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Biomedical subjects

D W Simborg

Publications and source records attributed to D W Simborg.

25 records · Page 2Linked to original sources

A highly automated hospital medication system. Five years' experience and evaluation.

Since 1969, medications have been provided to patients at the Johns Hopkins Hospital using a computer system that controls the entire medication process from entry of physician's order to hourly drug distribution. Special envelopes containing patient and dosage information are computer generated for each dose to be administered. These envelopes, containing individually labelled ready-to-administer doses, are delivered to the nursing units hourly. The system provides daily medication profiles, drug administration histories, discharge summaries, and management and billing reports. Medication errors of commission were 4.6 times more frequent on the traditional nursing units compared to the units with the computer system. Registered nurses spend 56% less time performing medication-related activities on the units served by the computer. For 250 beds, total costs are 7% higher using the computer system. For 450 beds, total costs are 14% lower using the computer system.

Costs and Cost Analysis

Rational staffing of hospital nursing services by functional activity budgeting.

Nursing services are a costly item in the hospital budget, yet their justification is usually based on precedent and anecdote. Patient classification systems enable quantification of the nursing load on a daily basis. This methodology for determining the size of the nursing staff, however, has not gained widespread use because it tends to formalize existing staffing patterns. At the Johns Hopkins Hospital, physicians and nurses drew up a list of activities that should be performed for patients and that need to be considered in budgeting for nursing services. The largest and most variable components of the nursing workload are the tasks specified by physicians' orders and the nursing care plan. A computerized information system which communicates these orders can also be used to quantify these components of the nursing workload, since standard times to perform these tasks have been documented. The variability of these tasks from day to day and from patient to patient is the source of most of the problems of staffing. Other components of the workload, such as patient education, depend on the nursing program desired and must be added separately. Budget decisions can then be based upon the specific nursing functions which the hospital desires to perform. The technique of functional activity budgeting can also be used for the utilization review of physicians' use of nursing services.

Economics, Hospital