To Prepare:
- 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?
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.
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During my time working in long-term care and skilled nursing facilities, I noticed several problems that could have been fixed if we had better data. One big problem was the high number of pressure ulcers that patients developed while they were in the skilled nursing facilities. Lavallée et al. (2019) found that when patients go to nursing homes, they’re more likely to get pressure ulcers. This can make healthcare costs go up, make patients stay in the facility longer, and lead to worse outcomes.
Sweeney (2017) says that nursing informatics, which combines nursing and computer science, can help make patient care better. Luckily, the skilled nursing facility where I worked already had a computer system for keeping health records. We could use this system to gather, look at, and use data. We could collect data like how many patients got pressure ulcers after they arrived, and if any existing ulcers got worse. For example, if a patient came in with a small ulcer and it got bigger while they were there.
Also, all patients get a Braden assessment when they arrive, and this data could help too. We could use this data to find out how often patients are getting pressure ulcers and how often existing ones are getting worse. A nurse leader could use this information to start a project to make things better. Nagle, Sermeus, and Junger (2017) say that nurse leaders can make big changes by improving how things are done. The nurse leader could use the data to start a project that would involve other leaders, an expert in nursing and computers, and the nurses who work there. They could use the data to see what’s happening and make a plan to stop pressure ulcers. This plan could include things like making sure patients move around more, using special beds, doing more checks on the skin, and using special kits to prevent ulcers. This is a problem that needs to be fixed to make sure patients get the best care possible.
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
Discussion Response
Thank you for your feedback and further inquiries. I’m glad to provide more detail on how the nurse leader and the team would use the collected data to follow trends and improve overall patient care quality.
Once the nurse leader and the team have gathered data on pressure ulcer development and trends, they would analyze this information regularly to identify patterns or areas needing improvement. They might use statistical tools or software to help them visualize and interpret the data. For example, they could track the number of new pressure ulcers occurring over time, the severity of these ulcers, any common risk factors among patients who develop them, and the effectiveness of interventions in preventing or treating them.
Based on their analysis, the team could then develop evidence-based protocols or guidelines tailored to their facility’s specific needs and challenges. These protocols might include standardized procedures for skin assessments, repositioning schedules, use of specialized equipment, and staff training on pressure ulcer prevention and management.
Furthermore, the team could use the data to educate both staff and patients about pressure ulcer prevention strategies. They might create educational materials, conduct training sessions, or implement reminder systems to ensure that everyone is aware of the importance of skin care and regular monitoring.
Additionally, as you mentioned, nursing informatics principles could also be applied to optimize resource utilization. By analyzing data on staffing levels, supplies usage, and other resources, the team can identify areas where resources may be underutilized or where adjustments are needed to better support pressure ulcer prevention efforts.
Overall, leveraging data and nursing informatics principles in this way can empower healthcare teams to make informed decisions, implement targeted interventions, and continuously improve the quality of care provided to patients in long-term care facilities.
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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Collapse 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 The Healthcare Information and Management Systems Society (HIMSS), (2022) explains nursing informatics as the specialty that combines nursing science with various information and analytical sciences to manage and communicate data, information, knowledge, and wisdom in nursing practice. Over the years, nursing has transitioned from paper charting to electronic medical records (EMRs), greatly benefiting in terms of information availability, accessibility, and patient safety.
I began my nursing career around 22 years ago, when paper charting was standard practice. Obtaining information was challenging, often requiring nurses to search through books available at the care location. However, with the introduction of nursing informatics, necessary information and data are now easily accessible.
I currently work in an acute care mental health setting with a high patient turnover rate and admission rate. Our facility uses EPIC, a system that provides nurses with comprehensive patient data and previous care information. When a patient’s personal information is entered into the system, their past admissions, diagnoses, medications, progress, and nursing notes from all EPIC-using facilities are accessible. This availability of information speeds up the admission process, facilitates medication reconciliation, and provides insight into the patient’s behavior during prior admissions. Understanding past behavior patterns helps in predicting future behavior and aids in determining the most suitable housing location for the safety of both patients and staff. Having adequate information about past treatment is crucial for effective patient care and staff safety.
Shoshanna Tillman Follow Up Sick Visit: Musculoskeletal Shadow Health Transcript
ReferenceHealthcare 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 Thank you for your thoughtful response. Indeed, as medical knowledge expands and more treatment options become available, the healthcare landscape has evolved significantly. Patients are living longer, and the prevalence of chronic conditions has increased. In this dynamic environment, it’s essential for healthcare providers to have access to reliable sources of information and to foster strong relationships with multidisciplinary teams and specialists.
Family physicians face the challenge of addressing complex patient needs while recognizing their limitations in knowing everything about every condition. This is where tools like electronic medical records (EMRs) and information technology play a crucial role. EMRs provide healthcare professionals with streamlined access to patient information, allowing for more informed decision-making and coordination of care across different specialties.
The transformation of healthcare practice facilitated by EMRs and associated technology has been instrumental in meeting the evolving needs of patients and providers alike. By improving access to information and enhancing communication among healthcare teams, these tools contribute to more efficient and effective patient care delivery.
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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
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.
Collapse SubdiscussionGuoming Feng Hi Mansong,
When we’re talking about nursing informatics, most of the time, we’re talking about data storage. Yes, electronic health records have significantly made our routine work more convenient. I haven’t worked in a healthcare setting with paper charting, so I didn’t know how a medical surgical unit was run, until recently when there was an unexpected power outage, the doctors were struggling to write paper orders, the nurses were struggling with where to find the doctors orders and where and how to chart, and all the professional struggling to communicating to each other without the EHRs. But EHRs should not only store information but also support the delivery of better care. Rudin et al. (2020) point out that despite the widespread adoption of electronic health records (EHRs), healthcare in the United States remains low-value, and the expected improvement includes better clinical decisions, better triage decisions, better collaboration, and automation of tasks. I believe nursing informatics will continue to improve the quality of our nursing care.
Rudin, R. S., Corporation, R. A. N. D., Friedberg, M. W., Blue Cross Blue Shield of Massachusetts, Shekelle, P., Shah, N., T.H. Harvard Chan School of Public Health, Bates, D. W., Hospital, B. and W., & Auerbach, A. (n.d.). Getting value from electronic health records: Research needed to improve practice. Annals of Internal Medicine. Retrieved December 2, 2022, from https://www.acpjournals.org/doi/full/10.7326/M19-0878
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Collapse SubdiscussionSheila Ankrah NURS-6051N Week 1 Discussion
Discussion: The Application of Data to Problem-Solving
In personal nursing practice, collecting patient data on admission is one of the most vital areas of data collection. Working at a facility that deals in adolescent psychiatric and behavioral health, it is essential to collect enough background data on patients before they are fully admitted. It has to be ensured that the patients meet the admission criteria before they are accepted. The knowledge acquisition process begins soon after admission to learn more about patients.
The data collected before admission is mostly patients’ electronic medical record that is typically fed to the computer systems. The collected information would comprise primary and secondary diagnoses, hospitalization history, prior assessments, past treatment history, obtained lab results, and medications. According to Stoots (2015), psychiatric nurses involved in optimizing EHR to support behavioral health population management improvements can be generated cost-effectively. These efforts are regarding preventing and treating mental health disorders and preventing the myriad of co-occurring health conditions. Regarding developing new plans, it is essential to note what has been done in the past. Documenting the plans that failed and those that succeeded is vital in creating a successful strategy and attaining positive patient care.
The computer era has brought significant changes and efficiency. Safety alerts and more information have been provided through such systems as technology continues to expand. Knowledge is inevitably embedded into electronic patient records. New algorithms that assist in decision-making are also taken care of. Despite EHR not being the latest form of healthcare technology, it is constantly updated to ensure that the provided information is valid (Nagle, Sermeus, Junger & Bloomberg, 2017). Besides gathering the necessary information and providing care, educational material can also be provided to patients to improve them.
The hypothetical scenario I chose to discuss involves the awareness of a patient’s adverse psychiatric reaction to a medication prescribed during hospital admission. Extreme distress can result from an undesirable response to psychiatric medication. Even though patients may not achieve the desired reaction from psychiatric drugs, such are not explicitly listed as “allergy” in the patient’s records. In the electronic records, it may be indicated in the patient’s chart that they had the specific medication, but it needs to be apparent where such a drug was discontinued. At times, discussing all prior medications with patients may be imperative. For patients who are not in their right state of mind may not be able to tell particular events in their life. Using patients’ medical records, staff notes, and past providers’ notes can be looked through and determined by the patient’s health state. Upon a nurse reporting findings to the provider, all patient behaviors must be recorded. A better level of care can be utilized and reviewed, given the information collected is helpful.
Understanding how a patient experiences a specific reaction to a medication is vital. This is critical to the psychiatric field. We would ensure that the drug was not used again during care for patients who have had manic, aggressive, or self-injurious behavior in response to previously used medication. We could also flag the medical record to alert others of the reaction if that was not already done. There have been previous dangerous situations; under such circumstances, quick adjustments are necessary. Such adjustments are essential in helping care for patients. It is known that most adolescents are hesitant to discuss sensitive information with adults they are not close to. The experience I have had has helped me obtain information ahead of time. This is vital as it plays a role in understanding what teens indulge in and the situations they usually are in. In addition to the recorded medical record, verbal information and reports are extremely important. Oral information, in addition to medical records, gives a clearer picture of the state of patients. The care team is always set to realize any notable patient changes.
Communication and continued collaboration among team members is critical for overall patient care. I’m grateful that my facility uses computer systems linking local hospitals and providers. In addition to verbal communication among our care team, progress notes can also be read by coworkers and outside providers that care for patients. Critical information gives the team all the necessary advantages to handle various patient issues. With all the information I can acquire from the verbal report, record, and patient, I can then analyze what has been found to develop a plan to move forward. McGonigle and Mastrain (2017) shared the necessary steps to using information and applying knowledge to solve problems, acting with wisdom based on nursing practice science. Knowing where my patient stands and their situation is key to developing a starting point and creating a care plan with which the patient and care team feel most comfortable.
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.
Collapse SubdiscussionMenard Tchatchou-Tchoubia 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=fLUygA8Hpfo
Sweeney, 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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