Archive for August 3rd, 2009

Online Education

August 3, 2009

Most health care facilities now use online courses to keep their employees up-to-date on policies, procedures, documentation rules, and also current assessment criteria. These classes are self-taught and include text, pictures, and audio. The most recent class I took online for my job was on myocardial infarctions/angina. The hospital I work at is trying to become a chest pain center. The classes were helpful; you could go at your own speed, you could click forward or go back as you needed, they were interactive slides, and also a quiz at the end that you had to pass to get credit for the course. Much of the teaching were assessment tools. Criteria to look for when a patient begins complaining of chest pain and the ways to assess the type of pain it is and how to proceed from there.

                  This year I also took extensive classes online concerning pressure ulcers; their protocol, treatment, staging, and documentation. This online class was helpful. There were lots of pictures which is probably most important in learning to properly stage a pressure ulcer. Also it was very interactive. I believe that a big use of healthcare informatics is in teaching hospital/clinic staff. It is able to keep the employees current on their practices; including legal issues, abbreviations that we are able to be used, the correct way to chart, and also assessment tools. I was able to learn valuable pieces of information regarding the way I complete a patient’s assessment and how to document my findings. I believe this will continue to emerge as the predominant way that new information is given to the employees of a facility.

Tags: , , ,

Advertisements

Paper versus Computerized Charting

August 3, 2009

Computer Documentation

I have worked at 3 different hospitals; all had different modes of charting your assessments/admission information. The first hospital I worked at everything was computerized: medication administration, admission information, assessments, labs, orders, history and physicals, discharge notes, nursing notes, etc. All were in one system and any healthcare team member could retrieve the information they needed on a specific patient easily. If you had a patient that was transferred to you (I worked in the ICU) then you could review the nurse’s notes and see what had happened for their status to decline. Also when charting your assessment you could click the boxes that described how the patient presented in the exam but also at the bottom of each section was “other” where you could type anything that was not available in box form. It was very helpful and also much easier to read that physician’s and nurse’s notes (no messy handwriting).

The second hospital I worked at had online order entry system along with online lab results. All the assessments and admissions packets were paper charting. It was very difficult to use because a lot of it was redundant. It was also constantly changing because the cardiac floor would want something added then the surgery floor would need a section on incisions/drains. Many times there were things I found on my assessment but no appropriate box to chart my findings. In that case I had to hand write a nurse’s note about my assessment which they called “charting by exception.” The packets for admission were redundant but they were prepackaged and always readily available which was useful.

The hospital where I currently work is all paper charting. The lab prints their results to the floors’ copiers. The admissions packet repeats things up to 3 times. The paperwork does not allow you to assess certain areas of a patient. Like incision sites are terrible to assess with the paperwork and there’s no option for coarse lung sounds. Also the papers are in drawers and not put together in a packet form. This leads to missing paperwork on more patients than not. It has been a very trying experience, especially when I know there are such easier ways to document.

I very much prefer computerized charting/documentation. I believe that it leads to less documentation errors. I also believe that it is helpful for the healthcare workers to be able to access all the information they need in one place.

Tags: , , , , ,

Is Online Learning Easier? (comment)

August 3, 2009

I believe that online classes prepare you to enter graduate school. Graduate students must be responsible for large amounts of information that must be self-taught. It would be impossible to expect to get everything you need for an exam, or eventually your career, from the classroom as a graduate student. I like that in NR534 Advanced Health Assessment (as taught by Dr. Johnson) I am responsible for reading the book, completely the interactive exercises, and memorizing the basic information. I then go to clinical and exam a patient using the knowledge I have taught myself along with guidance through the exam from my preceptor. I learn how to perform an assessment on a patient from information from the book and experience of my clinical faculty. I am forced to be productive at home because I am expected to report to clinical prepared to use the knowledge from the book without getting a lecture from my clinical preceptor. I feel better prepared for the graduate classes I will take in the fall knowing that I can guide my learning and get the information I need from the books at home.

Original Post:
July 20, 2009
Title: Is Online Learning Easier?
While at work last night we had a discussion of the different types of programs where nurses can earn their BSN and/or MSN. I was surprised that the majority of nurses said they preferred the traditional classroom over online or distance programs. The view was there would not be the instructor support to help with elements of a course that the student was not able to understand. I look at this experience totally opposite, with the entire Internet at my disposal; I can research any topic and find the answers myself. In a classroom I would be limited to what the instructor was putting forth. Yes, I can always later do the online research but how often will that happen. I think in the classroom, instructors consciously or subconsciously teach to how they will test to insure the success of their students. With online learning, I am responsible for learning the material and have no idea what specific topics will be on an exam. It isn’t that it is easier to do an online degree program; it requires the desire to look for and learn the information as opposed to having it spoon-fed.

Online Advanced Health Assessment Course

Tags: , , , , ,

Documentation of Bedsores, comment

August 3, 2009

The hospital where I currently work also includes documentation of existing pressure ulcers on admission of a patient. However, the protocol asks you to assess the patient’s skin then to document on paper what the ulcer looks like, stage, size, drainage, etc. The paper charting does not require a picture of the pressure ulcer that was found by assessment of the RN. I think this leaves a wide margin for error. It is probable that some ulcers will not be documented correctly. I believe that a photo would be advantageous to the medical record along with perhaps a computerized charting system where you can label with an X any area of the body that has breakdown and then attach a photograph to the document. Also the documentation I work with does not allow for updates on how the pressure ulcer heals or worsens. This also leaves room for criticism and error. I think my place of work would benefit from photo/computerized documentation of pressure ulcers.

Original Post:
July 31, 2009
Title: Documentation of Bedsores, comment

I found this post and other comments relative to my new nursing job. As an experienced ER nurse, we found little time to assess or document pressure ulcers. With the new CMS guidelines that came out this past October, Medicare will not longer be reimbursing for facility acquired pressure ulcers. My new nursing role focuses on prevention and education. I was very surprised how little I knew about pressure ulcers from working in the ED. Yet it is so vital that our assessment starts there. The photo proof documentation mentioned in this Post sounds like an excellent idea. One of the hospitals I work with, just installed a whole new soft ware program for nursing documentation. It is really easy to chart your skin assessments and pressure ulcers. With drop down choices, body diagrams. But the wound care nurse still has to validate the floor nurses documentation with her own patient assessment every month. I helped her with this, and it was very time consuming. It was double the work in my eyes. Yet we did find, many pressure ulcers that were resolved and many that were staged incorrectly, as well as several that were missed by the RN. Even though we have many different technologies to help us with our documentation and assessment, it still comes down to basic education.

Original Post:
June 17, 2009
Title: Documentation of Bedsores
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!

Tags: , , , ,

Is Online Learning Easier? (comment)

August 3, 2009

I agree that online learning is much more challenging than traditional classroom learning. Teachers do spoon-feed the students the information that is needed in order to pass the exams. Whereas online instruction is based on the assignments given and one must be prepared for every aspect of that assignment and not just focus on what the teacher says will be on the exam. Granted, you have some students who are more comfortable with having an instructor available immediately for any questions or unclear information. Online classes also offer access to the instructor as often as needed but much of online instruction requires the student to do the research and try to come up with the appropriate responses on their own before referring to the instructor. Online instruction requires individuals to become more independent and in charge of their own learning at their own pace. For me it has been a godsend.

Original Post:
July 20, 2009
Title: Is Online Learning Easier?
While at work last night we had a discussion of the different types of programs where nurses can earn their BSN and/or MSN. I was surprised that the majority of nurses said they preferred the traditional classroom over online or distance programs. The view was there would not be the instructor support to help with elements of a course that the student was not able to understand. I look at this experience totally opposite, with the entire Internet at my disposal; I can research any topic and find the answers myself. In a classroom I would be limited to what the instructor was putting forth. Yes, I can always later do the online research but how often will that happen. I think in the classroom, instructors consciously or subconsciously teach to how they will test to insure the success of their students. With online learning, I am responsible for learning the material and have no idea what specific topics will be on an exam. It isn’t that it is easier to do an online degree program; it requires the desire to look for and learn the information as opposed to having it spoon-fed.

Tags: , , , ,


%d bloggers like this: