Risk Management: The Health Center Log — Rich Source of Risk Management Data

Linda Ebner Erceg, RN, MS, PHN

As camp professionals become more effective risk managers, the need to periodically review camper and staff injury and illness events is a given. One of the best sources of this information is a health center’s log. Knowing why people seek healthcare not only provides an indicator about the effectiveness of risk management strategies, but can also inform incoming nurses about anticipated camper and staff needs, help determine if medical protocols cover anticipated injuries and illnesses, and inform decisions about what supplies are needed in the health center.

The log succinctly lists, by date and time, the reasons why people sought healthcare. How might someone quickly and meaningfully organize this information?

How to Organize Log Data

With the log in hand, consider the timespan you’d like to use for the review process. Some may want to review the whole season; others might select a representative portion of the program. Using the entire season means you’d definitely capture all information. If not doing the entire season, I suggest selecting at least a three-week timespan during the “heart” of the camp season. The goal is to look at a sufficient amount of information so collected data reliably reflects the reality of what happened.

While doing this, keep in mind the limitations of logged information. For example, the log typically lists the reason why individuals sought care; that reason may not remain once health center staff complete their assessment. The camper who is logged in because of an itchy rash may actually have hives, poison ivy, impetigo, or something else. Yes, logged information will reveal some things, but it has its limits. Recognize this. Logged data is an indicator, not a definition.

Next, determine what you’ll use to collect and organize the data. Setting up a computer-based spreadsheet facilitates sorting data in various ways. On the other hand, a simple tally sheet done by hand may be sufficient; one can quickly add totals using hash marks.

Then consider how to enter the actual data. I recommend initially sorting logged data into classic, broad categories, specifically injury, illness, psychosocial concern, or “other” categories. This gross organization is illustrated in Table 1. Other options to consider include separating camper and staff data, noting incidents that result in health center admission or pulling the individual from their routine for an hour or more, and/or incidents for which the person was referred to an external provider (e.g., MD, dentist, chiropractor, or mental health professional).

From this point forward, one will be working with actual logged entries. To improve consistency, have the same person enter data. This is particularly important when the reason for seeking care doesn’t cleanly fit into a category. Take, for example, menstrual cramps (dysmenorrhea). These cramps aren’t an injury, but they typically aren’t an illness either. The person doing data entry will have to make a decision about how dysmenorrhea and other such events will be treated — and then consistently apply that decision. On the other hand, those familiar with research might want interrater reliability (no matter who enters the data, the outcome is the same). If so, use a process to assure that outcome.

Now it’s time to get discrete and work with (enter) the actual data. List each logged entry under one of the broad categories. Wounds get put under injuries, nausea and/ or headache get tucked under illness, and so on. Again, Table 1 illustrates some discrete labels. If your sorting process includes other factors, such as distinguishing between camper and staff entries, also complete those fields.

Making Sense of Information

Once data has been sorted, it’s time to look at what it is telling you. The simple sort described in this article means one is dealing with descriptive data. It’s possible to do calculations such as count entries, rank order them, and determine totals, but be cautious about doing much more or consult someone skilled in statistics.

One obvious result of your work will be a list of reasons why people sought healthcare and the frequency of those requests. This is great information to give incoming health center staff. They’re often interested in knowing what injuries and illnesses are anticipated so they can assess their own skill set — can they competently handle this needed care? Getting this information at the time of hire also allows one to address knowledge gaps — a definite asset! This being said, point out incidents that may be outside the typical experience. Perhaps the data set included a number of nausea/vomiting cases because of a Norwalk virus outbreak. Make note of such incidents so their impact isn’t lost over time.

Then look at the frequency with which events occurred. Do those frequencies make sense? Are they reasonably anticipated? Because campers are youth, some wounds might be expected given the cuts and scrapes associated with camp activities. However, if a particular activity is causing those wounds, if staff are more wounded than campers, and/or if wounds are associated with behaviors like not using protective gear or not wearing appropriate shoes, then the dataset indicates a point (or points) of intervention.

Some frequencies may trigger more questions. Look again at the data in Table 1. As an injury category, “rashes/poison ivy” ranks third, and “stings” are in fifth place. Why? Among illness, “headache” got top ranking. Is this a symptom of other problems — perhaps related to allergies — or a problem of its own? Answering questions like these requires deeper investigation, something a robust risk management program might want to do. People sign up for a camp experience, not to experience illness and/or injury. By looking at the reason for selected incidents (e.g., reading health record documentation), one may gain insight that would otherwise have been missed. Use tabulated log entries to find those points for which you’d like more information so your efforts are appropriately focused.

The resulting list can also be used to determine if the camp’s medical protocols sufficiently cover anticipated needs. Sometimes a surprise area may emerge, like “trouble sleeping” under Table 1’s psychosocial category. Most camp protocols don’t address this problem, but if campers and staff are seeking care for it, perhaps it should be added. A similar question can be asked about the health center’s stocked medications and supplies. Are they adequate for the injuries and illnesses that are present for care?

One might also note something unusual. What does “accessing personal OTCs” (over-the-counter meds) mean under Table 1’s “Other” category? Might this have implications for documentation, or should the reason for needing that OTC be logged instead? These are the kind of questions that management can address but only if data pointing to the question is noted.

It’s certainly possible to continue this discussion and exhaust the many learning points that a review of information from the camp health center log can provide. The purpose of this article, however, is to tease you into looking at your camp’s logged data. It’s rich with information, including indicators that affirm what is going well. That, too, is important. At minimum, your logged data provides baseline information that can be used to orient health center staff, as an indicator about the effectiveness of your risk reduction initiatives, and to give you tips for improving the management of your health services.

Use it. Your campers and staff will have a better camp experience when you do.

Additional Resources

The Basics of Camp Nursing (Second Edition), by Linda Erceg and Myra Pravda, www.ACAbookstore.org/p-5838-the-basics-of-campnursing-second-edition.aspx

Camp Health Record Logs, Health History Forms, and more, www.ACAbookstore.org/c-478-forms.asp

Linda Ebner Erceg, RN, MS, PHN, is the associate director of Health & Risk Management for Concordia Language Villages and executive director of the Association of Camp Nurses in Bemidji, Minnesota.
 

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