Healthcare Informatics Resources

I have been touched by the many recent news headlines of medication errors, especially those involving newborns. In yesterday’s news covering a Las Vegas malpractice case, a sobbing pharmacist was apologizing to the parents of a deceased infant who was the recipient of a drug overdose prepared during her watch. The pharmacist was so distraught that the mother of the deceased infant left her seat in the court room to comfort her. Our text discusses the potentially harmful effects of medications during pregnancy, during labor, and to newborns. In watching the coverage and reading the text, I was reminded of the many times during my career that I have witnessed errors and myself experienced serious near misses with medication administration. It is devastating when such events occur to both the patient and the health care practitioner. Safe administration of medications has always been the goal of healthcare providers, but it seems that despite all of the resources available, errors continue at alarming rates. This is so much the case that The Joint Commission has charged hospitals to improve the safety of medication administration in their National Patient Safety Goals. Information regarding dosing, drug interactions, etc. is readily available in many formats to those preparing and administering medications. We have medications provided in unit dose increments and dispensed by machines. As a standard of nursing care, we perform a minimum of five checks before administering medications. Some medications require two nurses to verify the dose. We have changed our practices with patient identification to reduce the likelihood that medication is given to the wrong person. Yet, with all of the available information and redundancies built into the system, life threatening errors occur. There is a federal movement underfoot for all healthcare organizations to have electronic medical records in place. A medication administration record that does not require manual transcription would be an adjunct in reducing transcription errors. However, the data base is only as good as the information that it is provided with, leaving the potential entry for errors. Electronic data bases provide very useful information for tracking, measuring and determining clinical quality. This would help us evaluate process errors and to revises processes based on the knowledge gained. At the end of the day, with all the tools and information at hand, it is the end user who is the last and most important stopgap in safe medication administration. The available tools are like a hammer. A great hammer still needs a skilled carpenter to achieve a great outcome. It is my belief that our focus should be in development of the “carpenter” and the processes used by the “carpenter” with regard to medications. This would involve more training with medications; time to recalculate what is prepared in pharmacies, and an evaluation of the environment, including patient assignments and ratios. The costs incurred would be minimal compared to the cost of a human life or a lawsuit related to negligent practice.

Medication Drug Error Attorney Lawyer

Tags: Healthcare Informatics, Healthcare Informatics Resources, Health Care Informatics Medication Administration Record, Health Care Informatics Electronic Medical Record, Health Care Informatics Medication Safety, Medication Drug Error Attorney Lawyer

I absolutely agree with all the comments presented in the below link. Being that computerized documentation is less than 6 months old in our main facility, bedside point of care charting is a relatively new concept. It used to be that the only documentation performed at the bedside was the patient database and even then, most of that information was gathered on initial assessment and we would then go out to the desk to complete the paperwork. I think as more organizations embrace technology, more thought needs to go into the purchasing of equipment. At our facility, the managers for each unit were given a budget to purchase the style of computer they thought would be best suited for that particular unit. Pods were designed with central computers, handheld devices were purchased as well as COWs (computer on wheels). Many units after the fact discovered that the COWS were too big to get to the second bed in the room. This caused non-compliance with The Joint Commission standard stating that the e-mar must be at the bedside when administering medications. Other units found the hand held devices to small to use – the type to difficult to read. Pods are great for the primary nursing concept but takes the nurse away from the bedside. Many areas discovered just how few available outlets they had how short a battery life really is. We even had to become politically correct when a patient complained to administration that she overheard a nurse in the ER referring to "that stupid COW that had died in the hallway" – not realizing the nurse was frustrated that no one had bothered to plug the computer in to charge. We now refer to COWS as WOWS – work stations on wheels. With all that aside, we are finding that wall based point of care computers work best allowing optimal contact with the patient while gathering crucial information to be utilized in their treatment of care – as long as the computer is not on a wall that forces your back to the patient the entire time you are typing!

Original Post
December 14, 2009
Title: Assessments and Point of Care Charting
Charting patient assessments is often a time consuming task, but vital to the care of the patient and record keeping. Nursing often jot notes down on a piece of paper, to only later record them into the computer system. Much may be lost in the translation. In addition, actions may be taken on the charting that in currently in the computer, though it may not always be the most current reflection of the patent’s status. Point of care systems have become paramount for charting in acute care settings, especially on critical care units. They often interface with medical devices to collect data automatically. These systems are often flowsheet orientated and provide graphing and trending capabilities. Optimally these systems create less redundancy, offer quick responses and interface with other clinical operations such as the laboratory and pharmacy departments. The computer availability is also an important consideration. Central computers have not always enhanced charting as they may take nurse from the bedside. Point of care charting should be convenient points of access to the system. Computers on Wheels (COWS) are found in many organizations. The portable, efficient system allows the nurse to chart in the patients room when appropriate. Bedside systems at the point of care focus on quickly capturing information that a nurse may otherwise jot down on their notes. Computer location should be given thoughtful consideration before investments are made in addition to the device’s speed and ease of use.

Tags: Healthcare Informatics, Healthcare Informatics Resources, Health Care Informatics Point of Care Charting, Health Care Informatics Computers on Wheels Charting, Health Care Informatics Assessments Charting, Health Care Informatics Work Station on Wheels

Part of my role as a nurse clinician is that of ensuring that a newly hired RN is able to independently pass medications. Our facility policy is to have the initial med pass performed with a clinician and once deemed competent the new hire can continue medication administration under the supervision of a nurse preceptor (another RN assigned to that nurse). Like most hospitals, the demand to push these new nurses through the orientation process and into independent practice is tremendous. We often short come the orientation and nurses today are learning on the fly. A proper preceptorship should consist of a seasoned and experienced RN with a smaller patient load, working with the new hire and delegating tasks until they feel the new nurse can perform and handle a patient load on their own. In the real world – the new hires are often treated as additional staff and the preceptor is ending up with double the patient assignment because they have an "extra" pair of hands. The preceptor is so busy trying to complete and care for the additional patients the new hire is often left unattended. During an observed medication pass this morning I was dismayed to watch the nurse flip to the drug information screen on her e-mar instead of actually taking the time to look up the medication in a drug guide. Was it more time effective? Yes, but she just glanced at the first sentence or two grabbed a keyword and assumed that was the drug’s intention. A few times I had to encourage her to go back and read the entire screen – point out that she was glossing over key information such as adverse reactions or drug interactions. With all the tremendous technological advancements we are making in healthcare today, I hope it is not as the cost of patient safety and nursing accountability.

Original Post
January 4, 2010
Title: Charting in the Era of EMR
I am still of the era of nurses that entered a patients room with my rounds sheet tucked into my uniform pocket.  The secret was to not let the patient see this sheet, and be able to remember their name, main diagnosis, and what you needed to check in them.  You would go through your complete assessment including vital signs, and when you left the room you would pull out your little sheet of paper and write down all of the information you just collected.  This procedure was repeated for all eight of your patients.  When you were done, you then sat at the nurses’ station and pulled the individual charts so you could transfer the information onto the required forms. 

It is not hard to see how the electronic medical record has benefited the role of nursing.  The first improvement is in time management.  You can actually take the information and enter it once.  This is the only time you write the information.  The second advantage is in correct data entry.  You can enter the data as you gather it.  There is less chance of forgetting the information before you write it in the patient record.   The third benefit is in gathering the correct information on each patient.  Electronic medical records prompt you to gather the required information.

I speak purely from a hypothetical standpoint because I personally have not had the chance to utilize an electronic medical records system.  Our hospital is still struggling to come up with the money required to purchase and implement a system.  I can, however, dream about how easy it will make my life once we get one!!!

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Tags: Healthcare Informatics, Healthcare Informatics Resources, Health Care Informatics Electronic Medical Record, Healthcare Informatics Electronic Health Record, Healthcare Informatics electronic medication administration record e-mar