THE APPLICATION OF DATA TO PROBLEM-SOLVING Discussion Post
To Prepare:
Table of Contents
Toggle- Reflect on the concepts of informatics and knowledge work as presented in the Resources.
- Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.
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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BY 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.
Interaction of Nurse Informaticists with Other Professionals
In my experience working in long-term care and skilled nursing facilities, I’ve noticed several issues that could have been greatly improved with better data collection. One significant problem is the high occurrence of pressure ulcers in patients admitted to skilled nursing facilities. According to Lavallée et al. (2019), patients entering nursing homes face a higher risk of developing pressure ulcers. This can lead to increased healthcare costs, longer patient stays, and potentially worse outcomes. Sweeney (2017) points out that nursing informatics combines nursing and computer science to enhance patient care in healthcare settings.
The good news is that the skilled nursing facility I worked in already had an electronic health record system in place. This system could be used to collect, review, and apply data to address this issue. Some of the data that could be collected to help reduce pressure ulcer development includes the total number of pressure ulcer cases that developed after admission. It should also track pre-existing pressure ulcers that worsened during a patient’s stay. For instance, when a patient is admitted with a stage 1 pressure ulcer, but it worsens to a stage 2 during their stay. Additionally, the Braden assessment that all patients receive upon admission could be valuable in analyzing data to prevent pressure ulcers.
Analyzing this data can provide essential insights, such as establishing a baseline for the rate at which patients are acquiring pressure ulcers and the rate at which existing pressure ulcers are worsening. A nurse leader can use this data to develop a project for process improvement, as suggested by Nagle, Sermeus, and Junger (2017). This could prove beneficial in reducing pressure ulcer incidents in long-term care facilities. A nurse leader could form a team involving nurse informaticists, leadership, and staff nurses to follow trends and create an improvement plan. This plan may include better tracking of patient repositioning, improved use of available bed technology, more frequent skin assessments, and pressure ulcer prevention bundles. This issue requires ongoing attention to enhance overall patient care quality.
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References
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: a feasibility study. Health & Social Care in the Community, 27(4), e417-e427.
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. In J. Murphy, W. Goosen, & P. Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionMenard Tchatchou-Tchoubia Discussion Response
Menard Tchatchou
Walden University
NURS 6051 N
Dr. Lynne Taylor
12/01/2022
Discussion Response
Thanks for providing valuable insights on how the facilities you worked with could collect, review, and apply data to help reduce pressure ulcer development. I can see how Sweeney (2017) defines nursing informatics principles as integrating nursing and computer science to enhance the delivery of quality health care that could be applied in this situation. From your insights, I was impressed to learn that all ulcer patients would receive a Braden assessment upon admission. This data could prove helpful in preventing pressure ulcer development. I would also note from your insights that the nurse leader would use the collected data from ulcer patients to develop a process improvement project in support of Nagle, Sermeus, and Junger (2017) that would be useful in reducing the incidence of pressure ulcers in long term care facilities with the help of other medics. However, I would like to know in more detail how the nurse leader and the team would use the data to follow trends to improve overall patient care quality.
Lastly, I better understood how the nurse leader and health facility team can follow pressure ulcer trends and how nursing informatics principles could be applied. I agree that collecting and using data to reduce pressure ulcer development and identify areas for improvement, using data to develop evidence-based protocols/guidelines, and using data to educate staff and patients are all great ideas. Using data to improve resource utilization (e.g., staffing levels, supplies, etc.) would be another great way to apply nursing informatics principles. Do you have any other thoughts?
References
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. In J. Murphy, W. Goosen, & P. Weber (Eds.), Forecasting Competencies for Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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ollapse SubdiscussionMaxine A Lewis Irvin with the collection and reviewing of the data (Braden score) at your facility how meaningful is the data? Is it being used to staff according to the acuity? I am curious of the percent increase or decrease in pressure ulcer as well at deterioration of existing ones. My rational for asking is that so often the Braden scale and documentation is done but if the manpower is not available to do the frequent turns etc. the electronic paperwork is meticulous but the incident of pressure injuries remains the same or increases.
Inadequate staffing can be a contributing factor in pressure ulcer studies have “shown a direct relationship between nurse staffing and patient outcomes such as PUs…” (Kim et.al 2022). Pressure injuries are preventable if the preventative measures are instituted however if there is no manpower to initiate evidence base practice then we are back to square one.
Harrington et.al cites “nursing home staffing levels are highly variable and much lower on weekends than during the week.43Links to an external site. RN levels were 42% lower, LVN/LPN levels were 17% lower, and CNA levels were 9% lower on weekends in 2017 to 2018.” Furthermore ” based on resident acuity, 54% of nursing homes did not meet the total CMS expected staffing level 80%of the time. About 75% of nursing homes almost never met the CMS expected RN staffing level based on resident acuity in 2017 to 2018″ (Harrington et.al 2020). Kim et.al cites that ” the higher the level of nurse staffing, the lower the risk for PU development” (Kim et.al 2022).
Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health services insights, 13, 1178632920934785. https://doi.org/10.1177/1178632920934785
Kim, J., Lee, J., & Lee, E. (2022). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of Nursing Management (John Wiley & Sons, Inc.), 30(5), O1–O9. https://doi.org/10.1111/jonm.12928
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Collapse SubdiscussionIrvin Michael Jones Hi Maxine and Mernard,
In my previous experience working in the nursing home, pressure ulcer development became such a major issue due to the federal survey team that came to do a full inspection of the facility. The facility was tagged with several areas of improvement in the appropriate prevention of pressure ulcers. During this time my team and I were responsible for collecting the data, reviewing the data, and developing project proposals. Some of the plans we came up with were to start weekly wound rounds where we contracted a physician assistant that would come each week to do assessments. This was a great help because the nurses could assess patients then submit a referral for the physician assistant to see them that week. Nurses were trained to submit referrals even at the sign of redness to coccyx to help provide treatment early. We also purchased additional pressure-relieving air mattresses to provide to patients immediately upon admission.
We also increased the Braden assessment from weekly to BID and the unit managers were expected to review any changes or trends. According to Anaba-Wright and Kefas (2020) quality improvement projects to reduce pressure ulcers are beneficial when staff are able to buy-in. Through various trainings and meetings with the staff we were able to come up with additional improvements based on staff feedback. We initiated the use of the patient turning clock as well so that the nurses could assist the CNA’s in making sure the patient is repositioned every 2 hours. As you mentioned Maxine, with staffing being variable to low maintaining these initiatives proved difficult. We decided to have the entire leadership team rotate through the units daily to assist in any way that they could. We did see a reduction of pressure injuries when reviewing the data 3 months later and the facility was able to pass the inspection as well.
Thank you all for your feedback.
References
Anaba-Wright, U., & Kefas, J. (2020). Reducing pressure ulcers in care homes in Barnet: a quality improvement project. British Journal of Community Nursing, 25(Sup9), S33–S37. https://doi.org/10.12968/bjcn.2020.25.Sup9.S33
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
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Collapse SubdiscussionChristiana Nuworsoo Irvine,
I consider your topic of interest a hot topic of great importance and priority at all health facilities. In the United States alone, approximately $2.5 million in hospitalizations are due to pressure ulcers (Afzali Borojeny et al., 2020). Surgical and ICU patients are at the greatest risk for pressure ulcers in the hospital setting due to bedrest and immobility (Truong et al., 2016). What sets each facility apart are the standards and protocols in place to decrease the development of pressure ulcers. I have had the privilege of working with 3 of the major hospital systems in Maryland, and only one has a rigorous approach to prevention. This one hospital system I’ve worked with has a Pressure Ulcer Prevention Committee that includes, at minimum, two nurses from each unit, one for the day shift and the other for the night shift. Each week they compile a list of all patients with a Braden Score of 18 or less. Using the electronic charting system information, they can tell who is being turned and who is not. To confirm best practice, they must visit the patients with low Braden Scores to ensure that turns are indeed being done according to the charting and that the types of equipment needed are present in the rooms. They do random checks to ensure that the charting matches the patient’s disposition. If a patient is not turned, they turn the patient. The list of patients with low Braden Scores and nurses not adhering to prevention tactics are then sent to the Unit Manager.
Although I agree with you about determining a baseline Braden Score, one thing I have learned working at the hospital is that Braden Scores change by the day. Therefore, the best practice should be to determine a daily or shift Braden Score because it indicates whether a patient is declining or recovering. A patient with a decreasing Braden Score will need to be turned more. A program that automatically sends a list of low Braden Score patients to the Unit Managers daily for analysis can be written.
References
Afzali Borojeny, L., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The Incidence of Pressure Ulcers and its Associations in Different Wards of the Hospital: A Systematic Review and Meta-Analysis. International journal of preventive medicine, 11, 171. https://doi.org/10.4103/ijpvm.IJPVM_182_19Links to an external site.
Truong, B., Grigson, E., Patel, M., & Liu, X. (2016). Pressure Ulcer Prevention in the Hospital Setting Using Silicone Foam Dressings. Cureus, 8(8), e730. https://doi.org/10.7759/cureus.730Links to an external site.
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Collapse SubdiscussionBertina Boma Soh Hello Irvine,
Pressure ulcers, primarily in-house-acquired, are a real issue for every facility. While working at a nursing home, I found a pressure ulcer as a clinical priority. Pressure ulcers can lead to significant health conditions and increase the patient’s morbidity and mortality. A pressure ulcer is important because patients come to the healthcare facility to cure their disease. However, patients suffer from pressure ulcers that can lead to life-threatening conditions such as infection of the wound, osteomyelitis, sepsis, and the reimbursement system to the health care organization. Residents in long-term and skilled care facilities have impaired mobility due to chronic illness; these residents are at increased risk for further disability due to pressure injuries. It is our responsibility to prevent this from occurring. Most nursing homes cure pressure ulcers in nursing homes using a care bundle (Lavallee et al., 2019). Routine assessment of skin, nutritional assessment, hydration, repositioning, and pressure ulcer care bundle. The nursing evidence-based practice committee should focus its next research project on this nursing practice problem. Pressure ulcers can be the gateway to many life-threatening health conditions and increase the patient’s mortality risk (Lavallee et al., 2019).
Reference
Lavallee et al., 2019. Preventing pressure ulcers in nursing homes using a care bundle: A
feasibility study. Health &Social Care in the Community. 27(4). Permalink https://chamberlainuniversity.
idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?
direct=true&db=her&AN=137037259&site=eds-live&scope=site
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Collapse SubdiscussionOlufunke Ajayi-Festus Irvin,
I enjoyed reading your post, I will like to say that nursing informatics has helped us with data collection, unlike before, when collecting data was strenuous work and most of the data were not accurate. The problem is what we do with the data collected which is a topic for another day. Braden score, for example, is a way to know how the skin integrity of a patient is either improving or worsening, what we don’t do is turn the patient frequently, get them out of bed when appropriate, or walk them as the case may be.
Reference
Lavallee et al., 2019. Preventing pressure ulcers in nursing homes using a care bundle: A
feasibility study. Health &Social Care in the Community. 27(4). Permalink https://chamberlainuniversity.
idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?
direct=true&db=her&AN=137037259&site=eds-live&scope=site -
Collapse SubdiscussionRemi Oluremi Ojo Hi Irvin,
I agree that pressure ulcers (PU) are a serious, frequent, and costly complication in health care settings and are commonly used as a quality indicator for nursing care. The prevalence of PU in healthcare settings is high, especially in hospitalized patients or in a nursing facilities. As a result, there is a huge need to continually measure the incidence and prevalence in health care (Gunningberg, et al., 2009). The impact of health information technology (HIT) should be widely noted in the development of standardized documentation practices for pressure ulcer prevention and care. Adverse occurrences such as healthcare-acquired pressure ulcers (HAPUs) are being enhanced through the application of HITs. An example is the risk assessment tools in Kaiser Permanente (KP) HealthConnect. KP completed the execution of an organization-wide EHR known as KP HealthConnect in March 2010 which improved practitioner prescribing, increased efficiencies in organizations, improved communication, and improved quality of care and outcomes. KP HealthConnect is used to calculate an overall risk score of PU, identify patients that are a high risk of developing a pressure ulcer, and alert nurses to implement preventative measures. For HAPUs, KP incorporated Ascension Health’s SKIN care bundle into the KP HealthConnect build and provide education for the nursing employees. The EHR system was designed to provide flowsheets that prompt nurses to implement proper actions related to skin care by turning the patent that is at a high risk of pressure ulcers regularly. The implementation of this EHR has contributed to improvements in the nursing care outcome and processes (Dowding et al., 2012).
References
Dowding, D. W., Turley, M., & Garrido, T. (2012). The impact of an electronic health record on nurse-sensitive patient outcomes: an interrupted time series analysis. Journal of the American Medical Informatics Association: JAMIA, 19(4), 615–620. https://doi.org/10.1136/amiajnl-2011-000504
Gunningberg, L., Fogelberg-Dahm, M., & Ehrenberg, A. (2009). Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care. Journal of clinical nursing, 18(11), 1557–1564. https://doi.org/10.1111/j.1365-2702.2008.02647.x
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Collapse SubdiscussionMansong Ntekim Healthcare Information and Management Systems Society (HIMSS), (2022) defines nursing informatics as “the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice.” Nursing as a profession has benefited immensely from the paper charting to electronic medical record (EMR) in terms of availability of information, accessibility of information, and patient safety.
I started nursing about 22 years ago, when paper charting was the norm, any information sought had to be found in books, if such books were available at the point of care. Information and data were hard to obtain, mostly, while on the job as one had to go and search for the information/data in the books available at the care location. With nursing informatics, needed information and data are within the finger reach.
I practice in an acute care mental health setting with a high patient turn-over ratio, which also means, a high admission rate. The facility uses EPIC, this system provides the nurse with data and current information about the patient’s previous care information. When a patient’s personal information is logged into the system, the patient’s past admissions, diagnosis, medications, progress and nursing notes are accessible from all facilities that the patient has been to the uses EPIC. The availability of these information/data helps in speeding up the admission process, medication reconciliation, and giving the nurse information about the patient’s behavior on the unit during prior admissions. The past behavior pattern can help to determine future behavior and help in housing location for the safety of other patients and staff. Having adequate information about past treatment is strategic to the treatment and safety of the patient and staff.
Reference
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.
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Collapse SubdiscussionIrvin Michael Jones Hi Mansong,
You mentioned using paper charting during your career as a nurse. While I have spent most of my career utilizing electronic health record systems, I certainly understand the importance of nursing informatics in our evolving health care system. In my current position as a mental health nurse, we continue to do paper charting which has proven to be very time consuming. Time management in nursing is of great importance and when we are spending several hours documenting on paper that could be improved using an electronic health record, it highlights the importance of using nursing informatics. Trout et al. (2022) states that the use of electronic health record systems is associated with an increase in overall patient safety as well as documentation efficiency. Fortunately, the facility that I am currently a part of has recognized the need to utilize an electronic health record system. They are planning on launching EPIC early next year and I hope to see similar improvements as you mentioned in your facility.
-Irvin
References
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).
Trout, K. E., Chen, L.-W., Wilson, F. A., Tak, H. J., & Palm, D. (2022). The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety. International Journal of Environmental Research and Public Health, 19(19). https://doi.org/10.3390/ijerph191912525
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Collapse SubdiscussionBarkisu Fortenberry Hi Mansong,
Wow! Your discussion is truly reflective of your career as a nurse. Since I have spent most of my career using electronic record systems, I am fascinated by the significance of nursing informatics within the changing healthcare system. In my current role as a nurse, we continuously do paper charting, which is indeed time-consuming (Alexandru, Radu & Bizon, 2018). Besides, time management remains essential in nursing; thus, when we use several hours in the documentation of a paper, which could be enhanced using electronic health records, it underscores the significance of using nursing informatics. The use of electronic health record systems has been related to a general increase in relation to patient safety and documentation effectiveness. However, does this spell doom for facilities that fail to adopt electronic records? However, our facility projects to have improved services as a result of launching EPIC.
Reference:
Alexandru, A. G., Radu, I. M., & Bizon, M. L. (2018). Big Data in Healthcare-Opportunities and Challenges. Informatica economica, 22(2).
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Collapse SubdiscussionAndrea M Allen Hi Monsong,
Unfortunately, I too work in mental health where most of our charting are done by writing on paper. The hospital has started certain aspects of charting via computer such as doctors dictation, labs and medication administration. Coming from previous hospitals where writing was a thing of the past can be very challenging and really time consuming. For example, if someone documents an error, they have to draw a straight line through the error, sign, time and date the error before moving on plus the charts become quite heavy quickly. Another issue I observed is the older nurses who worked there for many years are very resistance to using a computer. Prior attempts to change the system by other administrators have failed. Administering medication via computer has made significant improvement so far. I am hoping that advancement will continue where technology will continue to prove that its safer and saves time.
Healthcare Information and Management Systems Society (HIMSS) (2022). What is Nursing Informatics? Retrieved from https://www.himss.org/resource/what-nursing-informaticsLinks to an external site.
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Collapse SubdiscussionBertina Boma Soh Hello Mansong,
Thank you so much for the detailed work. I agree that Healthcare Information and Management Systems Society defines nursing informatics as “the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice. You are correct that Nursing has benefited immensely from paper charting to electronic medical records (EMR) in terms of availability of information, accessibility of information, and patient safety.
Over the past few decades, our medical knowledge has increased. More investigative and treatment options are available; as a result, our patients are living longer, and we are dealing with more chronic conditions. Family physicians cannot “know all things,” nor can we be “all things to all patients.” To adequately address our patients’ complex needs, we need good sources of information and good relationships, including access to a multidisciplinary team of professionals and other specialists. We need tools that improve access to information and relationships. We have had to transform how we practice, and the EMR, with its associated information technology, has facilitated that transformation.
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Collapse SubdiscussionDawn Lorde Hi Mansong,
Thank you for your post. I currently work in the emergency room (ER), and we see a lot of patients with mental health issues. We also use EPIC charting system, and it is very helpful in collecting all the data on past medical history, medications, and the previous hospital stays. We often have patients arrive under a temporary custody order (TDO). Often, these patients are not forthcoming in giving any medical history because they are unhappy about being in the emergency room against their will.
In the hospital where I work, there is no mental health unit. Therefore, those patients requiring inpatient mental health treatment may be in the ER for an extended time until placement is found. We collaborate with doctors, psychiatrists, and community service board (CSB) using telecommunication every day. Therefore, current electronic health records (EHR) are crucial for accurately recording and sharing critical patient health information with other medical professionals (Alenezi & Alghamdi, 2022).
Reference:
A. Alenezi & A. A. Alghamdi, “Progress of Nursing Informatics for Mental Health Initiatives,” 2022 Second International Conference on Interdisciplinary Cyber Physical Systems (ICPS), 2022, pp. 152-158, DOI: 10.1109/ICPS55917.2022.00036.
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Collapse SubdiscussionJodian Walford Hi colleague,
You have made noticeable points regarding informatics and the electronic medical record (EMR). It has contributed positively to the healthcare profession. On the island I am from, we only had paper charting, which was stored in folders. Often Papers would be misplaced, which delays patient care. Now upgrading to the use of EMR has solved that problem. EMR provides easy access for authorized users and allows for the flow of information specific to the patient treatment, from the nurse at the bedside to the physician prescribing treatment to the pharmacy (Cipriano, 2011).
Nurses are uniquely positioned to be leaders in how this technology is organized and implemented for the patient’s betterment (Huston, 2013). With the experience of paper charting and EHR, I have experienced benefits and drawbacks. The benefits of EHR, however, outweigh the negatives. The world is evolving, and as professionals, it is vital to equip ourselves with the needed knowledge and skills as it saves time and lives.
References
Cipriano, P. E. & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 282, 286-289
Huston, C. (2013). The impact of emerging technology on nursing care: Warp speed ahead. The online Journal of Issues in Nursing, 18(2)
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Collapse SubdiscussionMenard Tchatchou-Tchoubia Discussion Response
Menard Tchatchou
Walden University
NURS 6051 N
Dr. Lynne Taylor
12/02/2022
Discussion Response
Hi Mansong, after carefully reading your post, I came up with the following questions that need clarification.
How did hospitals transition from paper charts to nursing informatics?
How much training was needed for the transition from paper charts to nursing informatics?
What challenges were faced during the transition from paper charts to nursing informatics?
In case the book that contains information at the time of care was not available, what were the procedures to care for the patients?
Did the transition from paper charts to nursing informatics lead to job losses or lower demand for nurses?
What were some of the difficulties encountered during the transition to nursing informatics?
What was the noticeable difference between the use of paper charts and nursing informatics?
How has nursing informatics affected the treatment and care of patients, and in what way?
How did you respond to the emergence of an unknown case during the paper chart era?
How do you obtain records for a patient who visited a hospital that didn’t use the EPIC system, and what is the procedure?
Who regulates and authorizes access to patient information to ensure patient confidentiality?
In case of unavailability of data, what is the procedure for admission, diagnosis, medication, and care of the patient?
How do you handle a case where the patient information captured in the system is incomplete and inaccurate?
What is the procedure for determining which patients require treatment and which do not?
In cases of misdiagnosis, how do you handle the patient’s treatment?
Is the EPIC system friendly to the user?
In the event of an EPIC system failure, how do you access information for patient care?
In this, I would like to give an alternative. The alternative use of the nursing informatics principle can be used in ideas such as aligning nursing practices with workflow and care, helping reduce medical errors, helping formulate training and learning based on the data collected, improving the quality of medical protocols, policies, or procedures, and helping achieve continuity of care.
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