Professional Portfolio

Running head: DATABASE DESIGN PLAN 1

Database Design Plan

Geroni, J., Patel, K., Wade, C. & Wouapet, A.

Team D Project – Part 2

Walden University

NURS-6411-1, Interprofessional Organizational and Systems Leadership

July 10, 2016

Database Design Plan

The database project that we undertook was to solve the clinical question "Does implementation of an established, evidence-based falls risk assessment tool reduce patient falls in a medical surgical unit?" The main objective is, therefore, to keep a record of each patient and a detailed review of the patient. This will include past medical records and other relevant data that can be assessed to determine the likelihood of the patient to fall (Coronel & Morris, 2015). The expected aim is to be able to predict the fall risk and take precautions in case the likelihood is high. The group members each put in effort to gather information in the current system and how the health workers determine the likelihood of falling while caring for their patients. We found there to be inconsistencies in patient care especially during shift change. Oncoming caretakers were unaware of the patients’ medical histories and fall risks, making them vulnerable to falls. Thus, the formulation of designing a database to determine the effectiveness of implementing an evidence-based falls risk assessment tool to assist in staff communication and prevention of patient falls. The improvement of patient safety and optimal outcomes is the goal. The purpose of this paper is to present the database project plan progress of Team D.

Data Elements Required to Answer the Question

In order to answer this particular question, we agreed to include various inputs to assist in determining the most appropriate analysis criteria to give us accurate results. These contributing factors include patient account number, patient age, patient sex, length of stay (LOS), medical record number (MRN), admission date, discharge date, fall, and fall risk score.

Collaborative team efforts produced the table headers and content for the development of the entity relationship diagram (ERD). The tables include, patient details, admission details, and health details. The patient details will include medical record number, age, gender, and fall. Encounter records will involve the patient medical record number, account number, date of admission and discharge, and length of stay. Fall information will include if a fall occurred and the fall risk score. These tables will show relationships to enhance the coordination of attributes between them and will be discuss later in this paper

Patient Table

The first table will be the Patient table with four pertinent attributes. The patient’s medical record number, age, sex, and fall data will be housed in this table. The patient medical record number will be the primary key attribute and the foreign key attribute within this table is fall. The patient sex will be text data type; the patient age is best as an automatically incremental number. The patient must have a medical record number that is also numerical data type and helps to better access physical records. The patient's risk of falling will also be recorded using a numerical index that will be decoded to denote just how high the risk is (Cox & Lambert, 2013).

Encounter Table

The second table is the Encounter table and will include five columns. The patient account number will be an incremental number data type and also the primary key in this table. The patient medical record number will be a foreign key attribute that will be a numerical data type. This will make a relationship with the Patient table. Since one patient can have many admissions but an admission can only be with one patient a one to many relationship is created. The patient medical record number is the next column on the table that will be a foreign key attribute producing a relationship with the Patient table. The relationship will also be one to many since every patient is assigned a unique medical record number, but each time the patient is admitted to the hospital they are assigned an account number to represent the records that make up a single episode of care. So since each patient has only one medical record number but can have many account numbers this data type will be numerical (Cox & Lambert, 2013).

The date of admission and date of discharge will be recorded with date and time data type. The length of stay column will be a derived value (Cox & Lambert, 2013).

The Falls Risk Table

The Fall table will have two main columns. The fall and the fall risk score, the primary key will be fall (Cox & Lambert, 2013).

Primary and Foreign Keys

In order to identify each field uniquely a primary key must be used for all the tables. In some tables foreign keys are required to enable referencing between tables and provide the ability to query multiple tables in a single query. To have a foreign key we must first create a relationship (Cox & Lambert, 2013). A relationship will help to reference other tables effectively and help us not to delete tables unknowingly which can lead to data loss. The various primary keys will include: patient medical record number in the Patient table, patient account number in the Encounter table, and fall in the Falls table. Foreign keys will include patient medical record number in the Encounter table, and the fall in the Patient table.

Our Database Design Plan to Secure the Database

Since end users are dependent on the availability and use of retrievable data contained within information systems, any interruption to this flow can produce detrimental results. The delivery of care and associated costs of an organization can be negatively impacted. This is where the security of a system becomes a major requirement. Coronel & Morris (2015) define security as: “Activities and measures to ensure the confidentiality, integrity, and availability of an information system and its main asset, data” (p. 730). Having a security policy in place provides the guidelines and criteria to preserve and protect vulnerable data. These measures also assist in meeting compliance and auditing standards. Ensuring that valuable data is protected from any potential or actual security breech/threat is crucial to the integrity and preservation of an information system. Thus, routine monitoring measures to readily identify and prevent any vulnerability to the integrity of the system is vital. Our team plan is to implement security guidelines that include the use of secure passwords, limited user access, and end user education to maintain the protection and security of the data enclosed within the database.

Further, even if the database has advanced controls and monitoring techniques in place without a solid encryption, it can be all in vain. In order to prevent database bypass from malicious people, we will enhance encryption so that the data may not be understood by people who are not supposed to have access since they can steal the data or even alter it (Pollock, 2010). The foundation of database security is data encryption and without it, a bypass can be very easy for an attacker to perform. Even with the assistance of database administrators, data security experts, or a mix of both, the group tasked with protecting the data held inside an organization's databases must set up specific propensities to achieve their security objectives. These practices lie at the establishment of a strong information security program (Pollock, 2010).

Another way that we will use to improve the security is by instituting measures such that a person can only access the database if and only if he/she is using the application so that it will prevent direct access to the database. When one is in direct contact with the database he can alter the data using the SQL commands such as DELETE * FROM TABLE PATIENT. Such a query can delete every record in that table causing loss of data. When data is accessed via the application, it is possible to prevent unauthorized users from accessing the application (Cox & Lambert, 2013). It is vital to protect the integrity of data. Integrity of data is a measure of the legitimacy and loyalty of an information object. As a capacity identified with security, a trustworthy information administration keeps up data precisely as it was inputted, and is auditable to confirm its unwavering quality. Information experiences any number of operations in backing of basic leadership, for example; catch, stockpiling, recovery, redesign and exchange. Information trustworthiness can likewise be an execution measure amid these operations in view of the distinguished mistake rate (Campbell, 2014).

Another good way of ensuring the safety of data is by involving multiple relationships so that it will not be able to delete tables; this helps to refer data into other tables and avoid redundancy and also helps to draw multiple tables at once (Coronel & Morris, 2015).

Experience and Challenges Encountered while Developing the Database

The design allows for the regular creation of reports so as to provide the ability to track patients and their conditions. These reports are what will enable the tracking of the risk of falling (Pollock, 2010). While coming up with this database we gained some practical experience which we could not have achieved if we just based our information on observation only. One of the new skills we learned is how to develop relationships that effectively relate to each other. We also acquired the ability to draw/create various entity relationship diagrams.

However, we encountered challenges such as a relationship producing errors while creating it which we struggled with and fortunately were able to resolve. The biggest problem encountered was in the process of sorting the data into tables and finding a way in which the tables would relate without redundancy. It was surprising that the data values provided didn't columns (Coronel & Morris, 2015).

Summary

In summary, Team D is working collaboratively on completing our database project. We have been able to successfully compile and develop data relevant to answering our posed question of "Does implementation of an established, evidence-based falls risk assessment tool reduce patient falls in a medical surgical unit?" Thus far our team has acquired the basic skills in designing a database that will prove beneficial to answering a clinical question that will impact the safety and outcomes of patient within the hospital setting.

Entity Relationship Diagram

References

Campbell, J. (2014). Ultimate guide to entity relatioship diagrams. Retrieved from Creately: http://creately.com/blog/diagrams/er-diagrams-tutorial/

Coronel, C. and Morris, S. (2015). Database systems: Design, implementation, and management (11th ed.). Stamford, CT: Cengage Learning.

Cox, J. & Lambert, J. (2013). Step by step: Microsoft Access 2013. Richland, WA: Microsoft Press.

Pollock, A. (2010). Access 2010 essential training. Retrieved from http://www.lynda.com/Access-2010-tutorials/essential-training/62642-2.html