Interoperability in Nursing. Implementation of ICNP® in Poland....2006 -2014 POLAND–415...

The ICN-Accredited Centre for ICNP® Research & Development at the Medical University of ŁódźD. Kilańska

Interoperability in Nursing. Implementation of ICNP® in Poland.

Dorota Kilańska RN, MSc, PhDEHealth Council in Nursing at the Center for Health Information Systems MoH

ICN-Accredited Centre For ICNP® Research & Development at the Medical University of Łódź

Iwona Szymańska RN, MSc, Medical University of Lodz

[email protected]


Plan of the lecture

1) Recommendations for implementation of ICNP®2) Application of the ICNP in the EHR in Poland3) Use of the ICNP for knowledge management and

patient safety (results of care).


1989 – Resolution of ICN , Seul , South Korea;1991 –1999 research - analysis of literature, questionnaire, the first draft of the list of terms, version α, β

version and then β2 (PNA involvement in the work in 1999);

2000 - Conference Translators and Reviewers ICNP®, sponsored by the "Tele Nurse“ & ICN Combra, Portugal;

2005 – Version 1.0 – 1st Polish version;2008 – Version 1.1

2009 – Version 2.0, PNA Recommendation & Policy Statement;2011 – Version 2011,

Statement MoH/ICN/PNA, support letter of Minister of Administration and Digitization,Statements of Main Chamber Nurses and Midwives (NRPiP),

2012 - Polish Version of ICNP ® 2011 (November),2013 – Melbourne Version 4.,

Recommendation of Ehealth Council in Nursing, CSIOZ - NMDS in Poland, 2015 – Version 4 – Completed of Polish translation,2006 - 2014 POLAND– 415 activities, lobbying , dissemination, teaching process, researches, & pilot

projects.

Background ICNP(R) development and dissemination in Poland


STRATEGIA EUROPEJSKIEGO

KSZTAŁCENIA PIELĘGNIAREK

WHO 2000

„Elektroniczna Platforma Gromadzenia, Analizy i U

dostępniania zasobów cyfrowych o Zdarzeniach

Medycznych (P1)” -rekomendacje

2004 r. standard ISO FIDS18104:2003 (Integration ofa Reference TerminologyModel for Nursing) - Komitet Techniczny ISO

nr 215 – 3 grupa robocza (pojęcia zdrowotne) we współpracy z Grupą Pielęgniarską

Międzynarodowego Stowarzyszenia Informatyki Medycznej oraz ICN.http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=33309

WHO European Strategy

for Nursing and Midwifery

Education, WHO 2000

RecommendationsElectronic Platform for

Collection, Analysis and Dissemination of digital

resources for Medical Events (P1) – recommendations

http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=33309




WHO 2000

„Elektroniczna Platforma Gromadzenia, Analizy i U

dostępniania zasobów cyfrowych o Zdarzeniach

Medycznych (P1)” -rekomendacje

2004 r. standard ISO FIDS18104:2003 (Integration ofa Reference TerminologyModel for Nursing) - Komitet Techniczny ISO

nr 215 – 3 grupa robocza (pojęcia zdrowotne) we współpracy z Grupą Pielęgniarską

Międzynarodowego Stowarzyszenia Informatyki Medycznej oraz ICN.http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=33309

WHO European Strategy

for Nursing and Midwifery

Education, WHO 2000

WHO accepted ICNP within the WHO-FIC to extend coverage of the

domain of nursing practice as an essential

and complementary part of professional

health services

Mapping ICNP to SNOMED CT

I-NMDSICNP Catalogues

HOBIC

Dir 24/2011/UE• eHealth• Integrated

Care -EUNRs4CAREThe position of national

consultants in the areas of:Oncology Nursing

Nursing of the Chronically Ill and Disabled

Family NursingPaediatric Nursing

Palliative Care NursingPsychiatric Nursing

regarding the application of the ICNP ® classification in clinical

practice

RecommendationsElectronic Platform for

Collection, Analysis and Dissemination of digital

resources for Medical Events (P1) – recommendations

http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=33309


- The Provisions of the International Council of Nurses( ICN), 22nd May 2005 http://www.icn.ch/images/stories/documents/news/press_releases/2005_PR_10_Release_of_ICNP_V1.pdf & 20th May 2013 http://www.icn.ch/images/stories/documents/news/press_releases/2013_PR_10_ICNP.pdf.

- Statement of XV National Congress of Delegates of Polish Nurses Association, November2009 http://www.ptp.na1.pl/pliki/PTP_Stanowiska/06_PTP_STAN_01_12_2009.pdf.

- Statement of Main Chamber Nurses and Midwives, June 2011, https://docs.google.com/folder/d/0B4uc8m-

ugQHFNzhmbUkycC1YZjg/edit?docId=0B4uc8m-ugQHFVGxqVTBWQTNBXzg. - Statement of National Congress of Delegates NIPiP, December 2011 http://www.izbapiel.org.pl/upload/Stanowisko%20Nr%204.pdf .

- Communique of MoH, ICN & PNA, 3rd July 2012 http://www.mz.gov.pl/wwwmz/index?mr=m7&ms=&ml=pl&mi=94&mx=0&mt=&my=0&ma=030372.- EFN Policy Statement Continuity of Care & EFN Policy Statement of Nursing Sensitive Criteria for the Selection of ‘European Centres of Excellence’ https://docs.google.com/folder/d/0B4uc8m-ugQHFNzhmbUkycC1YZjg/edit?docId=0B4uc8m-ugQHFcURHcVZpM3AwNHM.

- The WHO Family of International Classifications http://www.who.int/classifications/icd/adaptations/icnp/en/

The activities of the Polish Nurses Association in implementation eHealth services in nursinghttps://docs.google.com/folder/d/0B4uc8m-ugQHFNzhmbUkycC1YZjg/edit?docId=0B4uc8m-ugQHFR3BiQWd0YllqZlE.

The Provisions and Recommendations

http://www.icn.ch/images/stories/documents/news/press_releases/2005_PR_10_Release_of_ICNP_V1.pdf

http://www.icn.ch/images/stories/documents/news/press_releases/2013_PR_10_ICNP.pdf

http://www.google.com/url?q=http://www.ptp.na1.pl/pliki/PTP_Stanowiska/06_PTP_STAN_01_12_2009.pdf&sa=D&sntz=1&usg=AFQjCNEDMk51D16CMtbxKoDsw7cosUcdSQ

https://docs.google.com/folder/d/0B4uc8m-ugQHFNzhmbUkycC1YZjg/edit?docId=0B4uc8m-ugQHFVGxqVTBWQTNBXzg

http://www.izbapiel.org.pl/upload/Stanowisko%20Nr%204.pdf

http://www.mz.gov.pl/wwwmz/index?mr=m7&ms=&ml=pl&mi=94&mx=0&mt=&my=0&ma=030372

https://docs.google.com/folder/d/0B4uc8m-ugQHFNzhmbUkycC1YZjg/edit?docId=0B4uc8m-ugQHFcURHcVZpM3AwNHM

http://www.who.int/classifications/icd/adaptations/icnp/en/

https://docs.google.com/folder/d/0B4uc8m-ugQHFNzhmbUkycC1YZjg/edit?docId=0B4uc8m-ugQHFR3BiQWd0YllqZlE


The Council of Ministers Directive, dated 12 April 2012, regarding the National Interoperability Framework, the minimal requirements for public records and the exchange of

information in electronic form, as well as the minimum requirements for ICT systems

INTEROPERABILITY is achieved by:1. Unification, understood as the application of compatible norms, standards

and procedures by the various entities performing public tasks.2. Interchangeability, understood as the possibility of replacing the product,

process or service without simultaneous disruption of information exchange between providers of public tasks or between them and their customers, while meeting all functional requirements of cooperating systems.

3. Compatibility, defined as the suitability of the products, processes or services intended for common use, under specific conditions ensuring provision of essential requirements and the absence of adverse effects(...).


REGULATION OF THE MINISTER OF THE INTERIOR AND ADMINISTRATION

dated 25 October 2007regarding the type and range of medical documentation, as well as the method of its processing in health care centres created by the

Minister for the Interior§ 5. 1.6) Information of the state of health and illness, as well as the Nursing

Process , diagnosis and treatment or care, including in particular:a) a description of the actions performed by the doctor and nurseb) diagnosis of the health problem, illness or injury§ 11. 1. The history of the illness comprises: (…)2) c. Individual nursing care card;§ 14. 1. 3. Entries concerning the nursing process are made on a regular

basis by the nurse or midwife responsible for the care of the patient, and are checked by the ward manager or senior midwife.


REGULATION OF THE MINISTER OF THE INTERIOR AND ADMINISTRATIONdated 25 October 2007

regarding the type and range of medical documentation, as well as the method of its processing in health care centres created by the Minister for the

Interior3. The hospital treatment information card comprises: (…)4 . Recommendations for further treatment, nutrition, nursing and lifestyle;

(…)5. The section on health and illness associated with of Community Care

comprises:6. Date of commencement and completion of nursing or midwifery care;7. Type and range of nursing or midwifery activities including the patient and

environment, and in particular a recognition of the nursing and psychosocial problems, a care plan of nursing or midwifery actions, together with annotations connected with the performance of activities, including those resulting from the instruction of the doctor; (…)


REGULATION OF THE MINISTER OF HEALTH dated 21.12.2010 regarding the type and scope of medical

documentation, as well as the means of its storage 1)

1) Warszawa, dnia 7 lutego 2014 r. Poz.177 OBWIESZCZENIE MINISTRA ZDROWIA z dnia 6 czerwca 2013 r. w sprawie ogłoszenia jednolitego tekstu rozporządzenia Ministra Zdrowia w sprawie rodzajów i zakresu dokumentacji medycznej oraz sposobu jej przetwarzania

3. Particular individual internal documents are as follows:• health record; • medical history;• newborn medical record;• individual nursing care history; • individual midwifery care history;• visit card;• history of the environment and the family assesment.3.1 To the individual internal documentation is attached a copy of the

documentation submitted by the patient, giving information needed for diagnosis, treatment or nursing care.


REGULATION OF THE MINISTER OF HEALTH dated 21.12.2010 regarding the type and scope of medical

documentation, as well as the means of its storage 1)


§ 10. Individual records, if the provisions of the Regulation does not provide otherwise, includes: (…)

3) designation of the person providing health benefits and directing for examination, consultation or treatment :

• surname and name,• job title,• obtained specializations• number of the profession - in the case of a doctor, nurse and

midwife,• signature;

4) Date;

5) information on health and disease and thediagnostic process, therapeutic, nursingcare or rehabilitation, in particular :

• description provided health benefits,• (…),

• recommendations for patient, (…)


DIRECTIVE OF THE MINISTER OF HEALTH dated 21.12.2010 regarding the type and scope of medical documentation, as well as the means

of its storage


DIRECTIVE OF THE MINISTER OF THE INTERIOR AND ADMINISTRATIONdated 25 October 2007

regarding the type and range of medical documentation, as well as the method of its processing in health care centres created by the Minister for the Interior

Nursing Process – ICN 2005

Terminology of reference – ICNP®




WHO 2000ProjectsP1 - P6


P1.1 "Approach to classifying medical documentation",3.6 THE USE OF EXISTING TERMINOLOGY of REFERENCE3.6.1 Dictionaries

Table 6. A list of proposed Terminology of Reference

Platform for the Collection, Analysis and Dissemination of digital resources concerning Medical Events

lp. The area of terminology

Recomended of Classifications

1. Medications Registry P1 drugs, ATC (Anatomical Therapeutic Chemical Classification System)

2.Social and economic data

Dictionary of MPiPS; OECD, Social Indicators UNSTATS

3. Recognision ICD (…) ICNP

4. Treatment(…)ICNP – used in the actions, the outcomes obtained in nursing

care in Nursing (CSIOZ 2013: 29)


Attachment no.3 for P1.1 "Approach to classifying medical documentation", category "nursing documentation" - documents:

• History of the Individual nursing care 05.20• History of the Individual midwifery care 05.21• History of Patient 05.22• Nursing recommendations 05.26• Fluid balance 05.23• BP and/or pulse measurements 05.24• Nurse assessment card 05.25• History of the Individual care in the family settings PHC 05.28• Other nursing documentation 05.70 ????

Platform for the Collection, Analysis and Dissemination of digital resources concerning Medical Events (P1)


E-DOCUMENTATION Nursing - PROJECT

Council Ehealth in nursing (przewodnicząca – dr Dorota Kilańska)

przy CSIOZ - Center for Health Information Systems –Units:

ELECTRONIC PATIENT RECORDSUnit

(working on: schema of documentation, setting the type of documents included in the nursing

documentation and the creation of this document for different areas of nursing)

ICNP® Team (working on Standards of Nursing Care Plans,

using of ICNP® Catalogues)


Recommendation of The Council for Ehealth in Nursing, CSIOZ MoH, dated September 11, 2013 -

Proposed format of Nursing documentation


Council Recommendation of e-Health in Nursing at CSIOZ in MZ

Recommendation no. 1/2013 dated 11 September 2013.The Council for e-health in Nursing and the ICN-Accredited Centre for ICNP® Research & Development at the Medical

University of Łódźregarding the design of electronic forms of medical documentation in Nursing The Council for e-health in Nursing recommends an

introduction to the "Individual Nursing Care Card", indicated in the Directive dated 21 December 2010 regarding the type and scope of medical documentation, as well as the means of its storage § 2, provision. 3, point. 4. the following document

templates, being an integral part of the cards mentioned above:1. Nursing interview card;2. A patient evaluation card, together with a scaled evaluation of patient health, recommended by the International

Classification for Nursing Practice (ICNP), which can be found in the attachment to the recommendations below;3. A plan of care based on the International Classification for Nursing Practice (ICNP ®), including the nurse's diagnosis

and actions/interventions, as well as outcome described based on the ICNP ® Classification;4. Discharge card with instructions for the patient;5. Nurse's Report;6. Documents referred to in point. 1) to the point. 5) are the attachments from No. 1 to No. 5 to this Recommendation.It is recommended for creating the architecture of nursing documentation based on the terminology of the International

Classification for Nursing Practice (ICNP ®).


Catalogue ICNP ®International Classification for Nursing Practice (ICNP®)


ICNP Classification , PL version Axis:1. "diagnoza aktualna negatywna" - DC_negatywna_ICNP_2013.pdf (568 KB)2. "diagnoza pozytywna" - DC_pozytywna_ICNP_2013_www.pdf (593 KB)"OSIE PODSTAWOWE"1. "Działania" (A)

"Interwencje" (I)2. "Lokalizacja" (L)3. "Czas" (T)4. "Klient" (C)5. "Środki" (M)6. "Osąd" (J)7. „Przedmiot opieki” (F) – przeglądarka ICN http://icnp.stemos.com/index.php/pl/2013/

MATERIALS for TEACHERS

http://www.icn.ch/images/stories/documents/pillars/Practice/icnp/translations/icnp-Polski%20translation.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/DC_negatywna_ICNP_2013.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/DC_pozytywna_ICNP_2013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/A_ICNP_2013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/IC_ICNP%202013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/L_ICNP_2013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/T_%20ICNP_2013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/C_ICNP_2013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/M_ICNP%202013_www.pdf

http://www.umed.pl/pl/_akt/inf_tmp/2013/INCP2013/J_ICNP_2013_www.pdf

http://icnp.stemos.com/index.php/pl/2013/


Professional training

ResultsMoH/ACBiR/PNA 11.10.2014

Questionnaire was sent to 74 schools of nursing

Response – 23

# studentsBachelor level:

Lectures - 16 294Practical lessons -

5014Nursing practice –

1785

# students of Master Degree – 9907Lectures - 8337, workshops (Łódź, Bydgoszcz)# Case Studies with using of ICNP -1290 (Nysa, Gdańsk, Lublin, Łódź)

status 25.10.2014

ICNP topics were discussedLectures

Practical lessons

Nursing Practice

Seminars

Others

BachelorBachelor &

MSc

Not performed

Others

ICNP® in Curricula

Basic NursingHealth Promotion

PHCInternal Nursing

Surgical NursingPediatric Nursing

Psychiatric NursingInformatics

Other nursing subjects

Others


55 trainings &1590

Participants (2009, from December 2012 to

November 2014) 2014 – 395 nurses &

midwives

21 lectures (ICN-ACR&D, PNA)

3530 Participants

status 25.10.2014

1. Białystok2. Bydgoszcz3. Ciechanów4. Częstochowa5. Gdańsk6. Gorzów Wlkp.7. Jachranka8. Kalisz9. Katowice10. Kielce11. Kraków12. Krosno13. Łódź

14. Nowy Sącz15. Opole16. Płock17. Poznań18. Radom19. Rawa Mazowiecka20. Rzeszów21. Szczecin22. Warszawa23. Włocławek24. Wrocław25. Zielona Góra

Postgraduate training


HEALTH POLICY42 pisma w sprawie (2006-2014)

24.11.2009 – Paper CF/DSOZ/HKL/2009/076/0797/W/21897 for the consideration of the introduction to reporting by the NHF health care benefits under the procedures with using ICNP ®10.3. 2010 – National Health Found (NFZ) buisness meeting

MoH-2011 StatementICN/PNA/MoH Communigueon the MoH website, 3 July2012. „Significant contribution to the International Classification for Nursing Practice (ICNP) in the interoperability of data in health care”

Nurses & MidwivesDepartment MoH

11.12.2007 - meeting of the National Consultants –PNA lecture2009 – replay to thestatements XV KZD (NFZ, Departament Zdrowia Publicznego, KRASZM, CKPPiP)

10.4.2015

CSIOZ MoH2010 – ICNP Council (39

meetings)2012 – Ehealth Council

in Nursing (17 meetings)

2013 – SNOMED –CT meeting

Minister of Administration and

Digitization5.1.2012 - to apply to the Ministry of Health to consider buying a Classification for EHR inPoland

BUSINESS PARTNERS – the

agreementPNA/KAMSOFT

Company 2013/14 –consultations


CSIOZ:2012 - agreement for translation of brochures2013 – draft agreement with the ICN on the availability of the ICNP

Translation of ICNP

evaluation translations

wersji 1.0 (1.8.2006)

19 meetings (PTP ZG: Warszawa, Gdańsk,

Łódź)

translationsversion2.0

– 55 meetings(telekonferencje september

2010 – august 2012, PTP ZG)

Evaluation translations3.0 (ACBiR)

- The agreement with ICN inFebruary 2014-TELENRSCARE Project (April-June2014) - 2 meetings- Ehealth Council CSIOZ - 4 meetings

10.4.2015


EHR – 2017 ?

Business Partners•different functionality,•diversity of projects, partners

•lack of cooperation•inability to implement good practices

•the absence of clear indications in legal documents

stan 25.10.2014 r.

The computerisation

of health protection


Translation


The results of evaluation of the implementation of the ICNP® in clinical practice

Group - nurses and midwives participating in ICNP® workshops

N= 2621 = definitely not2 = not3 = no opinion4 = yes5 = definitely yes


Survey N=2621.Do you see a need for a standardized classification of nursing practice according to ICNP® in Poland?

Mean response = 3.972.Will the introduction of the ICNP® be possible inyour workplace? Mean response= 3.009

3. Are you sufficiently prepared to work with the computer in order to implement an electronic nursingdocumentation system? Mean response= 3.55

4. Are you ready to work with ICNP® in your practice?Mean response = 3.13

Euro

pean

Fed

erat

ion

of N

urse

s Ass

ocia

tions

Th

e N

urse

s’ V

oice

A Thematic Network to develop Evidence Based Guidelines for Nursing and Social Care on eHealth

Services

www.ens4care.eu

The objectiveThe main objective of the project is the development ofevidence based guidelines for the implementation ofeHealth services in nursing and social care, building onexisting good practices amongst the participants of theNetwork, sharing and transferring knowledge across theEuropean Economic Area. The ultimate goal ofENS4Care is the establishment of a sustainablemechanism to support nursing and social careresearch in the field of ICT enabled integrated care.

30

Requirements to implement the guidelineStakeholders are recommended to use referenceterminology models (such as ICD, ICF, ICNP, ICPC,SNOMED-CT), which interpret in the same way thediagnosis, interventions and outcomes.The WHO HIS Strategic Planning Process Guidanceshould also be considered, and in DRG can include allCare Providers Services (WHO, 2009).Every new device could be assessed by a nationalAgency, which can be responsible for the evaluationprocess on all devices needed by individuals and careproviders in health care.

31

ENS4Care General Assembly Dublin, 22 October 2014


ICNP ® PROJECT PARTNERS

Akredytowane Centrum badania i Rozwoju ICNP ® przy UM w Łodzi

http://ezd/

http://ezd/


"The student asks the master:

must one wait long for changes for the better?The master answers:

if you want it, EXPECT TO WAIT LONG..."

Thank you for your attention

Dorota Kilańska

ICNP® Programme

Interoperability in Nursing. Implementation of ICNP® in Poland....2006 -2014 POLAND–415...

Documents

Transcript of Interoperability in Nursing. Implementation of ICNP® in Poland....2006 -2014 POLAND–415...