Health Informatics and Nursing

Healthcare informatics started to evolve as early as the 1950's with the paging service for physicians and has continued evolve to this day. The last few decades have really made a difference in the way we see informatics today. In the 1960's the main drivers were Medicare and Medicaid, who ultimately were the main drivers with the Hitech Act and Meaningful use. In the 1970's the main driver of this era was the need for better communication between departments and the needs for discrete departmental communications such as in the pharmacy and lab. The 1980's then became driven by DRGs and reimbursement in order to help pull information together from both clinical and financial aspects to be reimbursed for treatments provided. In the 1990's the competition amongst healthcare organization and consolidation drove the need to integrate hospitals, providers and managed care. In the 2000's the main driers were with the need for more integration and the beginnings of outcome-based reimbursements for healthcare organizations.

 

The support of nursing informatics is important by healthcare leaders, physicians and staff. Every day and every minute, nurses are making important decisions about the care they are providing to patients. Using informatics helps save nurses time and helps prevent unnecessary steps in the care they are providing. There are systems that help pull vitals signs into the EHR to help save time as well as outline assessments making it easier and quicker for charting. With BMV medications can be administered safely and nurses can be assured that the proper medications are being administered to the right patient.

 

The clinical environment in all health care organization has increased in acuity and complexity of care, reimbursements have shrunk, and this requires nurses and all providers to be more efficient in their daily practice. These have challenges for many healthcare leaders in today's healthcare fields. Newer technology in healthcare helps nurses to fulfill their routine tasks and enable better outcomes and safer, quality of care. The leaders in healthcare need to consider these new technologies and how they can improve the workflow and the quality of work in their facility.

 





If Florence Nightingale was alive today she would be very happy with where technology has taken nursing and how it uses science, statistics and evidence-based care and interventions to save time and have the same goal that she had so many years ago of helping patients. Informatics has become an integral part of healthcare delivery, the evaluation and implementation of care in which supports safe, high quality, patient-centered care. Quality healthcare is a demand across the nation and a concern for many. Leaders in healthcare need to consider how important informatics tools are and meet the demands of the organization and assure staff they are behind them the whole way.



With HIMSS (Health Information and Management Systems Society) there is support for all healthcare organizations with the different implementations with the EHR and all of the steps involved with the integration of Meaningful Use. As well as NHSN and NDNQI databases to utilize the information obtained from other organizations to see where changes may need to be made to help the EHR and other technological systems work best for the organization.

 

A good nurse leader is someone that can inspire those around them to help reach a common goal, such as the implementation of more technology in the organization. It is important with everything evolving to think beyond the picture and see how one, as a leader, can be a part of the team, be supportive of the staff during the changes and give them positive feedback throughout the process. It is important to provide the staff with a supportive environment and most of all 'listen' to their concerns and focus on making the world that is changing around them easy for them to adapt to and improve their work flow while helping provide more efficient, safe, quality care to their patients.





Technology and healthcare is changing and it is important for us to remember what are main focus is on a day to day basis!

 

References:

 

http://www.nurseland.net/infographic-comptia-present-healthcare-is-huge/839

 

https://www.healthcatalyst.com/healthcare-information-systems-past-present-future

 

Meliniotis, C. (2015). Effective Nursing Leadership; Keeping your staff motivated to perform at top quality takes clever leadership. Advanceweb.com

 

Shuler, G. (2011). Role of Nursing Informatics for Leadership. Advanceweb.com.

 

 



Medication Reconciliation

Medication reconciliation is a problem that a lot of healthcare organizations struggle with.
Patients may receive a new medication or may have changes made to their existing medication during different transitions of care and though most these changes are intentional, unintended changes occur more frequently than one can imagine. If a medical provider is unable to obtain an accurate medication list from the patient and a new regimen is implemented at the time of discharge needed medications may be omitted, duplicate treatments may be implemented or incorrect dosages may be ordered. Discrepancies such as these can cause adverse drug events and the most common adverse reaction happens to patients after they are discharged from the hospital. This increases the chances of a readmissions in some patient populations.














Medication Reconciliation (Med Rec) and finding steps to improve the transitions of care are recognized as a critical aspect for managing patients. There are reports from Joint Commission that the most frequently found root cause when analyzing sentinel events is the break down of communication when it comes to the importance of medication reconciliations.   There are several steps in the ASHP toolkit that can help with implementing a process for reconciling medications in the healthcare organization.

 

 

Reconciliation is the process of  identifying the most accurate list of all medications a patient is taking : including name, dosage, frequency, and route, and then using this list to help the provider's in ordering the correct medications for patients anywhere in the organization. Reconciliation involves comparing the patient’s current list of medications against the physician’s admission orders, at the time of transfer from each point of care, and at the time of discharge. Experience has shown that hundreds of organization have poor communication and processes when it comes to medication reconciliation. This poor communication has been proven to be responsible for over 50% of medication errors and up to 20% of adverse events.

 

 

In our organization the workflow has been planned on how to implement the medication reconciliation process but it is the matter of having the physicians wait until all of the information is compiled prior to ordering regular medications. It is important for everyone in a healthcare organization to provide the most accurate list for the patient so there are no medications missed and the proper dosages are being ordered.

medication reconcilliation: medication reconcilliation | Piktochart Infographic Editor

 

 

References:
https://psnet.ahrq.gov/primers/primer/1

http://www.ashp.org/menu/PracticePolicy/ResourceCenters/PatientSafety/ASHPMedicationReconciliationToolkit_1.aspx

http://www.ihi.org/resources/Pages/Tools/BMHMemphisMedicationReconciliationForm.aspx

Nursing Leadership and Impact on Technology

 

Nurse leaders need to be at the heart of the discussion of selecting, adopting and using different forms of technology and technological devices in a healthcare setting. The CNO especially needs to play an important role in how an organization is going to select, implement and adopt technology. If the CNO has a part of the decision making and helps create a culture of shared decision making with the staff an organization is more apt to have a better buy in with the nursing staff when introducing new forms of technology into the organization.

In health care today it important to have a good working relationship between the staff and the IT department and that needs to start at the top. The IT department can be the support but the nurse leaders and staff need to be the drivers with the technology. An organization whose CNO embraces technology and stays involved with it are better apt to place the right equipment into the hands of the nursing staff that are going to be integrating the technology into their daily workflow.



In healthcare organization that implemented technology into their facility the nurse leader used this as a way to also help facilitate one common goal across all organization and that was for safe medication administration. By focusing on what the causes of error and looking for good problem solving tools the nurse leaders were able to build a trust among other team members and address how integrating technology such as the BMV and eMAR can help to minimize errors in medication administration and address medication safety practices and maximize the benefits of technology in the organization.

 

Technology is crucial to the healthcare environment and the integration is happening at a rapid rate. It is important for the organizations to build relationships and trust between the administrative nurse leaders and other stakeholders that are going to be affected by the transformation in the system. By coaching and mentoring the staff and developing collaborative skills and practices together goals can be met when addressing the IT initiatives.

 

 

Templates and tools can be introduced to help define what role everyone is going to play in the integration process and this way the targets can be aligned. If an organization can focus on what is going to work the best and the nurse leaders are being supportive and building a trusting relationship with the staff involved the integration of the world of technology will become transformed into something the staff will become more and more familiar with and know how it can help improve the quality of care and the safety measures that in place to help with their daily practices. Emerging technologies are going to change the way healthcare is looked at and change the practice of nursing.

 

References:

 

AONE Guiding Principles for the Nurse Executives: For the Chief Nurse Executive Chief Information Officer and Industry Partners to Work Together to Leverage Technology to Enhance Clinical Outcomes    

 



Nelson, R. & Staggers, N. (2014). Health Informatics: An Interprofessional Approach. Elsevier Mosby: St. Louis, Missouri.

Human-Technology Interface and How it Affects Nursing Practice, Patient Care and Nursing Leadership

 

 

The term interface, means an interaction between two objects or an object and a human, therefore human-technology interface, is the connection between humans and technology. In healthcare, new technologies are created and implemented on a daily basis, such as the EHR, mobile health apps, robotic surgical devices such as the DaVinci robotic device for surgical procedures and telemedicine that helps connect a specialist from a tertiary center to other rural organizations. Not only is the interface relevant to the nursing practice it is also important to patient care and nursing leadership. With barcode medication verification, smart pumps for IV infusions and documentation programs everything can be readily available for the nurses and right at their fingertips. Goals and outcomes can be integrated into the systems so that patient outcomes can be improved and certain core measures can be met. Nurse leaders can use the technology in today's practice and pull data that can help determine if certain measures are being met and to help determine where changes may need to be made to help improve not only the experience with the nurses using technology but also help improve the patient's experience as well.

When looking at safety measures that the technology has implemented it is important to look at our younger patients and see how even just the use of BMV to administer medications has helped decrease medication errors in pediatrics.  Medication errors are an important problem in the pediatric population and with the usage of information technology interventions the magnitude of benefits will be greater than even seen in the adult patient population.

 



One question that remains is with the usage of technology does the caring leave the nursing profession?  The main goal is through technology being implemented is to help improve patient outcomes, caring is part of that equation. As nurses use the documentation system and become more comfortable with it the technology will take a second seat to the patient. It is important to not focus on technology while in the presence of the patient and do the assessment and data mining after leaving the patient's room. It is important to build that trusting relationship with the patient. Technology and caring can coexist as long as we, in the nursing profession do not lose sight of where our commitment and dedication need to be directed. Doing an assessment while looking at a computer screen instead of at the patient is not the way to start that commitment.

 

 

 Patient portals have helped improve the human-technology interface in healthcare. With these portals information is shared in the cloud and can be accessed by patients and other healthcare facilities. This helps improve nursing care due to having information at their fingertips as well as keeping the patients involved in their care. This is very important so if a patient forgets what may have been discussed at an appointment or when they are discharged from then hospital they can log on to a secure site to access their information.

 

 

A scenario that can help affirm that the human-technology interface can help improve a patient outcome while the nurse still remains connected in a committed and caring relationship with a patient, is one of using the technology around us to help with patient education.  Patient education is an important aspect of the patient's hospital stay and with proper educational tools can help reduce readmission rates, help decrease the time for healing, improve any mental discomfort they may be feeling and produce better results and outcomes for the patient. With the usage of televisions, I-pads, and other sophisticated devices patients can learn more in regards to their illness and disease process. As a nurse we can use the technology available to help with the educational process of a patient that was having a difficult time with a new colostomy. By using video on the care of a colostomy and an interactive program to help stimulate the learning process the patient can feel more comfortable with their new medical device. After watching the video and going over the materials available a hands on educational session can take place between the patient and the nurse to assure that the patient understands and can demonstrate what they have learned. With these interventions in proper patient education it can help improve patient self-care, satisfaction, moral support, coping skills and mental

stability.

 

 

There are several different areas where the organization I work at uses the human-technology interface and it has improved patient care all the way around. We use RHIO for our patients being transferred to Rochester Health systems through the University of Rochester Medical Centers which helps improve their care through the availability of their medical records at the touch of a button so the providers have access before even setting eyes on the patient. Also with the usage of the Cloud networks our holter monitors can be viewed by a cardiologist 2 hours away as well as our EEGs.

Through technology the healthcare arena has come full circle with the abilities to help diagnose patients to helping improve the treatments they are receiving. Technology is the connection!

 

 

References:

Nelson, R. & Staggers, N. (2014). Health Informatics: An Interprofessional Approach. Elsevier Mosby: St. Louis, Missouri.

 



The Standardized Nursing Language and Informatics, The Language of Nursing:
How it used in our daily practices and why it is important for them in EHRs

NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) are integrated into the NANDA clinical decision framework  by practicing nurses in acute care hospitals, outpatient and ambulatory settings, rehabilitation and long term care facilities and in patient homes by nurses to help develop a standardized plan of care for patients that also have certain activities and interventions to help develop goals for positive outcomes with the treatment the patient is receiving.

These outcomes can be populated in the electronic health record assessments and with the evidence-based criteria support the decisions being made for the measurement of the outcomes and the interventions individualized to that specific patient.

It is important to use these standardized nursing terminology (SNTs) when describing and defining the nursing care that will be provided to the patients. They help provide clear definitions and concepts for the care allowing the providers and the nurses to use the same terminology to help in the description of patient problems, nursing interventions, and anticipated patient outcomes. With the EHRs the SNTs are required for nursing care plans. The EHR is now seen as the total reflection of the care being provided so the nursing diagnosis, interventions and outcomes need to be a part of this record so it can capture the nurses contributions to the care of  the patient.
These SNTs provide information and need to be developed in the electronic nursing care plan in the EHR so it can become a part of the nursing care on a daily or even shift by shift basis. (Park, 2014).

The Clinical Care Classification (CCC) System is  also a standardized, coded nursing terminology that can help identify certain elements of the nursing practice. There are four frameworks and certain structures for coding that are involved in recording the patient's care in all setting of the health care organization. This system is used to help document a nursing care plan using six steps by using a certain model.  This model helps bring the nursing diagnosis and the nursing interventions together to help with looking at the patient's outcomes.

When converting to the EHR it is important for nurse leaders to be involved with the process to rebuild the nursing documentation system using the CCC as an organized taxonomy. By doing this it will help create a patient record that will help nursing be guided in safe, effective and efficient care and also help produce the data needed to evaluate the care provided to the individualized patients or a certain population of patients when needed. The goal is to also eliminate duplicate documentation and eliminate unnecessary information from the record that is not directed to the care provided. The use of the CCC in the electronic health record can help clarify, document and communicate the elements of care among the nurses and help improve outcomes and collaborate processes. (Englebright, Aldrich & Taylor, 2014).

                                                                       


References:

Englebright, J., Aldrich, K., & Taylor, C. R. (2014). Defining and incorporating basic nursing care actions into the electronic health record. Journal Of Nursing Scholarship: An Official Publication Of Sigma Theta Tau International Honor Society Of Nursing / Sigma Theta Tau, 46(1), 50-57. doi:10.1111/jnu.12057

Park, H. (2014). Identifying core NANDA-I nursing diagnoses, NIC interventions, NOC outcomes, and NNN linkages for heart failure. International Journal Of Nursing Knowledge, 25(1), 30-38. doi:10.1111/2047-3095.12010