Archive for June, 2009

The 6 rights of drug administration

June 30, 2009

The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

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Internet Education and a changing belief among traditional nurse educators

June 29, 2009

I can’t help but be amazed how far nursing has come in accepting Internet based BSN programs. I spent the past week at a top university meeting with the director for their nurse anesthesia program. In the past I recall nurse educators that held a belief that if one didn’t get their BSN in a traditional university it was something less that a "real" degree. But these same educators hurt themselves when they view that a BSN is the gold standard as opposed to ADN/Diploma nurses. The problem became when those of us with life responsibilities could not drop everything and attend traditional classes so we didn’t try to obtain our BSN. To maintain the BSN as the gold standard for registered nurses the traditional nurse educators had to accept non-traditional programs. The director I met with not only embraces a BSN earned via the Internet but voiced belief that a BSN learned through independent learning is more challenging due to the discipline it takes to complete such programs. Finally, nursing is entering the twenty-first century. I’m grateful it did during my career; it makes my ability to achieve my goals more realistic.

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National electronic health record

June 26, 2009

In 2004, President George W. Bush charged the medical community to develop a National electronic health record.

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

The purpose of the EHR is to share pertinent patient information among healthcare providers and healthcare institutions. Sharing the information will save the patient money, increase patient safety, and improve the quality of care. The difficulty with this initiative is the variety of applications utilized to create and store the data.

As the need and ability to collect data has increased, so has the need to share the information, thus the development of technical health care standards. However, the lack of healthcare informatics standards to ensure the smooth transfer of data between systems is a major barrier to the national EHR initiative.

Another complicated area to deal with is the protection of patient information. Policies and Procedures are usually written at Healthcare Institutions that address patient confidentiality, electronic data access, integrity of electronic documentation, etc. Screen savers, privacy screens and short logout times are tools utilized on computers that are viewable by casual observers. Limiting access to the system based on job function is also used to secure patient data. The Health Insurance Portability and Accountability Act of 1996 mandates standards for developing unique patient identifiers that will provide privacy, security, and immaculate data transfer in order to link patient records.

The smooth joining of all this data is difficult to achieve. Institutions are currently challenged with trying to interface the different applications utilized in one hospital. It gets even more difficult when interfacing an entire Health System, let alone an entire nation of applications, patient identifiers unique, provider identifiers, etc.

In addition to the national EHR, hospitals continue to launch new applications to be used to support the care delivery. Over the years I have noted a lack of understanding regarding electronic signature, electronic documentation, access to patient records, etc. by nursing staff at all levels. The increase in electronic records has made information much more accessible to staff members but can also be deemed as too accessible if the staff members are not oriented to the confidentiality issues as they relate to electronic medical record access.

There is limited to no assessment of staff and their informatics knowledge on hire to healthcare organizations. Currently, the American Nurses Informatics Association is supporting a national initiative, Technology Informatics Guiding Education Reform (TIGER) aimed with writing competencies for nurses and nursing students to support the use of technology seamlessly in the delivery of safe and effective patient care. These competencies will incorporate theories, tools, and fundamentals of nursing informatics.

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June 18, 2009

Do not depend completely on electronic devices and equipment; or machines.  

I live in a college town. My patients are frequently from another country. My hospital has provided many language telephones and 24 hour interrupters to overcome the language barrier. One observation I have made is this. While you are waiting for the language interrupter to arrive, there is one communication that transmits across to all humans. Just touch them and smile.  This assures anyone that you are committed to their help in this crisis. Look into their eyes as you smile. They can sense your acceptance.

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Documentation of Bedsores

June 17, 2009

Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

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HEALTH CARE INFORMATICS – An Interdisciplinary Approach, review

June 16, 2009

A review of Health Care Informatics – An Interdisciplinary Approach – Englebardt, Nelson

Enclosed are topics from each chapter that were significant to me. I don’t know how well the graphics and colors transmit when pasted: HEALTH CARE INFORMATICS – An Interdisciplinary Approach Chapters 1-5 Chapter 1 focuses on Major Theories Supporting Health Care Informatics. Although several theories are listed in this chapter, I am defining information regarding the “diffusion of innovation theory.” This theory was developed by Everett Rogers to explain how individuals and communities respond to new ideas, practices, or objects in 1995. In addition, this theory is defined as, “the process by which an innovation is communicated through certain channels over time among members of a social system.” This theory provides a key role to health care informatics specialists as they assist others and organizations to maximize the benefits of automation with the technology. Five groups of classifications based on their response to change are defined as follows: 1) Innovators: the first 2.5% of the individuals within the system who are comfortable with uncertainty and above average in their understanding of complex technical concepts; 2) Early Adopters: the next 13.5% of individuals in the organization who are discreet with their adoption of the new change and are powerful because of their potential to be key leaders for the new idea. 3) Early Majority: the next 34% of individuals who are willing to adapt, but not to lead. 4) Late Majority: the next group of 34% that will eventually adapt to the new idea through peer pressure, but not because they agree with the idea. 5) Laggards: the final 16% of the individuals are resistant to change and come around because there is no other alternative. This theory and definition can be key to various areas of the health care continuum. Chapter 2 outlines, “Computer, Information, and Health Care Informatics Literacy.” The chapter identifies Health informatics literacy as, the study of how health data, information, knowledge, and wisdom are collected, stored, processed, communicated, and used to support the process of health care delivery to clients and for providers, administrators, and organizations involved in the health care delivery. I prefer the visual perspective of how health care intersects. HEALTHCARE INFORMATICS INFORMATION SCIENCE: WHAT IS IT? Chapter 3 “Understanding Databases” This chapter has a plethora of new terminology to grasp. I am going to focus on the anatomy (fields, records, tables). A database needs to be divided into the proper terms. First, a field is a vertical column in a database. It contains data that represent the same characteristic for all of the records. An example of a FIELD NAME or column heading could be Last Name. The horizontal data in the database represent records. In addition, the record contains the different pieces of data belonging to a given entity. The record is made up of a bunch of fields. A table consists of all the records. By structuring, the data in fields and records in a table makes it possible to manipulate and/or select records or fields based on specific data elements in the field. The following is an example created in Excel: ID NAME FIRST MIDT PROJ EXAM FINAL 123-43-3455 CARD SAM 65 70 67 67.3 124-77-8900 HITE HOE 87 75 90 84.6 123-87-8977 NUTCH JAME 85 90 95 90.5 123-56-7655 ROBB MIKE 85 80 90 85.5 127-89-6655 TWATE PAT 95 98 87 85.8 123-43-6677 WREN TOM 90 95 90 91.5 AVERAGES 84.5 84.66667 86.5 84.2 Chapter 4 “Supporting Administrative Decision Making” An important system term named within this chapter is decision support system. Decision support system (DSS) is defined as an interactive flexible, and adaptable computer-based information system (CBIS) that is specifically developed for supporting decision making related to the solution of a particular problem by utilizing data and easy user interface (UI) The components contain: User interface ; facilitates communication between the executive and the DSS ; Model manager ; accesses the collection of available models ; Model library ; includes a variety of statistical, graphical, financial, and “what if” models ; Databases ; provide clinical and financial data needed for decisions An important conclusion to DSS use in the decision-making process is to remember, DSSs are not immune to the environmental influences that influence the entire industry. In addition, with the growth in health care technology, it is very difficult to stay current with changes without a multidisciplinary support of team members within the organization. Chapter 5 “Supporting Clinical Decision Making” The processes and outcomes of care can be improved with optimal clinical decision-making. Clinical decision-making is invaluable at all levels of the health care system. A clinical decision support decision is an automatic DSS, which mimics the human decision-making and can facilitate clinical diagnostic process, promote the best of practices, assist with the development and adherence to guidelines, facilitate processes for improvement and prevention of errors. Clinical decision-making is the core to promote “best of practice.” This system characterization is valuable because it provides comprehensive examination of how humans make decisions. Other systems are outlined and defined, but this one was invaluable for me to remember and use.

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Stress and workload

June 15, 2009

Stress and workload; I thought it was appropriate to discuss stress because that’s exactly what I am feeling about my degree program. It does feature online interaction and computer use. The purpose of my degree program was to prepare myself on how to be a better Community Health Nurse; I did not think it was to send time on academic work. I went to bed last night feeling very stressed. My workday is already 9 hours long and by the time I get to my computer at night I am already tired and stressed. What am I going to do about it? I don’t know. I am sure I am not the only one feeling this way. Many Nurses are already feeling the strain of work, family, education etc. I graduated from Nursing in 1982 at the ripe age of 19; it was a 3-year diploma program. Now it’s all about the degree and it is becoming increasingly difficult for diploma nurses to move forward in their career. With the national nursing shortage one would think the government would concentrate on more effective ways for diploma nurses to bridge over to their degree. I can’t afford to take 2 years off to go back to school and taking a course at a time I will be ready to retire by the time I get my degree.

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Parent Participation

June 11, 2009

Today, parent’s are well informed about their children’s health. Having access to the Internet parent’s are able to access information about medications and diseases. In assessing children parent’s can contribute and share information about their child that may have an impact on the course of care. It is an opportunity for the health care team to include parent’s in the child’s care to have a better outcome of treatment.

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Primary health care model

June 9, 2009

We have just adopted the Healthcare Informatics, Community and Public Health, primary health care model where I currently work. It has been a huge adjustment for all of us but now that the dust is settling I think it really has its benefits. There appears to be more thorough follow through for the Pt’s often leading to earlier diagnosis and treatment plans as well as health promotion and prevention to adjust their lifestyles. Today for example I had a patient return for a TST reading and it was a positive conversion from 1 year ago; this particular patient travels on a regular basis to other parts of the world. His primary physician assessed him within 10 minutes and he was sent for a chest x-ray and lab work within a 1/2 hr. I was quite impressed as we now have him started on preventive treatment and there was no delay. I will be following him on a regular basis. A few years ago the process probably would have taken several weeks.

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Successful Implementation of New Clinical Systems

June 8, 2009

Being part of the implementation team for new clinical systems or major upgrades is always exciting, albeit stressful and frustrating at time. The programmers have to ensure each system communicated with each other where applicable. We have recently opened an Urgent Care Unit (UCU). It was decided that an Emergency Department Information System (EDIS), and not the current system would better manage the UCU. After the installation of the EDIS, there were the lots testing on the test site before going on to production or live site. The test patients to be admitted, the orders to had to be enter, along with height, weight and allergies. The Lab, radiology, and dietary check their systems to ensure the orders came across as intended. It was discovered that right and left indicators did not show on the other systems. That had to be fixed. Field had to be mapped. Mnemonics had to match. The EDIS had to change a few mnemonics to match the existing mnemonics in lab and radiology. Dietary orders were placed and received as were intended. Then the patients were discharged or transferred to an inpatient status. The test showed the discharges went well. There were some minor hiccups with the transfers, easily fixed by the analysis and programmers. The training for the end users had not been forgotten. The trainers were trained to give instruction to the end user. Finally, the application goes live, after some minor issues It was a success! The next project? Changing the emergency department over to the new EDIS. Being part of the implementation team is rewarding!

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