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The word alone may conjure up feelings of uneasiness among those who are not computer experts or financial wizards, but even staff with limited knowledge of computers can learn how to apply spreadsheets to expedite the daily operations of a nursing facility.

First, though, what exactly are spreadsheets? Financial officers have been using them for decades as a means of planning and budgeting. To manage large groups of numbers, spreadsheets provide columns and rows which intersect into cells. The resulting patterns of the various cells provide a snapshot of important trends and new developments.

One of the most commonly known and mastered spreadsheets is the Lotus software package, which is used commonly in the financial community. However, simpler, more easily understood programs are available within the First Choice, Microsoft and Q & A packages. A necessary first step is to choose a software program that is the most user-friendly for your staff and provide them time to sit down and get hands-on experience with the computer.

Now for specific uses. In nursing facilities that have a high degree of resident turnover, admissions, discharges and readmissions, it becomes difficult if not impossible to track weight fluctuations. By creating a spreadsheet of monthly or serial weights, the staff can identify at a glance the weight loss or gains of a wing, floor or the entire facility. The names of the residents are listed along the vertical or row grid in alphabetical order, or by room number, chronological order of admission or by highest weight loss risk to lowest weight loss risk. The timeframe of weeks or months is placed in the horizontal or column grid and the weights are inserted in the cells for comparison. Calculating the residents' weight changes between the months can easily be performed by the spreadsheet.

The weight spreadsheet should be used as a tool at care conferences as a point of discussion for residents at risk for weight loss and in need of an interdisciplinary approach to stabilizing nutritional status. Used in this way, it provides a focal point for documentation from dietary, nursing and activities.

Another use for spreadsheets is as a quality assurance tool for risk assessment. Incident Reports can supply the data needed to determine problem areas within the facility and residents who are at risk who require intervention to prevent further incidents. The names of residents who had incidents over a prescribed period of time are entered into the vertical axis; the type of incident, such as a fall when ambulating or a fall out of bed, is noted on the horizontal axis. In the cell where the two intersect can be noted the time of day when the incident occurred. Information regarding patterns of accidents can easily be identified using the spreadsheet and a risk prevention program tailored specifically to that resident can be initiated.

As some facilities are discovering these days, it can be difficult for the staff in a busy facility to keep track of care conferences and MDS updates. A simple solution is to plot the residents on the rows vs. their admission, initial care conference and dates of subsequent updates on the column. The MDs coordinator can be responsible for ensuring compliance with assessment using this tracking method.

As another potential use, it is the responsibility of the administrator to ensure that all physicians on staff in the facility have their current medical licenses, Drug Enforcement Administration (DEA) certificates and malpractice insurance status on file with the facility. The program is that these pieces of information frequently expire on different dates. Multiply three pieces of expiring data by the number of attending physicians, consultants, specialists and covering physicians and you have a paperwork nightmare. One solution is to plot the physicians along the vertical axis and the license, DEA certificate and malpractice along the horizontal axis. Enter the date of the information into the cell. The spreadsheet provides a quick way to identify which records need to be updated by the physician. As current information becomes available, the spreadsheet is updated. The medical records director can be responsible for implementing this program. (See sample.)

Spreadsheets may also be helpful from the personnel management perspective. Keeping track of the hire dates, anniversaries, evaluations and pay increases of a facility of employees can be made easier by plotting the employees' names along the rows and the milestones along the columns. (See sample.)
Name* 12/31/92 6/30/92 1/1/92 LETTER
Name* 12/31/92 6/30/95 10/20/92 IS
Name* 10/31/92 6/7/91 1/1/92 IS
Name* 12/31/90 6/30/92 5/18/91 IS
Name* 10/31/92 6/30/93 1/1/93 LETTER
Name* 10/31/92 1/1/94 1/1/91 LETTER
Name* 12/31/90 NONE 6/30/90 IS
Name* 12/31/92 7/31/95 1/1/93 IS
Name* 12/31/92 7/31/94 6/4/92 IS
Name* 12/31/92 7/31/94 7/1/92 IS
Name* 10/31/92 7/31/93 1/1/91 IS
Name* 12/31/92 7/31/94 7/1/93 LETTER
Name* 12/31/92 7/31/92 1/1/93 LETTER
Name* 10/31/92 7/31/95 1/1/91 LETTER
Name* 10/31/90 7/31/91 1/1/91 IS
Name* 12/31/92 7/31/93 11/15/93 LETTER
Name* 12/31/92 7/31/93 1/1/92 IS
Name* 10/31/92 7/31/94 2/1/93 LETTER

These are but a few of the uses of spreadsheets in nursing facilities, and by no means represent an exhaustive description of its place in the nursing home. Think of spreadsheets when large numbers or groups of data need to be digested into a practical form. When compliance becomes an issue, determine if using a spreadsheet can solve the problem. Your staff can easily learn how to use a simple spreadsheet and will most likely be motivated to do so, because it can reduce paperwork and enhance productivity.

Ilene Warner, RN, MA, NHA, is Program Director for the Haverford Geriatric Assessment Program and, at the time this article was conceived, was Administrator of the Haverford Nursing and Rehabilitation Center, Havertown, PA.
COPYRIGHT 1993 Medquest Communications, LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Warner, Ilene
Publication:Nursing Homes
Date:Jul 1, 1993
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