The development of a time-based nursing information system in dermatology outpatients and day therapy areas.

Over the past 10 years the provision of dermatology services in Nottingham has moved away from inpatient care and towards nurse-led day therapy and outpatient care. The current nursing information system supplies nursing activity data for management information and is a ward-based patient dependency classification system. Recently, it became apparent that nursing activity in day therapy and outpatients was being measured with a tool that was not designed for the purpose and managers were using professional judgement to aid their decisions. An evaluative internal consultancy was conducted to investigate the situation and provide recommendations for the development of an appropriate system that would supply more accurate information for non-ward areas. The report recommended a 'time-based' system that avoided the fundamental philosophical mismatch between a reductionist, task-orientated system and the reality of holistic nursing care. The new system was developed on a departmental personal computer using Microsoft Excel spreadsheets. The full co-operation and input of the nursing staff was an essential ingredient in its success. The original consultancy concentrated on the day therapy unit but the time-based system was developed to include all dermatology non-ward areas.