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).

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

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

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

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).

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.

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.

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)

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.

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.

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/

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.

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. 

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. 

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.

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.