BY DAY 3 OF WEEK 1
Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?
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ToggleBY DAY 6 OF WEEK 1
Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.
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NURS-6051N Week 1 Discussion
Discussion: The Application of Data to Problem-Solving
Discussion: Using Data to Solve Problems in Nursing
In my everyday nursing practice, one of the most critical aspects of data collection is gathering patient information upon admission. Working in a facility that specializes in adolescent psychiatric and behavioral health, it’s crucial to collect comprehensive background data about the patients before they are fully admitted. We need to ensure that these patients meet specific admission criteria before they can be accepted into our care. The process of acquiring knowledge begins right after they are admitted to help us better understand our patients.
The data we collect before admission primarily consists of the patients’ electronic medical records, which are usually entered into computer systems. This information includes primary and secondary diagnoses, hospitalization history, previous assessments, past treatments, lab results, and medications. As Stoots pointed out in 2015, psychiatric nurses are using electronic health records (EHR) to improve the management of behavioral health populations cost-effectively. This effort is about preventing and treating mental health disorders and the various other health conditions that may co-occur. To develop effective care plans, we need to know what has worked in the past and what hasn’t. Documenting successful and unsuccessful strategies is crucial for providing the best care.
The age of computers has brought significant changes and efficiency to healthcare. Systems like EHRs provide safety alerts and a wealth of information, making patient care more effective. Knowledge is now seamlessly integrated into electronic patient records. New algorithms also assist us in making better decisions. Although EHR technology isn’t the newest, it’s continually updated to ensure the information provided is accurate, as pointed out by Nagle, Sermeus, Junger, and Bloomberg in 2017. Beyond gathering data and providing care, we can also use educational materials to help patients improve their well-being.
Now, let’s delve into a hypothetical scenario involving a patient experiencing an adverse psychiatric reaction to a medication prescribed during their hospital admission. Undesirable responses to psychiatric medications can cause severe distress. While these reactions aren’t typically categorized as “allergies” in a patient’s records, the electronic records may indicate that the patient received a specific medication. However, it’s essential to clearly show when the drug was discontinued. In some cases, discussing all prior medications with patients is necessary, especially when patients may not be able to recall specific events in their medical history due to their mental state. By reviewing patients’ medical records, staff notes, and notes from previous providers, we can better understand the patient’s health history. When a nurse reports these findings to the healthcare provider, it’s essential to document all of the patient’s behaviors. This information can be invaluable in providing a higher level of care, and it’s essential to have a record of it.
Understanding how a patient reacts to a specific medication is crucial, especially in the psychiatric field. It allows us to ensure that the drug isn’t used again if it previously caused manic, aggressive, or self-injurious behavior in the patient. We can also flag the medical record to alert others about the patient’s reaction if it hasn’t already been done. In situations where there have been dangerous incidents, quick adjustments are necessary to ensure the patient’s safety. Most adolescents are hesitant to discuss sensitive information with adults they don’t have a close relationship with, so having prior information is valuable. It helps us understand their experiences and situations. In addition to recorded medical records, verbal information and reports play a crucial role. Oral information, when combined with medical records, provides a more comprehensive understanding of the patient’s condition. The care team is always ready to respond to any notable changes in the patient’s condition.
Effective communication and ongoing collaboration among team members are essential for providing comprehensive patient care. I’m fortunate that my facility uses computer systems that connect local hospitals and healthcare providers. In addition to verbal communication among our care team, progress notes can be accessed by colleagues and external providers involved in the patient’s care. This wealth of information gives our team the advantage in addressing various patient issues. With the data I gather from verbal reports, records, and direct communication with the patient, I can analyze the situation and develop a care plan that suits both the patient and the care team. As McGonigle and Mastrain shared in 2017, using information and applying knowledge to solve problems is about acting wisely based on nursing practice science. Knowing where the patient stands and understanding their situation is crucial for developing a starting point and creating a care plan that ensures the patient’s well-being.
References
McGonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
Nagle, L. M., Sermeus, W., Junger, A., & Bloomberg, L. S. (2017). The evolving role of the nursing informatics specialist. Stud Health Technol Inform, 232, 212-22.
Stoots, M. (2015). Unlocking Electronic Health Record Data Helps Drive Behavioral Health Population Management. Journal of the American Psychiatric Nurses Association, 21(5), 348-350.
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Collapse SubdiscussionMansong Ntekim Hi Sheila,
Thanks for you for your well-written discussion post. Like you stated, gathering a patient’s data is a vital part of the admission process. The data collection process is simplified and made faster by the application of EHR system in most facilities that has adopted the EHR. The availability of health information from prior treatment locations, the frequency and outcomes of past treatments has helped in the evaluation of the efficacy (or lack of) of past treatment and guide in the implementation of revised plan of care for better results for the patient.
You mentioned the use of data in understanding patients experiences and reactions to previous medication regime. The EHR has been a great tool in the safe management of medication, mostly, among patients with mental health who have a higher propensity for “doctor shopping” and medication misuse. It is important for nurses to acquaint themselves with informatics competency. Being competent in the use of informatics will aid the nurse in using information and technology to communicate, manage knowledge, reduce errors, and enhance good decision-making at the point of care (Glassman, 2017).
Reference
Glassman, K. (2017). Using Data in Nursing Practice. American Nurse Today. Retrieved from https://www.myamericannurse.com/using-data-nursing-practice/
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Collapse SubdiscussionBarkisu Fortenberry Hi Sheila,
Hi Sheila, your discussion post is not only insightful, but it is also thought-provoking. Indeed, obtaining patient information is an important part of the administration procedure. The data collection procedure is broken down through the use of the EHR system. In fact, most facilities have incorporated the use of EHR in their operations. The accessibility of health information from the existing treatment setups, and the frequency and results from past treatments have enhanced the assessment of effectiveness or lack thereof in past treatments (Nagle et al., 2017). Therefore, it will basically guide in implementing a revised plan of care to ensure better outcomes for the patient.
Reference:
Nagle, L. M., Sermeus, W., Junger, A., & Bloomberg, L. S. (2017). The evolving role of the nursing informatics specialist. Stud Health Technol Inform, 232, 212-22.
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Collapse SubdiscussionBertina Boma Soh Hello Sheila,
You are right when you say that it is essential to understand how a patient reacts to specific medications. Most medications have side and adverse effects, so distinguishing between a side and a negative impact will determine what actions a nurse can take to help a patient deal with the situation. The nurse usually reports allergic and adverse reactions to the doctor, who then gives an order for the next step.
That being said, communication and continuous collaboration are essential in overall patient care. When managers establish sound systems to facilitate communication, it goes a long way to improve comprehensive patient care and reduce risky incidences.
Huang et al. found that tackling complex team problems requires understanding each member’s skills to devise a task assignment to maximize the team’s performance. Visual people prefer written communication (email or cloud-based software), while auditory people benefit more from a phone calls, video chat, or face-to-face meetings. Realizing that everyone is different allows for better communication. It sends the message to your team members that you value them as individuals and recognize which form of communication works best for them.
Studies were conducted to describe interprofessional collaboration (IPC) in pain management in neonatal intensive care based on healthcare team members’ perceptions of partnership, cooperation, and coordination (Mäki-Asiala et al., 2022). Collaboration in teamwork is based on respect for and trust in oneself and others. Mäki-Asiala et al. highlighted that neonates’ well-being and brain development should be supported by pain assessment, prevention and treatment of painful procedures, and appropriate dosed medications(Mäki-Asiala et al., 2022).References
Huang, E. Y., Paccagnan, D., Mei, W., & Bullo, F. (2022). Assign and appraise: achieving optimal performance in collaborative teams. IEEE Transactions on Automatic Control.
Mäki-Asiala, M., Kaakinen, P., & Pölkki, T. (2022). Interprofessional Collaboration in the Context of Pain Management in Neonatal Intensive Care: A Cross-Sectional Survey. Pain Management Nursing.
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Collapse SubdiscussionRaminder Kaur Hi Sheila, Excellent Post!
I agree with you that collecting patient data on admission is one of the most vital areas of data collection. The first of the five steps in the nursing process, the initial nursing assessment, requires the systematic and ongoing collection of data; organizing, sorting, and analyzing that data; and the communication and documentation of the collected data. Decisive reasoning abilities applied during the nursing system give a dynamic structure to create and direct an arrangement of care for the patient integrating evidence-based practice ideas. The third leading cause of death in the United States is medical error. An error can occur while planning patient care, when the plan is not followed, or when a healthcare professional does not have all the information necessary to treat the patient. Accurate patient data collection and making the patient a partner in their care are two of the most effective strategies for preventing medical errors. The process of gathering patient data is called patient data collection. The gathered data can be put to use for a variety of purposes, including research into novel treatments and improving care quality. Be that as it may, if it isn’t gathered productively, it can prompt defers in treatment and different issues. The patient’s individual physiological, psychological, sociological, and spiritual requirements are the subject of the nursing assessment. By allowing the formation of a nursing diagnosis, the assessment identifies the patient’s current and future care requirements. The nurse helps to prioritize interventions and care by recognizing both normal and abnormal patient physiology. Experts in patient safety concur that effective communication and teamwork are necessary for providing high-quality healthcare, as you point out. Healthcare teams can improve patient outcomes, reduce medical errors, increase efficiency, and improve patient satisfaction when all clinical and nonclinical staff work together effectively.
Refernces:
Bhatt, J., & Swick, M. (2017, March 15). Focusing on teamwork and communication to improve patient safety: AHA News. American Hospital Association | AHA News. Retrieved December 1, 2022, from https://www.aha.org/news/blog/2017-03-15-focusing-teamwork-and-communication-improve-patient-safetyLinks to an external site.#
Toney-Butler, T. J., & Unison-Pace, W. J. (2022, August 29). Nursing admission assessment and examination. National Center for Biotechnology Information. Retrieved December 1, 2022, from https://pubmed.ncbi.nlm.nih.gov/29630263/Links to an external site.
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Collapse SubdiscussionAdrienne Aasand Response #2:
Sheila,
Thank you for your post about collection of medication reaction data for psychiatric patients. Adverse drug reactions account for about five percent of hospital admissions, 28% of emergency department visits and five percent of hospital deaths (Liu, 2013). Although I do not work with psychiatric patients, I also encounter issues with patients not being able to accurately report their current medications and their medication allergies or reactions. I have also found that in reviewing outside EMRs, often a discontinued medication is not documented.
Your post made me think of medication errors made in outpatient clinics that could be avoided by improving the medication data collection process. One article I read described a pilot study on a program called CancelRx which is an electronic communication of medication discontinuation from prescribers to pharmacies. The article stated that approximately 4.5 million outpatient visits each year result in adverse drug events (Pitts et al., 2022). The result of the pilot study was that CancelRx led to the elimination of the sale of e-prescribed medications after discontinuation in the EMR (Pitts et al., 2022). Not being aware of medications or reactions can be very dangerous when prescribing new medications or cancer treatments due to possible drug interactions. And as you stated, linking records from outside hospitals and facilities is very helpful when collecting data about a patient’s medications.
References
Liu, M., Hinz, E., Matheny, M., Denny, J., Schildcrout, J., Miller, R., Xu, H. (2013). Comparative analysis of
pharmacovigilance methods in the detection of adverse drug reactions using electronic medical records. Journal of the American Medical Informatics Association, 20(3), 420-426. doi.org/10.1136.amiajnl-2012-0011119
Pitts, S., Yang, Y., Woodroof, T., Mollenkopf, N., Wang, N., Thomas, B., Chen, A. (2022). The impact of
electronic communication of medication discontinuation (CancelRx) on medication safety: A
pilot study. Journal of Patient Safety, 18(6), 934-937. Doi.org/10.1097/PTS. 0000000000000998.
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Collapse SubdiscussionColleen Lewis Response 1
Hi Sheila,
Your discussion topic is thought provoking. I’ve experienced in the Emergency Department a similar problem with our adolescent patients presenting for aggression or psychiatric problems. For example, there have been a couple of cases where patients that were administered Haldol to help calm them, but instead experienced an increase in agitation. If there were, as you suggest, a way to document this reaction and have it linked to the MAR to populate a warning when ordering this medication for the patient in the future, it would prevent unnecessary agitation for patients. In the long term, having a reminder pop up for certain medications that have been ordered in the past, but were not therapeutic, could help providers to plan care better. The only downside is providers may begin to rely heavily on these reminders, and not review the chart in as much depth as would be appropriate for effectively planning these patients’ care.
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Collapse SubdiscussionMenard Tchatchou-Tchoubia Transforming Nursing and Healthcare through Technology
Menard Tchatchou
Walden University
NURS 6051 N
11/29/2022
Transforming Nursing and Healthcare through Technology
Nursing informatics is a term that has evolved over the past five decades. Its main aim has been to address the needs of healthcare organizations with the help of developing technology. It incorporates nursing, information science, and computer science (McGonigle et al., 2022). It ensures that the medical department is well-managed and developed. The data systems are designed to improve the outcomes of the patients and ensure that the overall performance of the healthcare organization is boosted.
Nevertheless, nurses, the most significant healthcare professionals, have the mandate of ensuring the safety of their patients. Therefore, to facilitate this, nurses need to make informed practice decisions, such as accessing data about their patients, the impact of their care, and interpretation of the data collected. It is, therefore, crucial for all nursing students to comprehend and understand the requirements of informatics. These include understanding the electronic health record (EHR), demonstrating how to navigate EHR, valuing the ability of technology to support clinical decisions, which helps reduce errors, and lastly, the ability to use evaluating technology systems to support patient healthcare. Informaticians, therefore, help translate the information from different data languages, such as capturing disease codes, thus ensuring efficient communication between the nurse and the patient (Sweeney, 2017).
On the other hand, it allows patients to have direct access to their records from the clinicians; the system enables the addition or editing of the patient’s information. The Health Information Technology for Economic and Clinical Health (HITECH) promotes freedom of share of information with the patient. Therefore, the article focuses on the applications and importance of informatics in the nursing discipline to help solve various patient problems.
Numerous healthcare organizations have decided to adopt the use of technology to ensure the efficient delivery of services. The applications of informatics knowledge in nursing have been depicted in different scenarios. I would focus on how the technology, based on the data that is analyzed and collected in conjunction with knowledge and skills, to solves patients’ problems. An example is that nurses regularly review an individual’s patient data; hence because they are essential communicators, providers have the mandate to subtle changes in the patient’s conditions. Information about the individual patient is extracted and compiled into flow sheet rows containing the patient’s story explaining why he or she sought medical assistance and the cause of the problem. Through technology, a patient with localized prostate cancer would seek treatment options online, which would help the patient with the help of a medical practitioner to develop and initiate a treatment remedy (Nagle et al., 2017). Another scenario is in ambulatory care, whereby the nurse documents the data collected, including screening tests, vaccines, and health teaching.
Other aspects of technology, such as middleware, a software monitoring device that links the patient and nurse, are vital to maintaining effective communication. Nursing is a practice that ought to be carried along. It takes a long time for health practitioners to complete their education. It is, therefore, vital for the advancement of technology to help close the gaps, in that their knowledge is likely to be outdated as they complete their education. To solve the problem, electronic patient records ought to be introduced. Conclusively, nursing informatics, a new form of technology introduced in the health sector, has helped solve different patient problems through data analysis. Over time the technology is likely to advance and transform more healthcare lives.
References
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist Links to an external site.
Public Health Informatics Institute. (2017). Public Health Informatics: “translating” knowledge for health Links to an external site.Links to an external site.
[Video file]. Retrieved from https://www.youtube.com/watch?v=fLUygA8HpfoSweeney, J. (2017). Healthcare informatics Links to an external site.Links to an external site.. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionMaxine A Lewis Maynard thank you for an interesting post have was not familiar with “middle-ware” which is referred to as the “missing link” in EHRS. Health information exchanges (HIEs) are more analogous to old-school mainframe systems, requiring data duplication in a centralized, non-distributed manner. Middleware (Voltz,2015). Furthermore cites Voltz, Middle-ware solves the interoperability problem by creating a platform that connects current EHR systems while allowing for a single way to integrate more upcoming healthcare technology. The need for digital transformation has showcased that middleware is here to stay cites Gazis and Katsiri (2022). Middleware allows you to achieve communication between different devices, applications, and software layers. There is a need to educate new developers about middleware and highlight its importance through education techniques and learning systems Gazis and Katsiri (2022).
GAZIS, A., & KATSIRI, E. (2022). Middleware 101. Communications of the ACM, 65(9), 38–42. https://doi.org/10.1145/3546958
Voltz, D.M. “Connecting the Disparate: Middleware’s Role in Solving Healthcare’s EHR Interoperability Problems” Journal of AHIMA 86, no.5 (May 2015): 28-33.
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Collapse SubdiscussionRaminder Kaur Hi Menard, Very Informative Post!
I agree that nurses are essential medical workers since they ensure their patients are safe. More than 20 years ago, the modern patient safety movement was established. Although there has been a tremendous improvement in patient safety since that time, there is still a severe risk that patients could suffer injury due to mistakes or other unfavorable events while receiving medical treatment. Approximately 10% of patients globally experience an injury while receiving care due to such occurrences. According to estimates from the World Health Organization (WHO), approximately half of those incidents are deemed preventable. More than any other healthcare provider, nurses spend much time with patients. They also have a variety of responsibilities that, when properly carried out, contribute to maintaining patient safety. The ability of a nurse to prevent adverse events and protect patients from harm can be compromised by various circumstances, including staffing levels and shift duration. In order to foster a productive workplace and provide their personnel with the best chance of success, nurse leaders may control these variables, which ultimately helps patients. Nursing staff and their particular role in delivering bedside care require a customized strategy for enhancing patient safety measures. Breaking down patient safety into a collection of practical strategies to reduce medical errors and enhance patient outcomes is helpful to many nurses. Leaders in the hospital’s nursing department are responsible for cultivating deliberate communication and teamwork, which is necessary to promote patient safety. Effective nurse administrators will commend individuals who diligently endeavor to reduce medical errors and inform others when errors have happened, establishing the tone for a dedicated, open medical team.
References:
The importance of a nurse’s role in patient safety: HPU online. Hawaiʻi Pacific University Online. (2022, February 3). Retrieved December 1, 2022, from https://online.hpu.edu/blog/nurses-role-in-patient-safety/Links to an external site.
Vaughn, N. (2020, September 24). Patient safety in nursing. Relias. Retrieved December 3, 2022, from https://www.relias.com/blog/how-nurses-can-help-improve-patient-safety#Links to an external site.
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Collapse SubdiscussionOdion Iseki THE APPLICATION OF DATA TO PROBLEM-SOLVING
Healthcare providers can only provide optimal treatment with access to patient medical records. The topic of vaccines interests the writer. She was a primary healthcare nurse in a sizable African neighborhood. The challenge of that work comes from the fact that families often need to take their immunization records with them when they move across state lines, so it is unclear what, if any, vaccines their children have or have yet to receive. For this information, parents may need to contact their child’s former doctor, the state immunization registry, or their child’s school. Having a single repository for all vaccine data will greatly facilitate this process.
DESCRIBE THE DATA TO BE USED AND HOW THE DATA MIGHT BE COLLECTED AND ACCESSED.
The current system for archiving vaccination histories is called the Immunization Information System (IIS). This program keeps track of immunization records and lets doctors know when it is time for booster shots (“Immunization Information Systems,” 2019). After that, the writer wants to set up a database that collects vaccine information from all offices. Having a centralized repository for vaccine records would make it easier for doctors to retrieve immunization histories for new patients. As a result, doctors might review their patients’ vaccination records and make more informed decisions about immunizations.
WHAT KNOWLEDGE MIGHT BE DERIVED FROM THAT DATA?
Analyzing this information could yield numerous insights. Healthcare providers may be able to see coverage rates and possible disease hotspots. They could also test the efficacy of herd immunity (a form of communal immunity). When enough people are immunized to stop the disease from spreading, a community is said to be disease-free.
HOW WOULD A NURSE LEADER USE CLINICAL REASONING AND JUDGEMENT TO THIS EXPERIENCE?
With this information, nurse managers can use clinical reasoning and judgment to make sure that their patients only get the number of vaccines they need and no more. Also, doctors who care for people with diseases they already have would be able to add vaccine-specific warnings and contraindications to the system. If the patient ever changed care facilities or were admitted to the hospital, the new staff would already be aware of this, which is a huge plus. Both healthcare providers and patients would greatly benefit from having easy access to a centrally stored immunization record.
References
Immunization Information Systems. (2019, April). Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Practice-Management/Pages/immunization-information-systems.aspx
Finding and Updating Vaccine Records. (2020, February 25). Retrieved from https://www.cdc.gov/vaccines/parents/records/find-records.html?CDC_AA_refVal=https://www.cdc.gov/vaccines/parents/records-requirements.html#finding-records
Vaccines Protect Your Community. (2017, December). Retrieved from https://www.vaccines.gov/basics/work/protection
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Collapse SubdiscussionAndrea M Allen Response
Hi Odion,
Thanks for the read. Just to add to your posting, using a centralized repository enables us to also receive other health records as well. We can now access our health history, pharmacies can obtain our drug history and physicians can monitor trends in our health. Not to mention if you are unable to communicate your health history due to some unforeseen event, measures taken from a information systems database can restore your health. The data not only help to solve problems but adds to the practitioner’s and the discipline’s body of knowledge and used not just for consistent care to patients but to conduct medical research to improve healthcare facilities.
Best,
McGonigle, D., & Martian, K. G. (2022). Nursing Informatics and the foundation of knowledge (5th ed.). ones & Bartlett Learning
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Collapse SubdiscussionColleen Lewis Response 2
Hello Odion,
It is an excellent idea to have a centralized repository for this information. I used to work in a Pediatric primary care office that attends many children who recently immigrated to the United States. Some of these families brought a paper pamphlet that had hand markings and scribbled dates next to vaccines in different languages that were often hard to decipher and interpret. Other families had no records of their child’s vaccinations. In those cases, we had to administer (over time) all vaccines that had not been accounted for previously. This is a waste of resources for sure, and unfortunate for the child who has to experience this all over again. Though we know its safe for the child to “receive a vaccine, even if he or she may have already received it”, there must be a better system in place (CDC 2022). As you mentioned, with a centralized repository providers could make better informed decisions. If there were some way to have a global database of any vaccination administered, of course this would be ideal!
Thanks for your post.
Colleen
Reference:
Centers for Disease Control and Prevention. (2022, October 15). Keep track of your child’s immunization records. Centers for Disease Control and Prevention. Retrieved December 7, 2022, from https://www.cdc.gov/vaccines/parents/records/keeping-track.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fparents%2Frecords%2Ffind-records.html
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Collapse SubdiscussionChristiana Nuworsoo Initial Post – The Application of Data to Problem-Solving
In a time such as these, where technology is so prevalent in our lives, it is quite baffling to find an environment that appears technologically advanced to still utilize paper charting for a procedure that could be detrimental if something goes wrong. I have seen at several hospitals that paper charting for blood transfusions is still being used. Although I am not completely against paper charting, steps can be easily skipped in the process allowing errors to occur. A consent form is incomplete if there is no RN witness to a provider’s education to the patient. However, I have seen several times when a patient needs a blood transfusion, but the consent form does not have an RN witness.
Several data could be used to determine if this practice is the best option. However, the data to concentrate on should be RN-to-RN verification because it involves several steps. According to Najafpour et al., the product’s safety is of utmost importance before a blood transfusion because it is where about 70% of the errors occur (2017). The RN verification process includes checking the physician’s order with the blood bank documentation; checking the patient’s name, DOB, and medical record number; checking the patient’s blood type with the donor’s blood type and Rh-factor compatibility; and verifying the blood has not passed its expiration date (Brookline College, 2022).
The collection of this data will be tedious and time-consuming. The Blood Bank can assist by providing a list of all patients in the hospital that have and are receiving blood products. Each patient chart will need to be retrieved with that list, and the RN verification form will be taken out. The forms will then need to be checked for accuracy, and those with errors will be set aside. The knowledge that might be derived from the data will be how often errors occur and whether they cause any harm to the patients, whether minor or severe.
Clinical judgment requires clinical reasoning. Clinical reasoning is practice-based reasoning requiring a background of scientific and technological research-based knowledge about general cases; it occurs within social relationships or situations involving patients, family, community, and the team of health care providers (Benner et al., 2008). A nurse leader can use clinical reasoning and judgment to form knowledge from this experience by analyzing the information collected and bringing it to the attention of other nurse leaders, where careful solutions could be brainstormed and applied. Then evaluate as time goes on if the solutions are beneficial. In my opinion, a computer-based application where each step must be completed before moving on to the next step is a good way to ensure that all information is verified before proceeding to transfuse. I understand that there are times when computers pose a technical issue, but I’ll rather have a technical issue to stop me from an error as opposed to human error that omits a step that could cause harm to the patient.
References
Benner, P., Hughes, RG., & Sutphen, M. (2008). Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), 6. Retrieved 11/30/2022 from: https://www.ncbi.nlm.nih.gov/books/NBK2643/Links to an external site.
Brookline College. (2022). Step-by-step master’s guide to blood transfusions. Retrieved 11/30/2022 from https://www.brooklinecollege.edu/blog/a-step-by-step-guide-to-blood-transfusions/Links to an external site.
Najafpour, Z., Hasoumi, M., Behzadi, F., Mohamadi, E., Jafary, M., & Saeedi, M. (2017). Preventing blood transfusion failures: FMEA, an effective assessment method. BMC health services research, 17(1), 453. https://doi.org/10.1186/s12913-017-2380-3Links to an external site.
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Collapse SubdiscussionAdrienne Aasand Response #1:
Christiana,
Thank you for your post about collecting data on the RN-to-RN verification process for blood transfusions. Working in oncology, I order blood transfusions for our patients every day. As we are clinic based, we are not able to offer blood transfusions to our patients on site and must place the orders for transfusions to be given at partner hospitals. This makes things more complex as our providers are not at the hospitals to consent patients at time of transfusion. And our EMRs are different, so we need to use paper orders.
As you stated, blood transfusion errors occur frequently and can be detrimental to a patient’s health. The risk of a patient death occurring due to a preventable medical accident while receiving health care is about 1 in 300 (McGonigle & Mastrian, 2022). “Nursing professionals have an ethical duty to ensure patient safety” (McGonigle & Mastrian, 2022, p. 323). As you stated, using a computer system to verify each step would be ideal to minimize errors. I read one study comparing two different systems for recording bedside observations during transfusions at Oxford University. Overall, the study found that electronic bedside systems resulted in improved monitoring of transfusion-related observations compared to manual processes and provided improved early warning of adverse events (Staples et al., 2017). I think most nurses would agree, that an electronic tracking system for administering and monitoring blood transfusions would be very beneficial for our patients.
References
McGonigle, D. & Mastrian, K. (2022). Nursing informatics and the foundation of
knowledge (5th ed.). Jones & Bartlett Learning.
Staples, S., Noel, S., Watkinson, P., & Murphy, M. (2017). Electronic recording of transfusion-related
patient observations: A comparison of two bedside systems. Vox Sanguinis, 112(8), 780-787.
doi.org.10.1111/vox.12569
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Collapse SubdiscussionDawn Lorde Christiana,
Thank you for your post. The use of health information systems can be beneficial in monitoring patient care, improving patient care outcomes, and helping reduce medical errors (Popescu et al., 2022). Unfortunately, healthcare professionals make errors with blood transfusion administration. In the hospital where I work, electronic scanning is used when administering blood products. When the blood is picked up from the lab, the blood bank technician will request a copy of the consent, the patient’s labels, and the order. Additionally, the blood bank technician will scan the blood and verbally confirm the patient’s medical record number, blood type, unit number, and expiration date of the blood. When administering the blood to the patient, the nurse will verify the same data by scanning the patient and the blood product, and a second nurse will confirm the data.
I understand that there may be times when the system is down and computer scanning is impossible. However, a computer-based application is a key to helping minimize human error.
Reference
Popescu, C., EL-Chaarani, H., EL-Abiad, Z., & Gigauri, I. (2022). Implementation of Health Information Systems to Improve Patient Identification. International Journal of Environmental Research and Public Health, 19(22), 15236. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph192215236
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Collapse SubdiscussionErica Schulte Response 1
Hi all,
I enjoyed reading each of your posts! Ultimately, the general conclusion in the posts and also in research is that the most accurate and beneficial direction is to go with an EHR or some type of electronic charting. In addition, and most importantly, it is the safest alternative to these processes. In reading (McCarthy et al., 2022), it emphasizes the benefits not only from a safety aspect but efficiency and timing aspect as well.
To take this a step further, I think that your posts highlight the opportunities in a lot of hospital systems. Whether it be a paper versus electronic documentation or another process opportunity, creating the safest environment possible for the patients is of utmost important. The data that can be collected in this scenario, in addition to what is noted, could be the number of errors or mistakes that are created in each model. This should quickly begin to establish data and trends for nurse informaticists and leadership roles to make the best decision for a process moving forward.
The opportunity for gathering and understanding this data is best supported electronically as well. Look no further than the definition of a computer in the text. “An electronic information processing machine that serves as a tool with which to manipulate data and information.” (McGonigle & Mastrian, 2022).
References
McCarthy, B., Fitzgerald, S., O’Shea, M., & Condon, C. (n.d.). Electronic nursing documentation interventions. Wiley Online Library. Retrieved December 3, 2022, from https://onlinelibrary.wiley.com/doi/abs/10.1111/jonm.12727
McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge. Jones & Bartlett Learning.
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Collapse SubdiscussionOdion Iseki Hi Christina,
Great post. Several things could be looked at to determine if this is the best thing to do. But since RN-to-RN verification has more than one step, this is the data to pay attention to. Najafpour et al. say that more than 70% of mistakes happen during a blood transfusion. This makes product safety the most important thing. The nurse will double-check the doctor’s order against the blood bank’s paperwork and the patient’s name, date of birth, and medical record number. She will also compare the patient’s blood type against the donor’s blood type and Rh factor compatibility (Brookline College, 2022).
References
Benner, P., Hughes, RG., & Sutphen, M. (2008). Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), 6. Retrieved 11/30/2022 from: https://www.ncbi.nlm.nih.gov/books/NBK2643/Links to an external site.
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Collapse SubdiscussionOluyemi Adeagbo The Application of Data to Problem-Solving
Introduction
The healthcare information revolution cannot get underestimated as it embodies a revolution. Clinicians partake in the need to have enhanced access to electronic treatment plans, health records, and diagnostics. Clinical collaboration and communication platforms keep simplifying the management of healthcare coordination, workflows, and patient outcomes (Seckman, 2019). The scenario in this setting exemplifies the use of nursing informatics in enhancing and cultivating patient care. Data access and system integration also showcase the importance of information analysis from an informatics viewpoint that ever happened in the healthcare space.
Data Utilization, Collection, and Assessment
The strategy behind utilizing healthcare data to avail the best care entails the comprehension of nursing informatics, its meaning, and the concepts behind it. Nursing informatics integrates nursing science with other expanses to recognize, manage, communicate, and manage wisdom, information, data, and knowledge. The principal aim behind nursing informatics remains to provide excellent patient-centered care.
Nursing informatics in the mentioned scenario related to improving patient care can get used on different fronts. The areas of nursing informatics use include improving clinical procedures, processes, policies, and protocols, aligning clinical care and workflow with the best nursing practice, and choosing new medical instruments (Nagle et al., 2017). Nursing data also presents a great avenue to make available a learning and training platform founded upon objective data.
Choosing and testing innovative medical instruments connected to the Internet of Things (IoT) can avail enormous amounts of patient data (Seckman, 2019). Nursing informaticists get trained to apprehend the true essence of such data and offer recommendations regarding the most appropriate techniques to record, access, and use the collected data. Nursing informaticists can likewise utilize data collected through inpatient and outpatient care engagements to classify endemic issues connected to the healthcare institution. The above will provide a learning environment for continuing in-house training, orienting new staff, and during external certification and education.
Nurse Leaders using Clinical Judgement and Reasoning
Nurse leaders can adapt to clinical judgment and reasoning within the health organization to collaborate and communicate with interdisciplinary teams regarding patient information. For instance, nurse leaders can identify gaps, offer recommendations, and audit individual patient cases to avert future errors. Clinical judgment and reasoning become the fabric of organizational effectiveness from a management and financial point of view (Lee & Lee, 2020). Subsequently, nurse leaders can produce processes and protocols that warrant adequate interaction and communication between patients, departments, and teams. They can assist healthcare staff in seeking out hidden truths by maximizing electronic health records. From the above, healthcare organizations can help map their sustainable work from an ethical viewpoint by aligning with data insights.
Conclusion
Through nursing informatics assimilation, nurse leaders can recognize high-risk patients and avoid severe conditions by taking preventive actions early. For example, utilizing automated alerts increases the chances of practitioners mitigating warning signals and taking patients from potentially deadly situations. More institutions should embrace nursing informatics as a pathway to improve patient outcomes. Finally, nursing informatics will continue morphing and opening up new frontiers in the healthcare industry as technology advancements keep emerging.
References
Lee, M., & Lee, S. (2020). Implementation of an electronic nursing record for nursing documentation and communication of patient care information in a tertiary teaching hospital. CIN: Computers, Informatics, Nursing, 39(3), 136-144. https://doi.org/10.1097/cin.0000000000000642Links to an external site.
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212-221. https://doi.org/10.3233/978-1-61499-738-2-212Links to an external site.
Seckman, C. (2019). Summer institute in nursing informatics 2019 healthcare informatics: Catalyst for value-driven care transitions. CIN: Computers, Informatics, Nursing, 37(11), 558-563. https://doi.org/10.1097/cin.0000000000000599Links to an external site.
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Collapse SubdiscussionOdion Iseki Hi Oluyemi
I like your post it is on point and clear to understand. The significance of the changes brought about by the information revolution in healthcare cannot be overstated. Clinicians want better access to electronic treatment plans, health information, and diagnostics. As clinical cooperation and communication technologies improve (Seckman, 2019), it’s getting easier to manage how healthcare is coordinated, how work is done, and how patients do it. This case shows how nursing informatics can be used to help patients get better and more care.
References
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212-221. https://doi.org/10.3233/978-1-61499-738-2-212Links to an external site.
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Collapse SubdiscussionSheila Ankrah Response,
Hi Oluyemi,
Thanks for such an informative post. The integration of healthcare and technology has resulted in a change in the health care industry from paper data to electronic data-keeping. The innovation in electronic health records makes it easy for nurses to verify physician’s orders via the computerized order entry system (Jimenez, 2017). Nursing informatics is significant in healthcare as it improves nursing practice and patient survival or improvement (Ivey, 2021).
Data collection is paramount in the healthcare industry as it helps in the efficient and effective delivery of care to patients. For instance, the ICD- coded data have been progressively and broadly used for illness surveillance, research, decision and policymaking, resource allocation, quality, and safety to improve peoples’ health (Otero et al., 2021).
At my place of employment, often, informatics experts also come around to keep us updated on any new system upgrade that all nurses need to be abreast with. I understand how we get upset for being distracted with our workload when these IT experts come around. However, let’s not also forget that they do this in the best interest of patients.
Cerner is very effective in identifying code sepsis, and it usually alerts all assigned clinicians, including MOD/MON, charge nurse, and other nursing leaders, for prompt interventions and treatment.
References
Ivey, J. (2021). Nursing Informatics Research. Pediatric Nursing, 47(1), 45–46.
Jimenez, M. (2017). Effects of Barcode Medication Administration: Literature Review. Proceedings of the Northeast Business & Economics Association, 157–160.
Otero Varela, L., Doktorchik, C., Wiebe, N., Quan, H., & Eastwood, C. (2021). Exploring the differences in ICD and hospital morbidity data collection features across countries: an international survey. BMC Health Services Research, 21(1), 308. https://doi.org/10.1186/s12913-021-06302-wLinks to an external site.
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Collapse SubdiscussionOlufunke Ajayi-Festus Oluyemi,
Good post! Healthcare delivery has really evolved since the introduction of healthcare informatics, we are able to do much and collaborate more especially with the automated alerts you mentioned in your conclusion. Lives have been saved through those alerts, if the nurse misses it, the rapid response team will not, t least someone will catch it, especially in case of sepsis alert and this will result in prompt treatment.
Reference
Ivey, J. (2021). Nursing Informatics Research. Pediatric Nursing, 47(1), 45–46.
Jimenez, M. (2017). Effects of Barcode Medication Administration: Literature Review. Proceedings of the Northeast Business & Economics Association, 157–160.
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Collapse SubdiscussionAdrienne Aasand Module 1 Discussion: The Application of Data to Problem-Solving
Description of scenario
I work for a private practice oncology clinic. Within our practice we use multiple different systems to collect patient data. For example, radiation oncology and medical oncology work closely to create treatment plans for patients, and often patients are receiving concurrent chemo and radiation. However, in addition to using the medical oncology EMR, the radiation oncology team has a separate medical record system that only they have access to. In addition, the lab, pharmacy, scheduling and billing departments all have separate systems that nurses do not have access to. “Accessibility is a must; the right users must be able to obtain the right information at the right time and in the right format to meet their needs” (McGonigle & Mastrian, 2022, p. 24). With these different systems, as a medical oncology nurse, I typically have to rely on others in the clinic to provide information to me that I need in a timely manner. This can lead to delayed communication with patients regarding medications, results, or treatment plans.
Access to Data and Knowledge Gained
My proposed change to this scenario is to give medical oncology nurses access to the radiation oncology EMR. With this data, the knowledge gained would include:
- Radiation start dates and length of therapy
- Radiation therapy side effects and held treatments due to toxicity
- Supportive medications ordered for side effects
- Follow up scans and provider visits
With this gained knowledge, medical oncology nurses would be able to easily order the patients’ chemotherapy to be given concurrently with radiation therapy. Specifically, timing of treatments could be properly coordinated as the treatments are given in different facilities. In addition, when patients call our triage nurses with complaints of symptoms or treatment side effects, we would be able to access radiation’s data to determine the cause of symptoms and how to best treat the patient. Last, this data would avoid both the radiation oncologist and medical oncologist ordering follow up scans. We would be able to see what scans are ordered and one can be reviewed by both providers for follow up evaluations. This access to data would save time for nurses and schedulers. “Time management is a prevalent issue in the healthcare setting, thus the use of informatics to aid and organize and not create barriers is essential” (Sweeney, 2017, section 3). Overall, sharing this data would allow both teams to provide more informed, better-quality care to the patients.
Nurse Leader’s Formation of Knowledge
A nurse leader is constantly using clinical reasoning and judgement in the formation of knowledge. In this scenario, the nurse should use their basic nursing education, combined with clinical experience in medical and radiation oncology to better utilize this new access to data. For example, if a patient calls with a new skin rash and he is taking oral chemotherapy while getting concurrent radiation therapy, the nurse leader can use the data from the radiation therapy system, combined with their knowledge of expected treatment side effects to properly diagnose and treat the patient’s symptoms. Data alone cannot help the nurse solve the problem, the “acquired data must be processed into knowledge” (McGonigle & Mastrian, 2022, p. 9).
In addition, it is the responsibility of the nurse leader to be aware that there can be risks to sharing data and to help facilitate this data sharing in a way that is still protecting patient information. According to McGonigle & Mastrian, “solid leadership, guidance and vision are vital to the maintenance of cost-effective business performance and safe, cutting-edge information technologies for the organization” (2022, p. 28). With this gained data and knowledge, it is the responsibility of the nurse and the nurse leader to use the data professionally and use it for the benefit of patients. To do this, communication between the two departments as well as with practice management is essential to detect and resolve any issues that may come from this new process.
References
McGonigle, D. & Mastrian, K. (2022). Nursing informatics and the foundation of
knowledge (5th ed.). Jones & Bartlett Learning.
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionChristiana Nuworsoo Adrienne,
Good post. As a nurse, I would find it quite difficult to work in an environment where patient information is difficult to access. I wonder if there is a specific reason why radiation oncology EMR is different from the medical oncology EMR. At my current place of employment, the ED uses a different EMR from what is used on the units; however, our systems are created by the same company and thus are integrated. Therefore, patient information from the ED EMR can be accessed on the floors for better continuity of care, even though we might not have access to the day to day processes in the ED. Also, patient information is easily accessed by all hospitals within the network.
It seems that your facility needs an integrated EMR. EMR integration connects multiple digital systems or devices enabling the smooth flow of clinical data, communications, and coordination between multiple systems (Majumdar, 2022) With an integrated system, medical oncology providers and caretakers will have access to patient information entered by radiation oncology with just the click of a few buttons. Integrated EMRs offers quick and easy access to patient information as wells as better health outcomes (Hyland Healthcare, 2022).
References
Hyland Healthcare. (2022). EHR integration solutions. Unify your EHR to achieve a truly integrated electronic health record. Retrieved 12/4/2022 from https://www.hyland.com/en/healthcare/content-services/healthcare-integrations/emr-integrationsLinks to an external site.
Mujumdar, S. (2022). EMR Integration: A comprehensive guide. Retrieved 12/4/2022 from https://www.selecthub.com/medical-software/emr/emr-integration/Links to an external site.
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Collapse SubdiscussionRaminder Kaur The widespread adoption of technology is transforming healthcare delivery. When treating patients, choosing between an electronic health record and a paper chart has been crucial. Information loss, poor retrieval, and a lack of standards among doctors and healthcare organizations are significant issues with traditional paper medical records. The healthcare industry has been entirely transformed by health information technology (HIT) to benefit both patients and providers. Communication is made more accessible, costs are reduced, efficiency is increased, patient outcomes are improved, and patients are more involved in their care.
With the introduction of the electronic medical record (EMR), the process of finding patient information and interpreting doctor instructions has been streamlined. Electronic medical records, or digitalized paper charts, include information about diagnoses, allergies, medical histories, vaccination dates, lab results, prescriptions, and the doctor’s comments.EMR frameworks are fit for every errand, including logging patient data, setting up arrangements, composing solutions, looking at protection, and so on. One of the forces transforming healthcare is thought to be the electronic medical record (EMR). From a patient care perspective, it is anticipated that an electronic medical record (EMR) will improve information accuracy, facilitate clinical decision-making, and improve information accessibility for continuity of care.
EMRs may provide healthcare workers with a dependable, centralized source of patient data (Jedwab, Chalmers, Dobroff, & Redley, 2019). In the area I work, bustling psychiatric patients in an acute care facility, it is essential for security and safety to identify risk factors for suicide and self-harm promptly. The EMR has significantly impacted time management and improved patient safety by acquiring data information. In the internet age of virtual monitoring and electronic sensors, a new tool has been added to nursing for the ongoing observation required to stop self-harming behavior. According to Nagle, Sermeus, & Junger (2019), many members of the healthcare team now regularly have access to remote patient monitoring, which has the potential to enhance treatment quality and patient safety.
The development of telepsychiatry has also led to improvements in safety concerns. The coronavirus disease (COVID-19) makes it particularly difficult to provide mental health care. An option in contrast to face-to-face assessments is telepsychiatry, which can be imaginatively joined with other innovations to develop care further. Many distressed patients find it difficult or uncomfortable to drive themselves to mental health consultations. In light of the absence of subject matter experts and the developing patient interest, telepsychiatry is presently utilized in more excellent medical services settings (Donley, McClaren, Jones, Katz, and Goh, 2017). Technology has closed the gap between the lack of specialists and patient safety. The electronic psychiatric appointment is delivered to the patient in several inpatient and outpatient settings. A crucial component of psychiatry treatment is the virtual capability of telepsychiatry, which has reduced the risk of harm to patients and staff during appointment transportation.
References
A; N. L. M. S. W. J. (2017). The evolving role of the Nursing Informatics Specialist. Studies in health technology and informatics. Retrieved November 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/28106600/Links to an external site.
Donley, E., McClaren, A., Jones, R., Katz, P., & Goh, J. (2017). Evaluation and Implementation of a Telepsychiatry Trial in the Emergency Department of a Metropolitan Public Hospital. Journal of Technology in Human Services, 35, 292 – 313.
Honavar, S. G. (2020, March). Electronic Medical Records – the good, the bad, and the ugly. Indian journal of ophthalmology. Retrieved November 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043175/Links to an external site.
Jedwab, R.M., Chalmers, C., Dobroff, N., & Redley’, B. (2019). Measuring nursing benefits of an electronic medical record system: A scoping review. Collegian.
Nagle, L. M., Sermous, W., & Junger, A. (n.d.). Evolving role of the Nursing Informatics Specialist. Studies in health technology and informatics. Retrieved November 30, 2022, from https://pubmed.ncbi.nlm.nih.gov/28106600/Links to an external site.
Smith, K., Ostinelli, E., Macdonald, O., & Cipriani, A. (2020). COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians. In JMIR Mental Health (Vol. 7, Issue 8, p. e21108). JMIR Publications Inc. https://doi.org/10.2196/21108Links to an external site.
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Collapse SubdiscussionBenedicta Kwevie Hi Raminder
I agree with you and your post. In my early years as a nurse, I had to work with paper medical records and charting. It was efficient at times, but on most occasions, patient records and files had gone missing, and since the patient had a hard time recollecting some information, we were unable to know the things we needed to treat them safely. Checkpoint HER (2017) brings up the matter of the location of files. “Paper records are vulnerable to being permanently lost or temporarily misplaced. Man hours are required to hunt down any missing files. Natural catastrophes such as fires, hurricanes, tornadoes and earthquakes—or even a break-in—can result in a permanent loss of paper records. EHRs are stored digitally on systems that are backed up for safekeeping.” Electronic medical records of a patient can be saved and kept safe from anything that might hinder giving the patient the correct care they need.
Reference
Benefits of EHR vs. Paper Records | Checkpoint by Integrity Support.
(2017, June 12). Checkpoint EHR.
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Collapse SubdiscussionOlufunke Ajayi-Festus Thoughts on how the development of IT has helped address the concerns about patient safety raised.
The Institute of Medicine (1999) published a well-known report that started a national effort to decrease medical errors in institutions across the country. Despite efforts to reduce errors, medical errors continue to occur at a high rate. According to an article written by Kavanagh, Saman, Bartel, and Westerman (2017) there continue to be well over 200,000 preventable deaths each year due to medical errors.
After IOM’s report, there have been significant strides made to encourage healthcare professionals to report errors to improve safety. According to Bleich (2005), before the report came out, 15 states had mandatory error reporting systems. Since the report, the number increased to 22 states (Bleich, 2005). Strides have also been made in technology to assist in reducing errors with medication administration.
We, as nurses, must stay diligent in checking and double-checking ourselves and not try to take shortcuts around safeguards put in place. As younger nurses join the field of nursing, they are much more tech-savvy than ever before. Many times, it is much quicker to cut corners, however, that can be the downfall of progress made.
In hospitals across the country, medication errors have been a common occurrence. I joined my current hospital where I work about six years ago and was very impressed with the IT system they use to administer medication. If followed properly, a lot of medication errors could be avoided, of course, the system is not foolproof. However, there have been great strides made to improve medication administration. Even with all of this improved technology, studies have shown that nothing takes the place of making sure new nurses have the training and mentoring from more experienced nurses (Orbaek, Gaard, Fabricius, Lefevre, and Moller, 2015).
References
Bleich, S. (2005). Medical Errors: Five Years After the IOM Report. Semantic Scholar. Retrieved from https://pdfs.semanticscholar.org/b132/d78f82d6a8f8f724069f6fbe4bdb85181b 2e.pdf
Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from
http://webarchive.org/web/20141016134546/http://www.iom.edu/s/1999/To-Err-is-Human/To %20Err%20is%20Human%201999%20%20report%20brief.pdf
Kavanagh, K.T., Saman, D.M., Bartel, R., and Westerman, K. (2017). Estimating Hospital-Related Deaths Due to Medical Error: A Perspective from Patient Advocates. Journal of Patient Safety, 1-5. DOI: 10.1097/PTS.0000000000000364
Orbaek, J., Gaard, M., Fabricius, P., Lefevre, R., and Moller, T. (2015). Learning and Teaching in Clinical Practice: Patient Safety and Technology-Driven Medication- A Qualitative Study on How Graduate Nursing Students Navigate Through Complex Medication Administration. Nurse Education in Practice, 203-211. doi: 10.1016/j.nepr.2014.11.015
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Collapse SubdiscussionRoberto Monroy An electrotonic health record (EHR) is essential in keeping a patient’s complete health history within reach of providers. If utilized correctly, they can significantly improve patient care by bridging the gap between providers. As an article states, “Mental health practitioners interested in adopting EHRs should establish a strong collaborative partnership with primary care physicians and clinic case managers to enhance bidirectional communication and information exchange about patients’ general medical and behavioral health concerns. Doing so will improve care coordination and the likelihood of identifying risk and protective factors associated with treatment planning, adherence, and improved outcomes.” (McGregor et al. 2015)
I currently work in an inpatient psychiatric ICU; In my organization, we lack EHRs and rely only on paper charting. This causes many issues as new patient data is collected at the point of admission. Many times, especially in mental health, patients are poor historians and cannot fully recall their medical diagnoses, medication names, dosages, frequency, etc. This leads to staff playing “catch up” until a caregiver or provider is found. This delay in care can be resolved by implementing electronic health records in our facility. In Mental health facilities, electronic records were shown to be 40 percent more complete and 20 percent faster to retrieve versus paper charting. (Tsai & Bond, 2008)
E-mental health is also an interesting and beneficial approach to treating patients with mental health disorders. Similarly to telehealth, E-Mental health utilizes technology to deliver treatment in remote settings. In addition to providing treatment,”…e-mental health systems can collect individual data to detect mental health symptoms and develop personalized programs that overcome the barriers to seeking help.” (Timakum et al., 2020). By implementing these useful data collection tools, providers and healthcare workers will be provided with clear complete health histories at a moment’s notice, leading to better patient care and better patient outcomes.
References
McGregor B, Mack D, Wrenn G, Shim RS, Holden K, Satcher D. Improving Service
Coordination and Reducing Mental Health Disparities Through Adoption of
Electronic Health Records. Psychiatr Serv. 2015 Sep;66(9):985-7. doi:
10.1176/appi.ps.201400095. Epub 2015 May 15. PMID: 25975885; PMCID:
PMC4558322.Tsai, J., & Bond, G. (2008). A comparison of electronic records to paper records in mental health
centers. International journal for quality in health care : journal of the International
Society for Quality in Health Care, 20(2), 136–143.
https://doi.org/10.1093/intqhc/mzm064Links to an external site.Timakum, T., Xie, Q., & Song, M. (2022). Analysis of E-mental health research: mapping the
relationship between information technology and mental healthcare. BMC
Psychiatry, 22(1), 57. https://doi.org/10.1186/s12888-022-03713-9Edited by Roberto Monroy on Nov 30, 2022 at 5:51pm-
Collapse SubdiscussionMleh Porter Hello Roberto,
I enjoyed reading your post and agree that electronic health records (EHR) can significantly improve patient care by allowing all providers to access vital patient information. All the healthcare systems I have worked in use EHR, making it easier to collect data at the time of admission since the information from other visits also populates. It can be time-consuming and more challenging to collect information when you must do it using a paper charting system with your current health organization. Even with the best historians, some of that information can get lost. In addition, some of the writings may not be legible, which could create room for potential errors.
There are benefits to using an EHR system. According to a source, more than 60% of hospital medication errors were due to illegible handwriting (Hoover, 2017). EHRs have reduced adverse drug events by 52% (Hoover, 2017). Nurses still have to do their due diligence to ensure that they follow the five rights of medication administration. Although the EHR I use in my current hospital is not foolproof, it will alert the nurse if the wrong medication is scanned.
The laboratory (lab) department calls nurses to report critical lab results, but the EHR system also alerts a nurse to critical lab values. Another benefit of the EHR system is showing nurses lab trends for the patient (Hoover, 2017). Fortunately, we have nursing informatics professionals who help healthcare organizations use these technologies and bridge the gap between the healthcare’s clinical and technical perspectives (Healthcare Information and Management Systems Society, 2022).
References
Healthcare Information and Management Systems Society. (2022, June 29). What is Nursing Informatics? December 2, 2022, from https://www.himss.org/resources/what-nursing-informatics
Hoover, R. (2017). Benefits of using an electronic health record. Nursing Critical Care, 12(1), 9–10. https://doi.org/10.1097/01.ccn.0000508631.93151.8d
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Collapse SubdiscussionMansong Ntekim Hi Roberto,
Thanks for sharing your perspective with us. It is surprising that some healthcare facilities still opt to paper charting despite the advantages of EHR over paper charting.
EMR has been recognized as a major transformational tool of the healthcare system. From a patient care perspective, EMR has improved the accuracy of the information, improved clinical decision-making and improved the easy accessibility of information for continuity of care. It has also generated vital health care statistics vital to the planning and management of health care services. (Honavar, 2020).
I am surprised that an acute care setting like yours would lack the benefit of the EHR. As you mentioned that some of the patients have difficulty giving needed information at the point of admission and care, leaving the care givers to guess and play “catch-up” while waiting for a provider. Such delay in care could be eliminated with an electronic system that that readily populates information from prior hospitalizations.
Hopefully, more facilities will adopt the EHR and make information more accessible to the staff for the benefit of the patients.
References
Honavar, S. (2020). Electronic Medical Records – The Good, the Bad and the Ugly. Indian Journal of Ophthalmology, 2020 March, 68(3): 417-418. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043175/
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Collapse SubdiscussionQuenyaita Ferguson The Application of Data and Problem Solving
It’s exciting to witness how EMR’s (Electronic medical records) have transformed the healthcare system. In the past before computers, using a pen and paper was the only option for healthcare workers. Thankfully, paper charting is history. According to the ARRA (American Recovery and Reinvestment act), all healthcare providers were required to convert all medical charts to a digital form (Burchill, 2010).
I work in a hospital as a lactation consultant. As a lactation consultant, we monitor the infant’s weight and pay close attention to intake and output. Having accurate data is crucial. We use weighted feeds to determine how much breastmilk an infant takes during a feeding session. This data is entered into our EMR. Our system records clinical data keeping records of all intakes, outputs, weights, and lots more. The system not only stores the information, but it also converts the information into a graph or a chart. Just at a glance, I’m able to determine if my patient’s weight is trending up, down, or maintaining. The same information is available to patients. Knowing this information helps when I’m providing recommendations to my patients. It’s also helps with problem solving, decision making, and ensures that I provide quality care.
As a lactation nurse knowing if an infant is transferring milk is essential for mom and baby. When assessing a patient as a lactation consultant our two main objectives are quality of breastfeeding and most importantly weight gain. The nurse leader having this information will assist in determining the best approach to take care of mom and baby. Essentially both the healthcare provider and the patient benefits from the EMR. Having accurate information literally at a glance enables rapid understanding and aids in the quality of care.
Burchhill KR. (2010). ARRA and meaningful use: is your organization ready? Journal of Healthcare Management, 55(4), 232–235.
Game, C. (1996). Nursing-related information and data: what is the role of computers in nursing practice? Collegian (Royal College of Nursing, Australia), 3(3), 20–22. https://doi.org/10.1016/s1322-7696(08)60175-4Links to an external site.
Healthcare Information and Management Systems Society (HIMSS) (2022). What is Nursing Informatics? Retrieved from https://www.himss.org/resources/what-nursing-informaticsLinks to an external site.
McGonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.
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Collapse SubdiscussionAndrea M Allen The Application of Data to Problem Solving
Initial Post
During my 22 years of working in healthcare as a registered nurse, both in acute setting and long term setting, Fall Prevention strategies has evolved from identifying patients via Morse Scale and placing high risk patients within eyesight at the nurses station to using various strategies such as call light within reach, positioning patients, checking and treating patients pain to using an Audio Computer-Assisted Self Interview (ACASI) to screen for example older folks that are high risk for falls.
Though Educating patients on fall prevention as well as safety, limiting fall risks that can eventually predispose individuals to injury and untimely death, decrease mobility, nursing home placement, hospitalization or decrease independence has not prevented falls. Research has shown that in empowering nursing informatics, there has been an increase in fall prevention through the use of quality improvement. Data that could be used for example are number of falls each month, number of patients who fall each month, number of patients with two or more falls each month and number of falls with serious injury each month as key indicators. These data could be used as key indicators for outcome measures. In addition, data such as changes in staff awareness and patient satisfaction as well as changes in staff organization could be considered. Gathering this information could identify trends related to falls such as time of day, activity and types of fall. The nurse leader can then use clinical reasoning and judgment with the use of nursing informatics to implement new fall prevention strategies and increase staff awareness for accurate reporting of falls through tracking records. As fall rate begins to decline, eventually more advance measures to prevent falls will be instituted in order to prolong elderly patients independence and eventually their untimely deaths.
Ogbuokin, U. (2022). Using Audio Computer -Assisted Self Interview (ACASI) to S in an Outpatient creen Older Adults for Fall Risk in an Outpatient Primary Setting http://www.himss,org/ojniLinks to an external site.
Sweeney, J. (feb. 2017). Healthcare Informatics. Online Journal of Nursing Informatics (OJNI), 21(1),
McGonigle, D., & Mastria, K.G (2022). Nursing Informatics and the foundation of Knowledge (5th ed.). Jones & Bartlett
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Collapse SubdiscussionRoberto Monroy Hello Andrea!
Gathering data to prevent falls is a great idea; falls, especially in the elderly, could have devastating consequences. As nurses, we have the responsibility to protect our patients from harm. Nazarko states, “Our role is to work with the older person to reduce risk wherever possible and to enable the person to lead a full life. This involves balancing risk and quality of life and supporting the person at risk of falls and respecting choices that the person makes.” (Nazarko, 2012).
One study conducted stated, “Annually, hospital-acquired falls result in an estimated $34 billion in direct medical costs. Falls are considered largely preventable and, as a result, the Centers for Medicare and Medicaid Services have announced that fall-related injuries are no longer a reimbursable hospital cost.” (Bjarnadottir & Lucero, 2018). Implementing measures to predict and prevent falls protects patients’ well-being and safety and can save hospitals substantial amounts of money. In an ideal world, these funds can be used to create more data-collecting programs to help protect patients from preventable accidents.
References
Nazarko, L. (2012). How to reduce risk of injury if a person remains at risk of falls. British Journal
of Healthcare Assistants, 6(9), 432–437.Bjarnadottir, R. I., & Lucero, R. J. (2018). What Can We Learn about Fall Risk
Factors from EHR Nursing Notes? A Text Mining Study. EGEMS
(Washington, DC), 6(1), 21. https://doi.org/10.5334/egems
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Collapse SubdiscussionBarkisu Fortenberry NURS-6051N Week 1 Discussion
Discussion: The Application of Data to Problem-Solving
A pregnant patient requested a doctor’s appointment at the OB/GYN clinic. I was able to learn that she went to the hospital and had tests done while she was thereafter triaging her and asking a few questions. A pregnancy test provides the information that may be used. These outcomes would inform us of any necessary follow-up tests. We could find out if she has been prescribed any meds or is presently doing so. The service provider had access to the hospital’s files. Lab results, ER visit notes, patient medical history, and demographic data were gathered.
The physician may upload the patient’s records if a patient is a mutual patient at our clinic. Additionally, they have the ability to receive faxes with patient data. They have access to information about the patient’s health issues, past and present drugs, results of blood tests, and vital signs. Clinicians and patients use email, personal data devices, electronic medical records, vital sign machines, glucometers, and online portal systems, to name a few, whether they are inpatients or outpatients (Sweeney, 2017). Because electronic nursing documentation enables real-time communication among all healthcare practitioners, health information technology (HIT) and nursing documentation directly affect patient safety (Lavin,Harper & Barr, 2015).
In order to make decisions about the patient’s care, a nurse leader would gather information about their status. They would next create a treatment plan using this information. This will assist in deciding what kind of care should be given. Clinical reasoning and critical thinking go hand in hand. Clinical reasoning involves generating every possible course of action, evaluating all assessment data, anticipating potential consequences for each, prioritizing activities, and remaining flexible and open to alternatives (Manetti, 2018).
References:
Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum, 54(1), 102–110. doi: 10.1111/nuf.12303.
Lavin, M. A., Harper, E., & Barr, N. (2015, May). Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings. Retrieved February 23, 2020, from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJ IN/TableofContents/Vol-20-2015/No2-May-2015/Articles-Previous-Topics/TechnologySafety-and-Professional-Care-Documentation.html.
Sweeney, J. (Feb, 2017). Healthcare Informatics. Online Journal of Nursing Informatics (OJNI), 21( 1), Available at http://www.himss.org/ojniLinks to an external site..
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Collapse SubdiscussionBenedicta Kwevie In this scenario, a patient comes in and reports being admitted multiple times before this but cannot recall the specifics or details of the admissions and has missing medical records.
Healthcare providers strive to give patients the best care possible. However, that plan can alter when problems arise, especially with manual charting. With this, some patient records might get lost due to misplacement, which takes up more time than electronic charting. When it comes to manual record keeping, there is a risk of fragmentation due to different records being with different health providers and losing records. There is also more time spent on manual documentation than electronic (Slyngstad & Helgheim, 2022), leading to a loss of productivity. Then there is the issue of the records being accessible to only one person at a time. Technology can help in this scenario by telling whether the patient’s relevant information is collated into an Electronic Health Records (EHR) system, which would not only drastically reduce the risk of loss of records, but will also make it so that moving forward, all Healthcare providers have access to the patient’s past records (treatment regimen and whether they worked) without much trouble. Integrating technology in this scenario would also help make the nurse’s routine tasks quicker and more efficient (Scott, 2021). An example of this will be the nurse’s ability to monitor the patient’s vital signs utilizing portable/ wearable monitoring devices while simultaneously performing other tasks. Using technology here will also enhance communication with other healthcare team members in that any information which may have been missed during the handoff of the patient will be quickly accessible by multiple team members simultaneously.
The data that could be used is their history of admittance in all hospitals, as electronic charting and documentation can keep all patient information and history, test/lab results, demographics, progress notes, medications, and past medical history. The data can be collected by getting the extended and complete history of the patient and reaching out to other facilities the patient has visited or been admitted to and can be accessed by cumulating all the data and information into a patient file that can be easy to find and locate. The knowledge derived from the data collected in the electronic chart can be the patient’s medical history and records, their health history, medications, and all sorts of things that would aid in providing care for the patient. A nurse leader could use clinical reasoning and judgment by reviewing and getting familiar with the different parts and sections of the patient’s electronic file and all the data inserted into it. They can implement their own methods and systems when they are familiar with them and know how to navigate the file and the patient’s history.
References:
Nursing Informatics – Canadian Nurses Association. (n.d.-b). Higher Logic, LLC.
https://www.cna-aiic.ca/en/nursing/nursing-tools-and-resources/nursing-informatics
The Impact of Technology in Nursing: Easing Day-to-Day duties. Available at
Scott, J. (2021).
https://healthtechmagazine.net/article/2021/05/impact-technology-nursing-easing-day-to-day-duties-perfcon
How Do Different Health Record Systems Affect Home Health Care? A Cross-Sectional Study of Electronic – versus Manual Documentation System
Slyngstad, L. & Helgheim, B.I. (2022)
https://pubmed.ncbi.nlm.nih.gov/35237067/
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Collapse SubdiscussionDawn Lorde Scenario:
A 57-year-old male arrives in the emergency department with nausea and vomiting for two days. The patient states that he has a history of diabetes, and his sugar level has been over 400 mg ml. The patient complains of weakness and is slightly confused.
Describe the data that could be used and how the data might be collected and accessed:
The patient is a poor historian and could not tell me everything about his medical history. I placed the patient on a monitor and obtained vital signs. Additionally, I performed an EKG and obtained blood work. The patient was hypotensive and tachycardic, which was concerning. After receiving all the lab results, it was confirmed that many of the tests were abnormal, and the patient was in critical condition.
What knowledge might be derived from that data?
I looked up the patient’s medical history using the electronic patient record [EHR] (Vernice, 2019). I obtained the patient’s pertinent medical history, which revealed a history of diabetes, heart attack, and hyperlipidemia. In reviewing the current lab results, it was evident that the patient was in diabetic ketoacidosis. His blood glucose was 1059, his potassium level was 6, his lactate acid was 4.43, and his Co2 was 8. I knew he was my most critical patient, and I had to prioritize my care and attention.
How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?
The patient’s potassium level was 6, his lactate acid was 4.43, and Co2 was 8. I knew he was my most critical patient, and I had to prioritize my care and attention to him. In gathering all the data on the patient’s history and current lab results, I treated the patient quickly with intravenous (IV) insulin and IV fluids. The emergency room is high-stress and fast-paced, which can lead to medication errors if the nurse is not careful. The help of a computerized system can help reduce medication errors by scanning the patient and the correct drug (Suh et al., 2021). A medication such as insulin requires a double check by another nurse to confirm accuracy. With all the data obtained, the patient can be quickly transferred to the ICU to improve his patient care outcome.
References:
Suh, S. R., Kim, J., & Song, Y. (2021). The predictive factors of medication errors in clinical nurse. Journal of Health Informatics and Statistics, 46(1), 19-27.
Vernice, C. (2019). Informatics in nursing. Current and future trends. Applied Medical Informatics, 41, 35.
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Collapse SubdiscussionJodian Walford Healthcare Informatics is “the integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information” (Saba & McCormick, 2015, p. 232). The invention and continuous upgrade of healthcare technology aim to save time and lives by reducing human errors.
I am an international nurse who moved to the USA recently from a small Caribbean Island. Before coming to the USA, I worked in a small hospital that still uses paper charting, which has been a norm in the nursing forum for years. Coming to the USA, I have upgraded to the use of EHR. Paper charting has been noted to be more time-consuming than electronic Health recording and is also more susceptible to human errors and mistakes. Electronic records organize the data collected, which reduces medication errors and misdiagnoses.
Documentation is vital in treating patients. Care is continuous and relies heavily on shift reports and documentation to ensure patient safety and illuminate errors, especially in medication administration. Let’s use the hypothetical scenario; Hospital A uses paper charting. RN Jane, a new graduate, works in this hospital. She has a patient on once-daily Heparin 5000u SC. Jane did what she was supposed to and got a colleague to check and administer the due medication as prescribed. However, after administration, Jane forgot to go and sign the medication card. She went on to complete other documentation and other assigned tasks. Another nurse comes on and decides to help serve all the unserved medication. As she was ready to serve RN Jane’s patient Heparin 5000u SC, she went and got a colleague to do her second checks and verify the patient. Luckily, the same nurse went with jane to serve the medication. She immediately recalled that she had already checked with RN Jane, who had already administered the drug. Medication errors are estimated to harm at least 1.5 million patients annually in the US, with about 400,000 preventable adverse events (Agrawal, 2009).
Electronic charting would have eliminated that error. The patient armband and medication barcode would have been scanned into the system. Upon entering the same patient data again, it would have given an alert that medication was already dispensed for this patient. RN Jane would not have been able to do another documentation on the same device without signing for that served medication. HealthStream (2021) states that medical errors cost nearly $40 billion annually, and many of those errors are preventable with informatics. Not only does information provide nurses with alerts to avoid mistakes, but it also helps to automate specific tasks, improving nurse productivity and preventing some of the costs associated with health care.
References
Abha Agrawal, A. (2009). Medication errors: prevention using information technology systems. British Journal of Clinical Pharmacology, 67 (6), 681-686.
https://doi.org/10.1111/j.1365-2125.2009.03427.xLinks to an external site.
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