Initial Post – The Application of Data to Problem-Solving

In a time such as these, where technology is so prevalent in our lives, it is quite baffling to find an environment that appears technologically advanced to still utilize paper charting for a procedure that could be detrimental if something goes wrong. I have seen at several hospitals that paper charting for blood transfusions is still being used. Although I am not completely against paper charting, steps can be easily skipped in the process allowing errors to occur. A consent form is incomplete if there is no RN witness to a provider’s education to the patient.  However, I have seen several times when a patient needs a blood transfusion, but the consent form does not have an RN witness.

Several data could be used to determine if this practice is the best option.  However, the data to concentrate on should be RN-to-RN verification because it involves several steps. According to Najafpour et al., the product’s safety is of utmost importance before a blood transfusion because it is where about 70% of the errors occur (2017).  The RN verification process includes checking the physician’s order with the blood bank documentation; checking the patient’s name, DOB, and medical record number; checking the patient’s blood type with the donor’s blood type and Rh-factor compatibility; and verifying the blood has not passed its expiration date (Brookline College, 2022).

The collection of this data will be tedious and time-consuming.  The Blood Bank can assist by providing a list of all patients in the hospital that have and are receiving blood products. Each patient chart will need to be retrieved with that list, and the RN verification form will be taken out.  The forms will then need to be checked for accuracy, and those with errors will be set aside. The knowledge that might be derived from the data will be how often errors occur and whether they cause any harm to the patients, whether minor or severe.

Clinical judgment requires clinical reasoning. Clinical reasoning is practice-based reasoning requiring a background of scientific and technological research-based knowledge about general cases; it occurs within social relationships or situations involving patients, family, community, and the team of health care providers (Benner et al., 2008). A nurse leader can use clinical reasoning and judgment to form knowledge from this experience by analyzing the information collected and bringing it to the attention of other nurse leaders, where careful solutions could be brainstormed and applied.  Then evaluate as time goes on if the solutions are beneficial.  In my opinion, a computer-based application where each step must be completed before moving on to the next step is a good way to ensure that all information is verified before proceeding to transfuse.  I understand that there are times when computers pose a technical issue, but I’ll rather have a technical issue to stop me from an error as opposed to human error that omits a step that could cause harm to the patient.

References

Benner, P., Hughes, RG., & Sutphen, M. (2008). Clinical Reasoning, Decisionmaking, and Action: Thinking Critically and Clinically. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), 6. Retrieved 11/30/2022 from: https://www.ncbi.nlm.nih.gov/books/NBK2643/Links to an external site.

Brookline College. (2022). Step-by-step master’s guide to blood transfusions. Retrieved 11/30/2022 from https://www.brooklinecollege.edu/blog/a-step-by-step-guide-to-blood-transfusions/Links to an external site.

Najafpour, Z., Hasoumi, M., Behzadi, F., Mohamadi, E., Jafary, M., & Saeedi, M. (2017). Preventing blood transfusion failures: FMEA, an effective assessment method. BMC health services research, 17(1), 453. https://doi.org/10.1186/s12913-017-2380-3Links to an external site.

The Application of Data to Problem-Solving

Introduction

The healthcare information revolution cannot get underestimated as it embodies a revolution. Clinicians partake in the need to have enhanced access to electronic treatment plans, health records, and diagnostics. Clinical collaboration and communication platforms keep simplifying the management of healthcare coordination, workflows, and patient outcomes (Seckman, 2019). The scenario in this setting exemplifies the use of nursing informatics in enhancing and cultivating patient care. Data access and system integration also showcase the importance of information analysis from an informatics viewpoint that ever happened in the healthcare space.

Data Utilization, Collection, and Assessment

The strategy behind utilizing healthcare data to avail the best care entails the comprehension of nursing informatics, its meaning, and the concepts behind it. Nursing informatics integrates nursing science with other expanses to recognize, manage, communicate, and manage wisdom, information, data, and knowledge. The principal aim behind nursing informatics remains to provide excellent patient-centered care.

Nursing informatics in the mentioned scenario related to improving patient care can get used on different fronts. The areas of nursing informatics use include improving clinical procedures, processes, policies, and protocols, aligning clinical care and workflow with the best nursing practice, and choosing new medical instruments (Nagle et al., 2017). Nursing data also presents a great avenue to make available a learning and training platform founded upon objective data.

Choosing and testing innovative medical instruments connected to the Internet of Things (IoT) can avail enormous amounts of patient data (Seckman, 2019). Nursing informaticists get trained to apprehend the true essence of such data and offer recommendations regarding the most appropriate techniques to record, access, and use the collected data. Nursing informaticists can likewise utilize data collected through inpatient and outpatient care engagements to classify endemic issues connected to the healthcare institution. The above will provide a learning environment for continuing in-house training, orienting new staff, and during external certification and education.

Nurse Leaders using Clinical Judgement and Reasoning

Nurse leaders can adapt to clinical judgment and reasoning within the health organization to collaborate and communicate with interdisciplinary teams regarding patient information. For instance, nurse leaders can identify gaps, offer recommendations, and audit individual patient cases to avert future errors. Clinical judgment and reasoning become the fabric of organizational effectiveness from a management and financial point of view (Lee & Lee, 2020). Subsequently, nurse leaders can produce processes and protocols that warrant adequate interaction and communication between patients, departments, and teams. They can assist healthcare staff in seeking out hidden truths by maximizing electronic health records. From the above, healthcare organizations can help map their sustainable work from an ethical viewpoint by aligning with data insights.

Conclusion

Through nursing informatics assimilation, nurse leaders can recognize high-risk patients and avoid severe conditions by taking preventive actions early. For example, utilizing automated alerts increases the chances of practitioners mitigating warning signals and taking patients from potentially deadly situations. More institutions should embrace nursing informatics as a pathway to improve patient outcomes. Finally, nursing informatics will continue morphing and opening up new frontiers in the healthcare industry as technology advancements keep emerging.

References

Lee, M., & Lee, S. (2020). Implementation of an electronic nursing record for nursing documentation and communication of patient care information in a tertiary teaching hospital. CIN: Computers, Informatics, Nursing, 39(3), 136-144. https://doi.org/10.1097/cin.0000000000000642Links to an external site.

Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212-221. https://doi.org/10.3233/978-1-61499-738-2-212Links to an external site.

Seckman, C. (2019). Summer institute in nursing informatics 2019 healthcare informatics: Catalyst for value-driven care transitions. CIN: Computers, Informatics, Nursing, 37(11), 558-563. https://doi.org/10.1097/cin.0000000000000599Links to an external site.

Module 1 Discussion: The Application of Data to Problem-Solving

Description of scenario

I work for a private practice oncology clinic.  Within our practice we use multiple different systems to collect patient data.  For example, radiation oncology and medical oncology work closely to create treatment plans for patients, and often patients are receiving concurrent chemo and radiation.  However, in addition to using the medical oncology EMR, the radiation oncology team has a separate medical record system that only they have access to.  In addition, the lab, pharmacy, scheduling and billing departments all have separate systems that nurses do not have access to.  “Accessibility is a must; the right users must be able to obtain the right information at the right time and in the right format to meet their needs” (McGonigle & Mastrian, 2022, p. 24).  With these different systems, as a medical oncology nurse, I typically have to rely on others in the clinic to provide information to me that I need in a timely manner.  This can lead to delayed communication with patients regarding medications, results, or treatment plans.

Access to Data and Knowledge Gained

My proposed change to this scenario is to give medical oncology nurses access to the radiation oncology EMR.  With this data, the knowledge gained would include:

• Radiation start dates and length of therapy
• Radiation therapy side effects and held treatments due to toxicity
• Supportive medications ordered for side effects
• Follow up scans and provider visits

With this gained knowledge, medical oncology nurses would be able to easily order the patients’ chemotherapy to be given concurrently with radiation therapy.  Specifically, timing of treatments could be properly coordinated as the treatments are given in different facilities.  In addition, when patients call our triage nurses with complaints of symptoms or treatment side effects, we would be able to access radiation’s data to determine the cause of symptoms and how to best treat the patient.  Last, this data would avoid both the radiation oncologist and medical oncologist ordering follow up scans.  We would be able to see what scans are ordered and one can be reviewed by both providers for follow up evaluations.  This access to data would save time for nurses and schedulers.  “Time management is a prevalent issue in the healthcare setting, thus the use of informatics to aid and organize and not create barriers is essential” (Sweeney, 2017, section 3). Overall, sharing this data would allow both teams to provide more informed, better-quality care to the patients.

Nurse Leader’s Formation of Knowledge

A nurse leader is constantly using clinical reasoning and judgement in the formation of knowledge.  In this scenario, the nurse should use their basic nursing education, combined with clinical experience in medical and radiation oncology to better utilize this new access to data.  For example, if a patient calls with a new skin rash and he is taking oral chemotherapy while getting concurrent radiation therapy, the nurse leader can use the data from the radiation therapy system, combined with their knowledge of expected treatment side effects to properly diagnose and treat the patient’s symptoms.  Data alone cannot help the nurse solve the problem, the “acquired data must be processed into knowledge” (McGonigle & Mastrian, 2022, p. 9).

In addition, it is the responsibility of the nurse leader to be aware that there can be risks to sharing data and to help facilitate this data sharing in a way that is still protecting patient information.  According to McGonigle & Mastrian, “solid leadership, guidance and vision are vital to the maintenance of cost-effective business performance and safe, cutting-edge information technologies for the organization” (2022, p. 28).  With this gained data and knowledge, it is the responsibility of the nurse and the nurse leader to use the data professionally and use it for the benefit of patients.  To do this, communication between the two departments as well as with practice management is essential to detect and resolve any issues that may come from this new process.

References

McGonigle, D. & Mastrian, K. (2022). Nursing informatics and the foundation of

knowledge (5^th ed.). Jones & Bartlett Learning.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

The widespread adoption of technology is transforming healthcare delivery. When treating patients, choosing between an electronic health record and a paper chart has been crucial. Information loss, poor retrieval, and a lack of standards among doctors and healthcare organizations are significant issues with traditional paper medical records. The healthcare industry has been entirely transformed by health information technology (HIT) to benefit both patients and providers. Communication is made more accessible, costs are reduced, efficiency is increased, patient outcomes are improved, and patients are more involved in their care.  

With the introduction of the electronic medical record (EMR), the process of finding patient information and interpreting doctor instructions has been streamlined. Electronic medical records, or digitalized paper charts, include information about diagnoses, allergies, medical histories, vaccination dates, lab results, prescriptions, and the doctor’s comments.EMR frameworks are fit for every errand, including logging patient data, setting up arrangements, composing solutions, looking at protection, and so on. One of the forces transforming healthcare is thought to be the electronic medical record (EMR). From a patient care perspective, it is anticipated that an electronic medical record (EMR) will improve information accuracy, facilitate clinical decision-making, and improve information accessibility for continuity of care.  

EMRs may provide healthcare workers with a dependable, centralized source of patient data (Jedwab, Chalmers, Dobroff, & Redley, 2019). In the area I work, bustling psychiatric patients in an acute care facility, it is essential for security and safety to identify risk factors for suicide and self-harm promptly. The EMR has significantly impacted time management and improved patient safety by acquiring data information. In the internet age of virtual monitoring and electronic sensors, a new tool has been added to nursing for the ongoing observation required to stop self-harming behavior. According to Nagle, Sermeus, & Junger (2019), many members of the healthcare team now regularly have access to remote patient monitoring, which has the potential to enhance treatment quality and patient safety.  

The development of telepsychiatry has also led to improvements in safety concerns. The coronavirus disease (COVID-19) makes it particularly difficult to provide mental health care. An option in contrast to face-to-face assessments is telepsychiatry, which can be imaginatively joined with other innovations to develop care further. Many distressed patients find it difficult or uncomfortable to drive themselves to mental health consultations. In light of the absence of subject matter experts and the developing patient interest, telepsychiatry is presently utilized in more excellent medical services settings (Donley, McClaren, Jones, Katz, and Goh, 2017). Technology has closed the gap between the lack of specialists and patient safety. The electronic psychiatric appointment is delivered to the patient in several inpatient and outpatient settings. A crucial component of psychiatry treatment is the virtual capability of telepsychiatry, which has reduced the risk of harm to patients and staff during appointment transportation. 

 References 

A; N. L. M. S. W. J. (2017). The evolving role of the Nursing Informatics Specialist. Studies in health technology and informatics. Retrieved November 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/28106600/Links to an external site. 

Donley, E., McClaren, A., Jones, R., Katz, P., & Goh, J. (2017). Evaluation and Implementation of a Telepsychiatry Trial in the Emergency Department of a Metropolitan Public Hospital. Journal of Technology in Human Services, 35, 292 – 313. 

Honavar, S. G. (2020, March). Electronic Medical Records – the good, the bad, and the ugly. Indian journal of ophthalmology. Retrieved November 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043175/Links to an external site. 

Jedwab, R.M., Chalmers, C., Dobroff, N., & Redley’, B. (2019). Measuring nursing benefits of an electronic medical record system: A scoping review. Collegian. 

Nagle, L. M., Sermous, W., & Junger, A. (n.d.). Evolving role of the Nursing Informatics Specialist. Studies in health technology and informatics. Retrieved November 30, 2022, from https://pubmed.ncbi.nlm.nih.gov/28106600/Links to an external site. 

Smith, K., Ostinelli, E., Macdonald, O., & Cipriani, A. (2020). COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians. In JMIR Mental Health (Vol. 7, Issue 8, p. e21108). JMIR Publications Inc. https://doi.org/10.2196/21108Links to an external site. 

An electrotonic health record (EHR) is essential in keeping a patient’s complete health history within reach of providers. If utilized correctly, they can significantly improve patient care by bridging the gap between providers. As an article states, “Mental health practitioners interested in adopting EHRs should establish a strong collaborative partnership with primary care physicians and clinic case managers to enhance bidirectional communication and information exchange about patients’ general medical and behavioral health concerns. Doing so will improve care coordination and the likelihood of identifying risk and protective factors associated with treatment planning, adherence, and improved outcomes.” (McGregor et al. 2015)

I currently work in an inpatient psychiatric ICU; In my organization, we lack EHRs and rely only on paper charting. This causes many issues as new patient data is collected at the point of admission. Many times, especially in mental health, patients are poor historians and cannot fully recall their medical diagnoses, medication names, dosages, frequency, etc. This leads to staff playing “catch up” until a caregiver or provider is found. This delay in care can be resolved by implementing electronic health records in our facility. In Mental health facilities, electronic records were shown to be 40 percent more complete and 20 percent faster to retrieve versus paper charting. (Tsai & Bond, 2008)

E-mental health is also an interesting and beneficial approach to treating patients with mental health disorders. Similarly to telehealth, E-Mental health utilizes technology to deliver treatment in remote settings. In addition to providing treatment,”…e-mental health systems can collect individual data to detect mental health symptoms and develop personalized programs that overcome the barriers to seeking help.” (Timakum et al., 2020). By implementing these useful data collection tools, providers and healthcare workers will be provided with clear complete health histories at a moment’s notice, leading to better patient care and better patient outcomes.

References 

McGregor B, Mack D, Wrenn G, Shim RS, Holden K, Satcher D. Improving Service
Coordination and Reducing Mental Health Disparities Through Adoption of
Electronic Health Records. Psychiatr Serv. 2015 Sep;66(9):985-7. doi:
10.1176/appi.ps.201400095. Epub 2015 May 15. PMID: 25975885; PMCID:
PMC4558322.

Tsai, J., & Bond, G. (2008). A comparison of electronic records to paper records in mental health
centers. International journal for quality in health care : journal of the International
Society for Quality in Health Care, 20(2), 136–143.
https://doi.org/10.1093/intqhc/mzm064Links to an external site.

Timakum, T., Xie, Q., & Song, M. (2022). Analysis of E-mental health research: mapping the
relationship between information technology and mental healthcare. BMC
Psychiatry, 22(1), 57. https://doi.org/10.1186/s12888-022-03713-9

The Application of Data to Problem Solving

Initial Post

During my 22 years of working in healthcare as a registered nurse, both in acute setting and long term setting, Fall Prevention strategies has evolved from identifying patients via Morse Scale and placing high risk patients within eyesight at the nurses station to using various strategies such as call light within reach, positioning patients, checking and treating patients pain to using an Audio Computer-Assisted Self Interview (ACASI) to screen for example older folks that are high risk for falls.

Though Educating  patients on fall prevention as well as safety, limiting fall risks that can eventually predispose individuals to injury and untimely death, decrease mobility, nursing home placement, hospitalization or decrease independence has not prevented falls.   Research has shown that in empowering nursing informatics, there has been an increase in fall prevention through the use of  quality improvement.  Data that could be used for example are number of falls each month, number of patients who fall each month, number of patients with two or more falls each month and number of falls with serious injury each month as key indicators.  These data could be used as key indicators for outcome measures.  In addition, data such as changes in staff awareness and patient satisfaction as well as changes in staff organization could be considered.  Gathering this information could identify trends related to falls such as time of day, activity and types of fall.  The nurse leader can then use clinical reasoning and judgment with the use of nursing informatics  to implement new fall prevention strategies and increase staff awareness for accurate reporting of falls through tracking records.  As fall rate begins to decline, eventually more advance measures to prevent falls will be instituted in order to prolong elderly patients independence and eventually their untimely deaths.

Ogbuokin, U. (2022). Using Audio Computer -Assisted Self Interview (ACASI) to S in an Outpatient creen Older Adults for Fall Risk in an Outpatient Primary Setting http://www.himss,org/ojniLinks to an external site.

Sweeney, J. (feb. 2017). Healthcare Informatics. Online Journal of Nursing Informatics (OJNI), 21(1),

McGonigle, D., & Mastria, K.G (2022). Nursing Informatics and the foundation of Knowledge (5th ed.). Jones & Bartlett

Healthcare Informatics is “the integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information” (Saba & McCormick, 2015, p. 232). The invention and continuous upgrade of healthcare technology aim to save time and lives by reducing human errors.

I am an international nurse who moved to the USA recently from a small Caribbean Island. Before coming to the USA, I worked in a small hospital that still uses paper charting, which has been a norm in the nursing forum for years. Coming to the USA, I have upgraded to the use of EHR. Paper charting has been noted to be more time-consuming than electronic Health recording and is also more susceptible to human errors and mistakes. Electronic records organize the data collected, which reduces medication errors and misdiagnoses.

Documentation is vital in treating patients. Care is continuous and relies heavily on shift reports and documentation to ensure patient safety and illuminate errors, especially in medication administration. Let’s use the hypothetical scenario; Hospital A uses paper charting. RN Jane, a new graduate, works in this hospital. She has a patient on once-daily Heparin 5000u SC. Jane did what she was supposed to and got a colleague to check and administer the due medication as prescribed. However, after administration, Jane forgot to go and sign the medication card. She went on to complete other documentation and other assigned tasks. Another nurse comes on and decides to help serve all the unserved medication. As she was ready to serve RN Jane’s patient Heparin 5000u SC, she went and got a colleague to do her second checks and verify the patient. Luckily, the same nurse went with jane to serve the medication. She immediately recalled that she had already checked with RN Jane, who had already administered the drug.  Medication errors are estimated to harm at least 1.5 million patients annually in the US, with about 400,000 preventable adverse events (Agrawal, 2009).

Electronic charting would have eliminated that error. The patient armband and medication barcode would have been scanned into the system. Upon entering the same patient data again, it would have given an alert that medication was already dispensed for this patient. RN Jane would not have been able to do another documentation on the same device without signing for that served medication. HealthStream (2021) states that medical errors cost nearly $40 billion annually, and many of those errors are preventable with informatics. Not only does information provide nurses with alerts to avoid mistakes, but it also helps to automate specific tasks, improving nurse productivity and preventing some of the costs associated with health care.

References

Abha Agrawal, A. (2009). Medication errors: prevention using information technology systems. British Journal of Clinical Pharmacology, 67 (6), 681-686.

https://doi.org/10.1111/j.1365-2125.2009.03427.xLinks to an external site.

Healthstream (2021). How Nursing Informatics Benefits Quality Outcomes. Retrieved November 30, 2022 form

https://www.healthstream.com/resource/blog/how-nursing-informatics-benefits-quality-outcomes#:~:text=Here%20are%20some%20examples%20of%20the%20benefits%20of,Cost%20Savings%20…%204%20Improved%20Care%20Coordination%20Links to an external site.

Saba, V. K. & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York: McGraw-Hill.

The application of Data to Problem – Solving

Describe the focus of your scenario

In past experiences I was lucky enough to spend time on post-partum and mother-baby floors.  While this position was extremely rewarding and offered the ability to see one of the most beautiful life-experiences unfold, there were also cases that resulted in a negative outcome.  While Post-Partum Depression was not always identified as early as the initial hospital stay, when it was prevalent, the negative impact on mother, baby, and even family members could be excruciating to watch.  The scenario that is being considered is the ability to help prevent or minimize post-partum depression in mothers who may be high risk.  While the ability to identify these risk factors may be challenging, the times that these issues could be identified early or prior to birth can provide a healthy and positive experience for all.  Rather than the alternative, which can result in negative or harmful actions both physically and mentally.  According to (Ghaedrahmati et al., 2017), there are five areas for risk factors to PPD.  These include psychiatric, obstetric, biological and hormonal, social, as well as lifestyle.  While screening options are available, it is not something that is a requirement nor tracked unless identified.  I think that OB offices and other related care facilities can begin to emphasize the importance and attempt to identify these risk factors and collect this data at an early stage.

Describe the data that could be used and how the data might be collected and accessed.

The data that can be used in this scenario is understanding the various exposure possibilities that a patient has to these risk factors.  This can be monitored at different stages throughout a pregnancy as various events may arise at different times.  When a risk factor becomes apparent, tracking this progression through the pregnancy and even after would be beneficial.  Nurses and medical professionals alike, involved in the care of a mother throughout the pregnancy should begin the collection of this data through visits and noted opportunities for screening.  Through the use of Electronic Health Records, this data could be collected and accessed by the various medical professionals who a patient encounters through the pregnancy and post-delivery experience.  The use of an EHR allows for the ability to organize and analyze a large amount of patient information (Kruse et al., 2018), which provides the platform for the collection and access to this information.

What knowledge might be derived from that data?

Knowledge that could be obtained would be the identification of risk factors for PPD and the possible progression of an issue.  If a risk factor is identified, treatment could be applied at an early stage to help lessen the negative impact of the issue at a later stage.

How would a nurse leader use clinical reasoning and judgement in the formation of knowledge from this experience?

As noted in (McGonigle & Mastrian, 2022), Nurse Informatics includes the management and communication of data, information, knowledge, and wisdom.  The collection of this data and these risk factors would provide valuable and needed information to treat individual cases as they became apparent and at an early stage.  It would also allow the ability of a nurse leader to identify potential trends from the collective data of patients.  Nurse leaders would be able to gain experience on these risk factors as well and would become more successful in their treatment as knowledge was able to expand and grow.  This could not only help individual patients, but future patients identify potential exposure and risk factors.  While the risk of PPD would never go entirely away, providing an avenue for a healthy experience and lowering risk, would benefit mother, baby, and everyone involved.

References

Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Ebrahimi, A., & Bahrami, M. (2017, August 9). Postpartum depression risk factors: A narrative review. Journal of education and health promotion. Retrieved November 30, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5561681/

Kruse, C. S., Stein, A., Thomas, H., & Kaur, H. (2018, September 29). The use of electronic health records to support Population Health: A systematic review of the literature – journal of medical systems. SpringerLink. Retrieved November 30, 2022, from https://link.springer.com/article/10.1007/s10916-018-1075-6

McGonigle, D., & Mastrian, K. G. (2022). Nursing Informatics and the foundation of knowledge. Jones & Bartlett Learning.

I work at an inpatient psychiatric hospital, and I find that the largest issue that we are having is medication errors. There are several reasons why this occurs. Firstly, there is a paper medication administration record. Second, it can be a high stress environment that can create an environment where dictating verbal orders can be challenging. Finally, there is an ineffective shift to shift reporting process that is prone to ineffective communication. Most of these issues are not new and the administration at the facility is aware. Perhaps the extent of the errors is not widely known and therefore, effective data gathering would demonstrate to the administration that an update in the medication technology might lead to improved medication compliance and then improved patient outcomes while under our nursing care. According to Sweeney, “enhanced delivery of care, improved health outcomes, and advanced patient education are just a few aspects that have improved,” (2017).  When used effectively, informatics can improve healthcare outcomes quickly.

This topic can be tricky because the first component to date gathering is nurses reporting medication errors. There has to be open and trustworthy communication with management and the nursing staff which then facilitates self-reporting on oneself. The nurse manager would then gather this data as well as potential antecedents that may have contributed to errors such as a patient outburst or being short staffed. In a paper published by the Institute of Health it discusses how medical errors can have any number of consequences, “Errors…are costly in terms of loss of trust in the health care system by patients and diminished satisfaction by both patients and health professionals,” (1999). When working with paranoid schizophrenics, there are not many opportunities to reestablish trust.

A nurse leader is particularly good at evaluating this type of information, because the nurse leader is a person that has real-time knowledge on the effectiveness of solutions proposed. Each solution that has been synthesized, either by committee or an administrative team, can be implemented and evaluated statistically and in real time as it is implemented with patient care and treatment plan objectives. Nagel et al. (2017) talk about how and why it is important to have an RN in this role. And the nurse’s unique ability to perform both statistical analysis through informatics and track subjective patient opinion on changes makes the nurse a well-suited social scientist of sorts.

In the example listed above, the data would likely indicate that a more effective way to deliver medications would be through a more technologically advanced system other than a three-ring binder, with handwritten physician’s orders. That seems like common sense.  It is also likely that the department that must find funding to pay for the technology upgrades would like to see data driven funding requests be paid for first.

References

Institute of Medicine. (1999). To error is human: building a safer health system. Retrieved on November 29, 2022, from https://waldenu.instructure.com/courses/23789/pages/doc-sharing?module_item_id=756538

Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212-221. https://doi.org/10.3233/978-1-61499-738-2-212

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

I currently work at an alternate care site facility that offers inpatient care for those recovering from COVID-19 who require continued medical care. Prior to COVID the facility relocated to a new building, therefore the building and equipment is outdated. The electronic health record (EHR) that we use is an outdated version of Cerner. While the system is outdated it does utilize electronic medication administration system (eMAR), which is “a system that uses bar-coding technology to submit and fill prescriptions, typically handheld scanners read bar codes and transmit them to pharmacy” (McGonigle & Mastrian, 2022).

At the beginning of my shift, I do a pain assessment as I introduce myself to the patient, being sure to note exactly what the patient states. Pain management has been an ongoing issue at this facility, partly due to the outdated EHR, Cerner doesn’t require the nurse to perform a pain assessment before administering the medication. “Documentation of pain assessment and the effect of interventions are essential to allow communication among clinicians about the current status of the patients pain and responses to the plan of care” (Wells et al, n.d.).

I recently had a patient who displayed visible signs of pain, grimacing and moaning while putting pressure on her right hand, who gave a pain score of 0 out of 10. I then asked are you having issues with your right hand she stated, “yes it’s been bothering me for about a week but all they do here is give me a Tylenol and keep it moving, if I had to say a number, I would give it a 7”. I assured the patient that I would follow up with the doctor for a better solution. After obtaining an x-ray and adjusting her pain regimen it was determined that she had been admitted for six days with a fractured wrist. It is the nurse duty to do a follow up assessment, but the system should also have alerts in place to ensure the nurse follows up.

An initial pain score should be taken upon admission and documented. A pain assessment should be done at the beginning of the shift and every 2 to 4 hours depending on the type of unit. Epic EHR alerts the nurse to perform a pain assessment upon scanning the medication; if the medication was given intravenously an alert will appear in 30 minutes or 1 hour if the medication was given orally to do a post assessment to rate how effective the medication was. As a result, doctors and nurses can review the pain regimen and suggest or make changes accordingly.

Assessment of pain is the most important step to providing good pain management. “Anderson and colleagues found lack of pain assessment was one of the most problematic barriers to achieving good pain control” (Wells et al, n.d.). The knowledge gained determines whether modifications are needed. “Understanding pain and how it works is a key part of how healthcare providers diagnose medical conditions” (Psychogenic pain: What it is, symptoms & treatment, 2022). A nurse manager/leader could utilize this data to create a daily charting checklist to ensure the full pain assessment is completed on all patients, create an education bulletin board highlighting the steps, create/provide patient education on pain management. Nurse leaders also have the ability of to gather information and meet with other healthcare personnel to brainstorm on new ideas and interventions.

Reference

 McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Psychogenic pain: What it is, symptoms & treatment. Cleveland Clinic. (2022, August 8). Retrieved November 30, 2022, from https://my.clevelandclinic.org/health/diseases/12056-pain-psychogenic-pain

Wells, N., Pasero, C., & McCaffery, M. (n.d.). Chapter 17 Improving the Quality of Care Through Pain Assessment and Management. Retrieved December 1, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK2658/

Week 1 discussion question Lewis.M

When someone is in extreme distress, they may find it difficult to tolerate what they perceive as “silly and repetitious questioning,” making in-patient admission time-consuming and annoying for the patients. In this scenario Mr. Pink has been admitted to the hospital at least four times in the last year and twice at another hospital in the past and week, now at this facility screaming in pain and also poor historian. There are some red flags but to have a full picture of the issues the health record must be obtained from the prior hospital. The nurse wonders how the utilization of electronic health record could be harness resulting in this patient’s health database being retrievable with the capacity to update the existing admission data base and admission process. Yet another patient, a 94 years old who is also very hard of hearing and 2 months ago had  just relocated from another state and has not being able to continue physical therapy post his hip repair 3 months ago: His mobility has declined and now he suffered a broken arm on the opposite side, no health history is available as he is waiting for the release of his medical records from his prior home state. Then there is the “direct” admission lacking vital information as to the reason for the proposed admission by their physician. My proposal is a unified nationwide admission database/ health record system.

The database begins at the initial patient contact within the medical system and travels with the individual i.e., consults, specialists, surgeries, treatment options, recommendation, plan of care as well as any pertinent information such as family involvement, issues, contact information, current medications: basically a complete electronic patient health diary. At any type of patient provider contact/appointment the info is loaded into the electronic patient data base which is updated and reviewed by providers. This data collection will now become an electronic patient health diary containing detailed patient health history at the tip of providers fingertips just like Star Trek!

The benefits of such a database result in continuity of patient care which leads to better doctor-patient relationships and medical outcomes through improved quality of care, as well as reduced healthcare costs and economic benefits (Kim ,2017). Decreasing patient admission wait time or incidence is another benefit of nationwide electronic health records (EHR).  According to Furukawa, Emergency departments (EDs) with fully functional EMRs had significantly lower length of stay (LOS) and shorter treatment times compared with EDs with minimal or no EMRs and EDs with simple EMRs. However, the relationship between EMR and efficiency depends on the severity level of the patient and the diagnostic services provided (2011).

Nurse leaders represent almost 3 million nurses, the biggest part of the US healthcare profession, in hospital, ambulatory, community, home, and long-term-care settings (Collins et.al 2017) therefore nurse leaders must endeavor to achieve competency in big data collection and interpretation in order combine their medical knowledge and analytical skills in caring for their patients; regardless of their future positions in healthcare, nurses must grasp the ethical application of information, computer, and cognitive sciences to improve nursing science and develop the nursing knowledge base (McGonigle and Mastrian, 2022).Health care Information is changing every second and the key to manage this  evolving data is to make it “ meaningful” by understanding “ how people obtain, manipulate, use, share, and dispose of information” (McGonigle and Mastrian, 2022).

References

Collins, S. , Yen, P. , Phillips, A. & Kennedy, M. (2017). Nursing Informatics Competency Assessment for the Nurse Leader. JONA: The Journal of Nursing Administration, 47 (4), 212-218. doi: 10.1097/NNA.0000000000000467.

Frukawa, M. F. Electronic Medical Records and the Efficiency of Hospital Emergency Departments. MEDICAL CARE RESEARCH AND REVIEW, [s. l.], v. 68, n. 1, p. 75–95, 2011. DOI 10.1177/1077558710372108. Disponível em: https://search.ebscohost.com/login.aspxead Acesso em: 30 nov. 2022.

Kim S. Y. (2017). Continuity of Care. Korean journal of family medicine, 38(5), 241. https://doi.org/10.4082/kjfm.2017.38.5.241Links to an external site.

Dee McGonigle D., Mastrian K., Nursing Informatics and the Foundation of Knowledge, 5^th edition, Jones & Bartlett Learning, 5 Wall Street, Burlington, MA 01803,978-443-5000, [email protected], www.jblearning.com.

In the medical field, access to data can be extremely beneficial in solving problems and forming new knowledge. This is especially true in the field of nursing, where nurses must have access to the correct data to provide the best possible care for their patients. One of the ways that data can be used to improve patient care is using nursing informatics. Nursing informatics combines nursing and computer science to provide nurses with the data they need to make informed decisions about patient care (Nagle et al., 2017).

One example of a situation that could benefit from data access is managing chronic conditions. Chronic conditions, such as diabetes and heart disease, are very common in the elderly and can be difficult to manage. Nursing informatics allows nurses to access data on the patient’s medical history, medications, lab results, and other important information. This data can then be used to develop a personalized care plan tailored to the patient’s needs.

Another area that could benefit from improved access to data and utilization of nursing informatics is the prevention of hospital readmissions. According to the Centers for Medicare and Medicaid Services, hospital readmissions cost the United States over $41 billion each year (Murphy, 2017). To reduce readmissions, nurses need to have access to data that can help them identify at-risk patients and intervene early to prevent readmissions. Nursing informatics can help nurses access the appropriate data to make decisions about patient care, including information about a patient’s medical history, medications, and lab results. By utilizing nursing informatics, nurses can develop a plan of care that focuses on preventing readmissions and improving patient outcomes (Nagle et al., 2017).

Data can also be used to identify trends in patient care. For example, nurses can use data to track the effectiveness of certain treatments or medications, and make adjustments as needed. By using data to identify trends in patient care, nurses can ensure that they are providing the best possible care for their patients. Finally, data can be used to add to the body of knowledge in the nursing profession. By tracking and analyzing patient data, nurses can better understand which treatments and medications are most effective, and what care strategies are most beneficial for certain patient populations. This data can then be used to inform future practice and research (Sweeney, 2017).

In conclusion, access to data is essential in the modern era and is especially important in the nursing profession. Data can be used to solve problems, make informed decisions, and add to the body of knowledge in nursing. Nursing informatics is a great tool for improving patient care and should be utilized by nurses to ensure that their patients are receiving the best possible care.

 References

Murphy, J., Goossen, W., & Weber, P. (Eds.). (2017). Forecasting informatics competencies for  nurses in the future of connected health: Proceedings of the Nursing Informatics Post Conference 2016 (Vol. 232). IOS Press.

Nagle, L. M., Sermeus, W., Junger, A., & Bloomberg, L. S. (2017). Evolving role of the nursing informatics specialist. Stud Health Technol Inform, 232, 212-22..

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Initial Post – The Application of Data to Problem-Solving

“Nursing informatics is the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice” (What is nursing informatics, 2019).  As a charge nurse in a busy medical-surgical acute care unit, one way I could utilize informatics where I work is by quickly tracking the patient’s information before they are assigned to the appropriate room. In our unit, there are share patient rooms for non-infection isolation rooms, semi-private patient rooms for contact and special contact isolation patient, and negative pressure private patient rooms for airborne infection isolation patients. When the bed czar assigns patients to our unit, I must quickly access the patient’s EMR and check the patient’s diagnosis, history, and infection isolation status, and based on these data, and I can assign the right patients to the right room These smaller-scale data collection can be interpreted and integrated in a shorter amount of time, allowing for a faster transformation into new guidelines and pathways (Nagle, 2017).

With the help of our collected information, our nurse leaders such as the nursing supervisors and the unit managers would be able to meet and discuss the best on-time patient transferring.  we will be able to work on each one individually to hopefully avoid delayed patient care, which is essential to decrease patient mortality. It is important that the nurses and healthcare providers in the emergency room and other setting acts on and synthesizes our data as soon as possible because the following nursing care and other healthcare will be largely based on their initial data collection. Collecting the necessary data through our EMR is the first step toward providing timely patient care. The more our leaders and nurses discuss the information found through this potential data collection, the more reasonable and appropriate, and effective patient assignment will be achieved, and the better patient care outcome will result. The information sharing and feedback provided allows our staff to make the appropriate changes to our department to make it run smoothly (McGonigle & Mastrian, 2020).

McGonigle, D., & Mastrian, K. G. (2020). Nursing informatics and the foundation of knowledge, (5th ed.) Burlington, MA: Jones & Bartlett Learning.

Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving role of the nursing informatics specialist. In J. Murphy, W. Goossen, & 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

What is nursing informatics? (2019). Retrieved from https://www.himss.org/resources-what-nursing-informaticsLinks to an external site.

Nursing Scenario

Most of my experience has been in the Emergency Department where (mostly) emergencies are happening. Floor nurses are also at some of the highest risks for back injuries. Although, there are devices such Hoyer lifts, sara-steadys, and other equipment that is safe for the patient and also for the nurse. Unfortunately, in emergency situations, there may not always be time to stop and use such devices. Back pain can be detrimental to the quality of life and can cause long-term difficulties for the nurse (Boughattes et al, 2017) . Being able to collect data, nation or even world wide on how the back injuries occur could be extremely beneficial in finding safe practices or inventions that can help prevent the injuries.

Data Collection

Being able to collect data and compare/ collaborate with other nurses that are going through the same things can be extremely beneficial to change. Collecting the exact way that the back injury happened would be important in this case. Being specific would also be important. Specifically saying “injured during patient lift” would be vague. More specific information would be needed such as “back injured during the lift of patient from the ground back to a stretcher after twisting motion”.  If multiple nurses are having the same issue then a safer practice can be investigated by the nurse leaders and evidence can be provided to back the information up. When detailed reports happen like this, it is hard to set classifications for the data separate it into more detailed categories. But that is what would have to happen. identify detailed categories, separate the data and evaluate trends (National Library of Medicine, 2022).

References

Boughattas, W. , Maalel, O. , Maoua, M. , Bougmiza, I. , Kalboussi, H. , Brahem, A. , Chatti, S. , Mahjoub, F. and Mrizak, N. (2017) Low Back Pain among Nurses: Prevalence, and Occupational Risk Factors. Occupational Diseases and Environmental Medicine, 5, 26-37. doi: 10.4236/odem.2017.51003Links to an external site..

National Library of Medicine (2022) Data Collection Reviews, https://www.ncbi.nlm.nih.gov/books/?term=data+collection

Introduction

     Data collection and documentation have evolved in the past decade of healthcare. Many healthcare settings have moved from paper charting to electronic charting systems. According to the Healthcare Information Management Systems Society (HIMSS), Nursing informatics professionals help incorporate nursing science with information technology to help improve nursing practice through the help of healthcare technologies such as electronic medical records (EMR) and other computerized data entry systems with the focus of maintaining patient safety (HIMSS, 2022).

Description of Scenario

     In my experience working in an intensive care unit, one issue that stands out is hospital-acquired infections (HAI), such as central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI), and other infections. CAUTIs are the second most common HAIs and occur more often in ICUs. Unfortunately, like other hospital-acquired infections, CAUTIs could often lead to poor patient health outcomes and increased healthcare costs (Shadle et al., 2021). 

Data Collection, Assessment, and Knowledge Derived

     EHR can be effective in the prevention of CAUTIs in ICU settings. With CAUTIs and CLASBSIs, some data that can be collected and assessed to help prevent these serious issues in a hospital setting will include documentation of every urinary catheter or central line placed, including documentation of evidence-based criteria for the insertion of these devices in the ICU setting, number of days the device has been in place, the necessity of continuing the device, nursing care of the insertion site, and description of the insertion site. All these data can be collected and documented by the nurse in the patient, which allows the nurse and other healthcare providers responsible for the patient to access the data and determine whether these devices are medically necessary for the patient, the number of days the device has been in place, signs of infection, and catheter care. The hospital where I currently work uses Cerner as its EHR system. Following a CAUTI protocol, nurses are prompted by the EHR system on each shift to reassess the necessity of the urinary catheters on patients with a urinary catheter and discontinue them if unnecessary. EHR systems have been shown to significantly decrease CAUTIs by improving catheter care practice and limiting catheter usage (Welden, 2013). Incorporating education, a daily electronic checklist, and removal protocol for nurses for indwelling urinary catheters was associated with reducing CAUTIs in critical care settings (Shadle et al., 2021). 

Benefits to Nurse Leaders

    EHRs benefit patient care because they help facilitate the quality and effectiveness of patient care (Nagle et al., 2017). The EHR system allows information such as the necessity of indwelling catheters, catheter care, length of catheter usage, and rate of CAUTI on the unit. Nursing leaders can analyze these CAUTI data trends to help develop the most effective plan of action to improve their unit’s CAUTI  or HAI prevention. Improved CAUTI trends will also improve patient outcomes considering HAIs are often associated with poor patient outcomes and increased healthcare costs (Shadle et al., 2021). 

References

Healthcare Information and Management Systems Society. (2022, June 29). What is Nursing Informatics? Retrieved November 30, 2022, from https://www.himss.org/resources/what-nursing-informatics

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A bundle-based approach to prevent catheter-associated urinary tract infections in the Intensive Care Unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934

Nagle, L., Sermeus, W., & Junger, A. (2017).  Evolving Role of the Nursing Informatics Specialist Links to an external site. 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

Welden L. M. (2013). Electronic Health Record: Driving Evidence-Based Catheter-Associated Urinary Tract Infections (CAUTI) Care Practices. Online journal of issues in nursing, 18(3), 6.