ANESTHESIA RECORDKEEPING: ACCURACY OF RECALL WITH COMPUTERIZED AND MANUAL ENTRY RECORDKEEPING By Thomas Corey Davis, PhD A dissertation submitted in partial fulfillment of the requirements for the degree of PhD in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Dr. Chuck Biddle Director of Research, Department of Nurse Anesthesia And Dr. Jeffery A. Green Assistant Chief of Anesthesiology, Department of Anesthesia Introduction: Anesthesia information management systems are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and permanent electronic record. At risk is a potential loss of “connectedness” to the patient with the use of computerized recordkeeping, perhaps jeopardizing vigilance. Methods: This research analyzed differences in the accuracy of Certified Registered Nurse Anesthetists' (CRNAs) recall of specific patient variables during the course of an actual anesthetic case. CRNAs using computerized recordkeeping systems were compared to CRNAs using manual entry recordkeeping. Accuracy of recalled values of 10 patient variables was measured - highest and lowest heart rate, systolic blood pressure, inspiratory pressure, and end-tidal carbon dioxide levels, lowest oxygen saturation and total fluid volume. In addition, a filmed educational vignette was presented to evaluate any effect on accuracy of recall following this presentation. Four tertiary care facilities participated in this research. A Solomon four-group research design was selected to control for the effect of pretesting on results of the filmed educational treatment. Results: 214 subjects participated in this study; 106 in the computerized recordkeeping group, and 108 in the manual entry recordkeeping group. Demographic covariates were analyzed to ensure homogeneity between groups and facilities. No significant statistical differences were identified between the accuracy of recall among the groups. There was no statistically significant effect of the educational film vignette on accuracy of recall. Conclusions: There was no difference in the accuracy of practitioners’ recall of patient variables when using computerized or manual entry recordkeeping systems, suggesting little impact on vigilance. The educational film presented did not have an effect on accuracy of recall following the discussion of benefits and limitations of methods of recordkeeping.

<p>The aim of the study was to describe what district nurses, who work with telephone- advice, document in patient record, to be able to develop their documentation. The Authors have examined 50 patient records. The examination tool is collected from “Lokal anvisning för hälso- och sjukvården I Södra Älvsborg”. The audit areas was record keeping, review and planning, realization, individual nursing and the patients participation, information, education and agreement. The sample was stratified to avoid examining only one district nurses´ documentation. The sample was from, the five first and the five last telephone-advices that was documented in patient record, the five first days in July 2006. The result of the audit shows a lack of documentation in nursing record with telephone-advice, for example the patients problems is missing, it can lead to a poorer security of the patient. The Authors conclusion is that the district nurses who works with telephone-advice needs education in documentation, to increase and improve security of the patient in nursing and treatment.</p> / <p>Syftet med studien var att beskriva vad distriktssköterskor dokumenterar i samband med telefonrådgivning för att kunna utveckla distriktssköterskors omvårdnadsdokumentation vid telefonrådgivningssituationer. Författarna har granskat totalt 50 patientjournaler. Granskningsdokumentet som använts är hämtat ur ”Lokal anvisning för Hälso- och sjukvården i Södra Älvsborg”. Den omfattar granskning av journalföring, bedömning och planering, genomförande, individuell omvårdnad och den vårdsökandes delaktighet och information, undervisning och överenskommelse. Urvalet var stratifierat, de fem första och de fem sista telefonrådgivningarna de fem första dagarna i juli månad 2006, för att undvika att granska enbart en distriktssköterskans dokumentation. Resultatet av granskningen visar på bristande dokumentation i omvårdnadsjournalen i samband med telefonrådgivning inom samtliga granskningsområden t ex så saknas dokumentation om den vårdsökandes aktuella behov. Det kan leda till att patientsäkerheten försämras. Författarnas slutsats är att distriktssköterskor som arbetar med telefonrådgivning har behov av utbildning vad gäller dokumentation i samband med telefonrådgivning för att förbättra och öka patientsäkerheten i vård och behandling.</p>

The aim of the study was to describe what district nurses, who work with telephone- advice, document in patient record, to be able to develop their documentation. The Authors have examined 50 patient records. The examination tool is collected from “Lokal anvisning för hälso- och sjukvården I Södra Älvsborg”. The audit areas was record keeping, review and planning, realization, individual nursing and the patients participation, information, education and agreement. The sample was stratified to avoid examining only one district nurses´ documentation. The sample was from, the five first and the five last telephone-advices that was documented in patient record, the five first days in July 2006. The result of the audit shows a lack of documentation in nursing record with telephone-advice, for example the patients problems is missing, it can lead to a poorer security of the patient. The Authors conclusion is that the district nurses who works with telephone-advice needs education in documentation, to increase and improve security of the patient in nursing and treatment. / Syftet med studien var att beskriva vad distriktssköterskor dokumenterar i samband med telefonrådgivning för att kunna utveckla distriktssköterskors omvårdnadsdokumentation vid telefonrådgivningssituationer. Författarna har granskat totalt 50 patientjournaler. Granskningsdokumentet som använts är hämtat ur ”Lokal anvisning för Hälso- och sjukvården i Södra Älvsborg”. Den omfattar granskning av journalföring, bedömning och planering, genomförande, individuell omvårdnad och den vårdsökandes delaktighet och information, undervisning och överenskommelse. Urvalet var stratifierat, de fem första och de fem sista telefonrådgivningarna de fem första dagarna i juli månad 2006, för att undvika att granska enbart en distriktssköterskans dokumentation. Resultatet av granskningen visar på bristande dokumentation i omvårdnadsjournalen i samband med telefonrådgivning inom samtliga granskningsområden t ex så saknas dokumentation om den vårdsökandes aktuella behov. Det kan leda till att patientsäkerheten försämras. Författarnas slutsats är att distriktssköterskor som arbetar med telefonrådgivning har behov av utbildning vad gäller dokumentation i samband med telefonrådgivning för att förbättra och öka patientsäkerheten i vård och behandling.

This thesis examines if and how information capture and documentation practices and the function of the public archive are changing in relation to archival concepts in contemporary administrative settings, as a result of e-government strategic development. The study aims for a holistic approach from the beginning of the life of the records to their long-term preservation. This research is situated in Sweden where the recordkeeping legislation takes a holistic approach: records management is understood as a dimension of the archival function and therefore records managers have not been recognised as a professional group, however recordkeeping practice involves two occupational groups: registrars and archivists. Swedish recordkeeping legislation is based on long administrative traditions in which the public right of free access to official documents is fundamental. Registration of official documents is important as the means of facilitating the citizens´ right to free access information and registrars are primarily responsible for this process, including classification. Archivists manage the full range of recordkeeping tasks, acting not only as custodians of repositories but also strategic experts on recordkeeping as well as auditing on behalf of the archival authority.  The archive legally consists of all the ‘official documents’ created or received in the organisation. This is an explorative and documented case study that used several local government bodies (municipalities) for the data collection by document analysis and interviews. Swedish municipalities are particularly interesting because they are autonomous in relation to the national government, with complex organisational structures consisting of several politically controlled committees and administrative departments that implement political decisions and provide services to the public. The National Archives does not have any supervisory role or monitoring function over local governments, but it does publish guidelines on recordkeeping. Nevertheless, the municipalities are controlled to a large extent by the implemented policies decided at national level by the Government and Parliament. Therefore, national initiatives regarding e-government have impacted on the municipalities’ recordkeeping. A theoretical lens combining archival science and theory of professions has been chosen to analyse the observed changes in practice. The thesis analyses the issue of recordkeeping awareness in three arenas: the legal arena; the political arena; and the workplace arena in the light of the records continuum model. The research findings demonstrate a gap between the legal and workplace arenas caused by lack of recordkeeping awareness primarily within the political arena. Despite the holistic view of keeping archives expressed in the recordkeeping legislation, observed practice appears closer to a life cycle model than proactive continuum thinking and planning.  A lack of recordkeeping legislation awareness in the wider organisation is potentially leading to a division between records management and archives management, jeopardising the continuum approach. Consequently registrars may in the future become more like records managers and archivists may be losing part of their professional jurisdiction. There is a strong focus on business benefits to the organisation rather than the wider view of democratic values and cultural heritage. As a result: archivists seem to suffer a lack of resources as well as skills in order to carry out their responsibilities. The future role of archival authorities such as the National Archives is unclear. / Just nu pågår en omdaning av den offentliga förvaltningskostymen för att möta politiska mål vad gäller utveckling av den offentliga sektorn med stöd av informationsteknologi. Denna avhandling undersöker konsekvenserna av en sådan ambition genom att använda den nuvarande offentlighets- och arkivlagstiftning som en referenspunkt i syfte att undersöka vad, varför och hur implementeringen sker. I Sverige utgör de allmänna handlingarna myndighetens arkiv och skall enligt rådande arkivlagsstiftning vårdas och förvaltas så att de tillgodoser behov rörande offentlighetsinsyn, rättskipning, förvaltning och forskningen. Det finns en lång förvaltningstradition och reglering kring registrering av allmänna handlingar relaterat till offentlighetsinsynen. Myndigheternas arkiv är per definition en del av det nationella kulturarvet. Allmänna handlingar är teknikoberoende, vilket medför att oavsett om handlingarna är pappersbundna eller digitala omfattas dessa av samma regelverk. Avhandlingen söker besvara frågan: Hur medvetna är offentliga organisationer om vikten av att hantera sina allmänna handlingar i det pågående e-förvaltningsarbetet på ett sådant sätt att de uppfyller kraven i offentlighets- och arkivlagstiftningen samt hur påverkas arkivariers och registratorers professionella status (positioner och arbetsutövning) inom organisationerna? Vidare analyseras relationen mellan nya strategiska initiativ avseende informationsfångst och arkivlagstiftningen. Avhandlingen förenar arkivvetenskap och professionsteori. En teoretisk analysmodell har skapats för analys av tre arenor: den legala, den politiska och arbetsplatsarenan vad gäller medvetenheten om de legala kraven gällande offentlighets- och arkivlagstiftningen. Förändringar avseende styrnings- och kontrollsystem på legal och politisk arena kan få konsekvenser, dels för synen på vad som definieras som arkiv, dels för professionerna (arkivarier och registratorer) på arbetsplatsarenan. Om professionerna minskar jurisdiktionen, dvs. länken mellan professionen och arbetet, riskerar de att bli marginaliserade. Avhandlingen baseras på fallstudier i svenska kommuner. Kommuner utgör till följd av den kommunala självstyrelsen inkluderande arkivorganisationen och mångfacetterande och komplexa organisationsstruktur intressanta studieobjekt. Datainsamlingen har skett via analys av dokument och intervjuer. Forskningsresultatet tyder på att det råder ett gap mellan den legala och verkställande arenan beroende på att de legala kraven inte beaktas tillräckligt på den politiska arenan, vilket i sin tur kan få konsekvenser för arkivets roll i samhället, inte minst när det gäller rättssäkerhet och demokrati. Arkivarier och registratorer finns företrädesvis representerade i hanteringen av traditionell arkiv- och dokumenthantering. Resurser liksom kompetens saknas dock när det gäller att arbeta strategiskt med e-förvaltningsfrågor. Omedvetenhet på politisk och verkställighetsnivå om vikten av att arbeta proaktivt med arkivfrågor resulterar i att professionerna exkluderas. Tillsyn kan ses som ett verktyg för att bibehålla och ytterligare stärka arkivariernas professionella jurisdiktion samt att bidra till en ökad medvetenhet i organisationerna. Fokus för e-förvaltningsutvecklingen har främst legat på verksamhetsnytta med betoning på den interna verksamhetsutvecklingen i organisationen, samt relationen till den enskilde medborgaren. Nya möjligheter att fånga och använda information väcker dock frågor kring informationens legala status i relation till offentlighets- och arkivlagstiftningen. Att strategiskt verka för offentlighetsinsyn och säkra informationen i ett vidare perspektiv som en del av ett kulturarv tycks inte ha samma dignitet. Arkivmyndigheternas framtida roll är oklar. Avhandlingen bidrar med ny kunskap om relationen e-förvaltningen och arkiv- och informationshantering ur ett praktiskt, legalt och arkivvetenskapligt perspektiv. Avhandlingen kan därför vara praktiskt användbar på politisk och verkställighetsnivå när det gäller att öka medvetenheten om dessa frågor i offentlig sektor. Avhandlingen bidrar även till teoriutveckling inom den arkivvetenskapliga forskningen genom kombinationen av det teoretiska ramverket med arkivteori och professionsteori. / <p>The result presented derives from four years of research conducted within the Centre of Digital Information Management (CEDIF) at Mid Sweden University. During this time I have been involved in two research projects; the CEDIF project and the GOINFO project. Without funding, this research had not been possible. Therefore, I would like to thank EU Objective 2, the Swedish Agency for Economic and Regional Growth, the County Administrative Board of Västernorrland, Härnösand Municipality, Sundsvall Municipality and Mid Sweden University – who all funded this research.</p> / CEDIF / GOINFO

55 pp. / Training resources for volunteer facilitators of grandparent discussion groups; Grandparents Raising Grandchildren / Grandparents-raising-grandchildren discussion groups may conduct their meetings by a) focusing on issues that members suggest and/or b) choosing from among a list of critical topics that are common issues to most grandparents. Sometimes, discussion group facilitators want help identifying topics that are both reliable and educational. To fill the need for conversation-starting topics, we have provided a series of discussion topics for a facilitator's reference. These discussion topics have been gathered from KKONA's experience listening to the issues grandparents bring up about raising grandchildren. Some of the best group discussions introduce a topic after grandparents have attended a related workshop or training that allows grandparents to process information that they have heard or read. Following through with a discussion topic will help the group more deeply explore the issue and gather grandparents' ideas. The themes of the discussion topics include legal issues, relationship issues, discipline, schools, accessing social services and recordkeeping. There are eighteen topics. The sources for these materials include research and parenting materials as well as practical recommendations gathered from discussion groups. As you use these sheets, remember that they are intended to spark discussion and give you some reliable references. The sheets are not meant to be a step-by-step method for conducting your discussion groups nor do they provide in-depth information.

This thesis examines records created through diplomatic activities and considers approaches to their archival description, using those created by the Canadian Department of External Affairs in the 1920s as a case study. The objective of the thesis is to explore the history of this record genre with a focus on how archivists can provide users with access to more authentic and meaningful diplomatic records. Chapter One will provide a broad overview history of the diplomatic genre as well as the place of such contextual knowledge about the creation and characteristics of these records. Chapter Two will introduce a key strategy that archives can implement to more effectively relay contextual knowledge to archival users through the function of description. Chapter Three will then introduce a case study, building upon the approach identified in Chapter Two, and based on Canada’s Department of External Affairs in the 1920s.

This thesis examines records created through diplomatic activities and considers approaches to their archival description, using those created by the Canadian Department of External Affairs in the 1920s as a case study. The objective of the thesis is to explore the history of this record genre with a focus on how archivists can provide users with access to more authentic and meaningful diplomatic records. Chapter One will provide a broad overview history of the diplomatic genre as well as the place of such contextual knowledge about the creation and characteristics of these records. Chapter Two will introduce a key strategy that archives can implement to more effectively relay contextual knowledge to archival users through the function of description. Chapter Three will then introduce a case study, building upon the approach identified in Chapter Two, and based on Canada’s Department of External Affairs in the 1920s.

Målet med denna studie är att undersöka om informationskultur är ett teoretiskt verktyg som kan bidra till en proaktiv informationsförvaltning, samt om informationskulturperspektivet kan vara till stöd för en organisation som genomgår ett förändringsarbete som påverkar informationsförvaltningen. I studien används Gillian Oliver and Fiorella Foscarinis definition av informationskultur, vilket de definierar som ”values accorded to information, and attitudes towards it, specifically within organisational contexts.” Förberedelsearbetet på två svenska universitet inför dataskyddsförordningen GDPR (EU) 2016/67, vilken trädde i kraft 25 maj 2018, är det fall som författaren prövar informationskultursteorin mot. Genom en kvalitativ metod, där fem respondenter har intervjuats, har författaren undersökt respondenternas värderingar gentemot information samt hur de hade organiserat sitt arbete inför GDPR. Studien visar på ett stort behov av samarbete mellan arkivarier och andra yrkesgrupper såsom it-ansvariga och jurister när komplexa informationsförvaltningsfrågor som GDPR ska hanteras. Men att detta samarbete involverar arkivet är inte självklart, vilket visas i skillnaden mellan hur de båda universiteten har arbetat. Studien visar även att det finns en skillnad mellan att anlägga ett informationskulturperspektiv under ett förändringsarbete och att använda informationskultur i Oliver och Foscarinis mening, vilket innebär att analysera redan etablerade strukturer och organisationer; de problemområden som Oliver och Foscarini anser att arkivarien bör undvika att lägga mycket arbete på, då de är svårföränderliga, visar sig enligt studieresultatet tvärt om vara viktiga att jobba med under ett förändringsarbete. Att en viss nivå av det informationskulturramverk som Oliver och Foscarini har tagit fram är svår att påverka i en organisation betyder inte att den är svår att inkorporera i ett förändringsarbete. Till skillnad från andra, allmänna förändringteorier så lyfter informationskulturperspektivet fram aspekter som är direkt kopplade till arkivariens roll. I stället för generella råd som ”samarbete” föreslås mer specifikt ”samarbete med it”. Informationskultur är dessutom en väldigt innehållsrik teori då den inbegriper många etablerade teoribildningar. I en informationsförvaltningskontext blir därför informationskulturansatsen paradoxalt nog både bredare och mer specifik på samma gång. / The aim of this thesis is to examine if information culture is a theoretical construct that can assist in creating a proactive recordkeeping environment. It also aims to investigate if information culture can be of help to an organization that goes through changes that affect its recordkeeping practices. The study uses Gillian Oliver and Fiorella Foscarini’s definition of information culture, which they define as ”values accorded to information, and attitudes towards it, specifically within organisational contexts.” The preparations for the GDPR (EU) 2016/67 at two Swedish universities functions as the case that the author uses to explore these questions. Using a qualitative method, interviewing five people, the author examined the interviewees’ values towards information and how the organizations had prepared for the GDPR. The study suggests that there is need for cooperation between archivists and people from other professions, such as IT and law, when preparing for complex recordkeeping issues such as the GDPR. However, the study shows that an archivist is not always involved in an organization’s change management effort.  The study shows that there is a difference between adopting an information culture perspective when managing change and using information culture as Oliver and Foscarini intend it be used. Their approach addresses organizations and structures that are already established. The problem areas that Oliver and Foscarini think an archivist should avoid focusing its change management efforts on, because they are hard to change, are shown to be as important to work with as other problem areas when managing change in an organization. Just because a level of the information culture framework that Oliver and Foscarini have developed is difficult to affect in an organization does not mean that it is hard to incorporate into a change management effort. In contrast to other change management theories, an information culture perspective highlights aspects that are directly connected to the role of the archivist. Instead of generic advice, such as “cooperation”, information culture specifically advices the archivist to “cooperate with the IT department”. Information culture is a theoretical construct that embraces other established theories. From a recordkeeping perspective, an information culture approach is therefore paradoxically both broad and exact at the same time.

<p>Records are a subset of information and recordkeeping requirements demand that a record is managed with maintained authenticity and reliability, i.e. with high quality. Records are evidence of transactions and are used and managed in daily work processes. Records may be preserved for anything from milliseconds to eternity. With computer based information systems the electronic record was born: a record that is born digital. With electronic records problems regarding maintenance of authenticity and reliability have been identified. Electronic records are no longer physical entities as traditional records were. An electronic record is a logical entity that can be spread over different locations in a computer based information system. In this research the aim is to improve the possibility of reaching high quality in recordkeeping systems, i.e. to maintain reliability and authenticity of electronic records, which is necessary if electronic records are to be usable as evidence of transactions. Based on case studies and literature studies, a recordkeeping quality model is presented: a predictive model for attaining quality in recordkeeping. The recordkeeping quality model consists of four major concepts which are interrelated with each other: Electronic records, Records use, Electronic record quality, and Multidimensional perspective. The model is proposed for use when designing and developing computer based information systems which are required to be recordkeeping, systems which manage electronic records. In this research two results beside the recordkeeping quality model are emphasized. The first is that quality in recordkeeping must be seen in a multidimensional perspective, and the second is that recordkeeping systems are information systems with a partially unknown purpose.</p>

<p>The starting point of this paper has to do with rapid changes within the information technology and the need for agile and fast systems. The primary goal is to investigate what happens with recordkeeping practices in agile environments like service oriented architecture (SOA). It is in the possible transfer between IT architecture and digital archive the area of this paper resides. The paper relates to the Records Continuum model by which records will be considered historical and active at the time of creation. In the Records Continuum model recordkeeping practices and archival requirements will have to be taken into account at the time of creation.</p><p>This paper concerns SOA from the perspective of Archival and Information science. It describes the different parts that make it possible to achieve a SOA with emphasis on those parts which have the most impact on the requirements of a digital archive. The main requirements discussed in this paper are the principle of provenance, the need to ensure that records remain authentic, reliable and keep their integrity and usability over time. The issue of keeping track of information and activities in a SOA is also discussed. It is established that records which need to fulfil the requirements mentioned above do exists in a SOA. The purpose of this paper is to investigate whether or not the principle of provenance and the archival requirements will be affected by SOA, and whether or not the requirements can be fulfilled over time.</p><p>Information collection for this paper is basically through studies of literature and information gathering on the Internet. The method is descriptive and comparison between the information gathered has been made. In addition one short interview has been undertaken with Skatteverket, a government that are in the process of implementing both SOA and a digital archive. The main purpose with the interview was to find out if there are any collaboration between SOA and the digital archive at Skatteverket.</p><p>The results indicate that a lot of the problem concerning preservation of digital records over time also applies for SOA, such as the lack of sustainable format and media and the potential loss of information. However some successful implementations of digital archives based on the OAIS-model with SOA as tool for realising the digital archive has been found. The archival requirements and the principle of provenance will be affected by SOA but it is only when there is a connection between SOA and a digital archive that it is possible to secure some of the archival requirements.</p>