framework and methodology developed in over 20 years of research by EXCELCARE partner, Elizabeth J. Mason, PhD. (See reference.)
The EXCELCARE Product line provides the operational framework to link quality interdisciplinary therapy/care with organizational resources. In EXCELCARE for Windows the Patient Plan becomes the primary vehicle for improved interdisciplinary communication and delivery of therapy/care. Accurate, timely staffing and costing information along with clear, concise documentation and an evaluation process based on outcomes of therapy/care are important results of the use of the EXCELCARE for Windows Clinical Knowledge Base.
The EXCELCARE for Windows Clinical Knowledge Base is customized to the therapy/care offered at your facility, enabling the costing, staffing and resource use information to provide you with a clear picture of your clinical setting work and costs.
The Clinical Knowledge Database content is based on the methodology to develop outcome-based standards of therapy/care created by EXCELCARE partner, Elizabeth J. Mason, RN, PhD and published in How to Write Meaningful Standards of Care, Third Edition. Albany, NY;
Delmar Publishers, Phone 800-998-7498.
ISBN 0-8273-5316-2
A more extensive description of how facilities effectively use the EXCELCARE product and the methodology, please see:
Mason, E.J., "Integrating standards into the decision-making of nurse clinicians and nurse administrators: the Excelcare System." In P. Shroeder (Ed.), The encyclopedia of nursing care quality,2, p.70. Gaithersburg, MD: Aspen Publishers, 1991.
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Minimum System Requirements
Minimum Recommended Hardware / Software Requirements
Overview
EXCELCARE SQL is a 32-bit application developed using Visual Basic 6.0 SP4. It utilizes the OLE DB MS SQL provider with ADO for MS SQL Server database connections as configured in a UDL file at installation time. It requires MDAC 2.7 (included and installed with the EXCELCARE application) to be installed on each workstation. DBMS is MS SQL Server 2000 SP3. (Not included) Crystal Reports 9.0 embedded report viewer only control is used for all reporting. (Included)
Workstation
· Pentium 400mhz processor or better
· 128 Meg of RAM +
· 2 Gig HD +
· 3.5 floppy drive recommended, not required
· CD ROM recommended, not required.
· Windows 2000 SP2, XP Pro 2002 +
· MS Internet Explorer 5.5 or higher (required for MDAC and Help system)
· SQL Server client access license (Depends on SQL license method) (not included with
EXCELCARE software)
· SVGA monitor, 1024x768 resolution
· Keyboard, mouse, UPS
· Network interface card
· HP or compatible Laser Printer
SQL Server
· Dual Pentium 400mhz processors +
· 1 Gig of RAM
· 10 Gig HD space available
· CD ROM
· Windows 2000 Server SP2 +
· MS SQL Server 2000 SP3
· Backup media
· Monitor, keyboard, mouse, UPS
· Network interface card
Additional Software required for System setup and support
· MS Access 2000 allows database maintenance and reporting via a Access Data Project.
· Crystal Decision's Crystal Reports 11 allows user to build and modify reports.
· MS SQL Server Enterprise Manager for database setup and maintenance.
Technical Diagram
Scheduling/ Staffing - The EXCELCARE care plan automatically generates the staffing requirements through the underlying database. This eliminates collecting acuity data. If needed, an interface passes this data on required staff by level to the facility's automated scheduling/staffing systems.
HL 7 / ADT - An interface to the facility's PMI system brings the necessary data into EXCELCARE and eliminates timely, unnecessary duplicate patient data entry. The interface will except HL7 version 2.3 transactions.
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