Entertainment world – radio and television.
changing nursing and health care.
Computers, in this era, were typically used in the business office to track financial aspects of health care (Saba & McCormick, 2006).
In the 1970s, nursing began to realize the importance of computers to the nursing profession and became involved in the design, purchase, and implementation of information systems (Saba & McCormick, 2006).
In the 1980s, medical and nursing informatics specialties emerged. The personal computer was introduced, which allowed for flexibility in how these clinical systems were used
The first certification exam for NI was taken in 1995 (Saba & McCormick). The post-2000 era saw an unprecedented explosion hardware and software. Electronic patient records became an integral part of clinical information systems.
Telemedicine became possible and was recognized as a specialty in the late 1990s (Saba & McCormick,2006).
Information – serial set of vital signs taken over time, placed into a context, and used for longitudinal comparisons
Knowledge – recognition of a pattern and identification of interventions reflects information synthesis (knowledge) based on nursing knowledge and experience.
Wisdom – accuracy of the synthesis of information and appropriate selection of interventions
The process of decision-making in nursing is guided by the concept of critical thinking.
Critical thinking is the intellectually disciplined process of actively and skillfully using knowledge.
Requires interaction with multiple medical devices and health IT
Increasingly likely to be involved in the design of new clinical systems
Technology is integral to all parts of healthcare delivery for healthcare providers (HCPs), patients, and healthcare settings
Patients with multiple or chronic conditions
Inaccurate or incomplete transfer of information related to patients transitions from inpatient to home care
Computerization will not fix process issues- instead it highlights them
Prior to any design there needs to be workflow review and redesign
Caregivers must come together and “process flow” their work and identify what is not working
Allow the decisions for redesign to be implemented and tested prior to automating
Knowledge work is defined as nonrepetitive, nonroutine work that entails a significant amount of cognitive activity (Sorrells-Jones & Weaver, 1999a).
Drucker (1994) describes a knowledge worker as one who has advanced formal education and is able to apply theoretical and analytical knowledge.
No silos – health care workers must work as a team
Health service organizations, societies, and governments throughout the industrialized world are charged with assuring that healthcare delivery is:
Good- more informed patients
Bad- more informed patients
*Knowing what material is accurate and relevant
Online medication administration/scanning
Clinical guidelines (e.g., best practice for prevention of skin breakdown);
Online information retrieval (e.g., CINAHL, Micromedics)
Clinical order sets and protocols; and
Online access to organizational policies and procedures. Many applications now have embedded case-based reasoning.
Voice and video recordings (client interviews and observations, diagnostic procedures, ultrasounds)
Voice-to-text files (voice recognition-documentation/ordering)
Medical devices (infusion pumps, ventilators, hemodynamic monitors)
Bar-code technologies (for medication administration, patient tracking)
Telehomecare monitoring (for use in diabetes and other chronic disease management)
“Medical Homes” where pts are monitored remotely
Over the years, nurses have been on the receiving end of systems which either did not add value to their work or created additional work.
Nurses must be engaged in the acquisition, design, implementation and evaluation of CIS
The core concepts and competencies associated with informatics will be embedded in the practice of every nurse, whether administrator, researcher, educator, or practitioner.
Increasing demands on professionals in complex and fast paced health care environments
May cut corners or develop workarounds that deviate from accepted and expected practice protocols.
2001 IOM Quality Chasm report
Agency for Healthcare Research and Quality (AHRQ) launched initiatives focused on safety research for patients
2002 Joint Commission National Patient Safety Goals
2002 National Quality Forum (NQF) adverse events and ‘never events’ list,
Creation in 2004 of the Office of National Coordinator for Health IT to computerize health care,
2004 World health Organization’s (WHO) Alliance for patient safety,
2005 Institute for Healthcare Improvement (IHI) 100,000 Lives campaign and 2008 5 Million Lives Campaign
2005 congressional authorization of Patient Safety Organizations (PSOs) created by the Patient Safety and Quality Improvement Act
to promote blameless error reporting and shared learning,
2008 “no pay for errors” Medicare initiative
$19 billion congressional appropriation to support electronic health records and patient safety
a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment
encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems
organizational commitment of resources to address safety concerns (AHRQ, n.d., para. 1)
system or process issues that lead to unsafe behaviors and errors are addressed by changing practices or work-flows processes
clear message is communicated that reckless behaviors are not tolerated
perform FMEA to understand error
examine workflow; educate
Enact zero tolerance policy; disciplinary measures
May be related to the sensitivity of alarm parameters
Alarms/alerts in Information systems can have the same effect
Strategies to improve alarm response
improving the nurse call system by adding Voice Over Internet Protocol (VOIP) phones
Minimizing alerts to must have from the nice to know
feeding alarm data into a reporting database for further analysis
encouraging nurses to round with physicians to provide input into alarm parameters
Reduce errors and adverse events
Increase the rapidity of response to adverse events
Make knowledge more accessible to clinicians
Assist with decisions
technology based forcing functions that direct or restrict actions or orders implemented by computer technologies.
Provide feedback on performance
Institute of Medicine highlights six main aims
QI system must develop measures of quality that reflect these aims
Question of whether an error or adverse event is likely to occur or is a rare, exceptional event
Constant re-evaluation and assessment of changes made in the past
Strive to make improvement the primary purpose of the organization
Human Error Factors: Distractions, unclear thinking, lack of knowledge, short staffing, and fatigue
the right time and frequency of administration
the right dose
the right route
the right drug
The right DOCUMENTATION
performing electronic checks
providing alerts to draw attention to potential errors
Accurate, current information that helps physicians keep up with new drugs as they are introduced into the market
Drug-specific information that eliminates confusion among drug names that sound alike*
Improved communication between physicians and pharmacists*
Reduced healthcare costs due to improved efficiencies
Allergy verification and medication reconciliation with other drugs already in use
Automated reports- medication reconcilliation; Medication useage
Nurse scans name badge thus logging in as the person responsible for medication administration.
patient’s barcode on the patient’s ID bracelet is scanned prompting the electronic system to pull up the medication orders.
the bar code on each of the medications to be administered is scanned.
This technology checks to ensure that the 6 rights of medication administration—right patient, right med, right dose, right route and right time, right documentation—are met.
Barcoded medication administration can be implemented from the bedside
Level 2 incorporates educational tools
Level 3 presents alerts and warning specific to the medication regimen and patient condition
Issues soft-stop or hard-stop alerts if a dose exceeding programmed limits is entered
Library can be tailored to a specific location
Provide data on care process and provider behavior
Must be updated to stay smart
Subject to programming errors
Will ensure that the order is complete (checks for drug interactions, duplications, or allergy contraindications, the right dose and right route
Provides double checks for interactions, allergies and appropriate dose orders during verification and dispensing.
Assists with infusion pump programming issues such as incompatibilities during infusion and proper notation and dispensing when portions of a dose must be wasted.
Checks for interactions with foods or other medications
Provides patient education guidelines and printable handouts
The monitoring functions of the CDS provide a structured data reporting system to track side-effects and adverse events across the population
SIMpill Medication Adherence System
Caps of pill bottles may contain RFID tags that monitor and collect data on when the bottle is opened, or contain flashing time reminders when a dose is due (Blankenhorn, 2010).
Smart inhalers track asthma medication compliance using a microprocessor that records and stores medication compliance.
Improves cost-effectiveness- alerting clinicians to “duplicate testing” orders (can put time frames into system), or suggesting the most cost effective diagnostic test based on specific patient data
track medical supplies and equipment
imbedded into surgical supplies to automate supply counting procedures
reduce the likelihood of wrong patient, wrong site surgical procedures
reducing the potential that a incorrect medication is inadvertently introduced into the supply, and providing for efficient medication recalls
specialized tags can detect temperature fluctuations and thus ensure that the blood or blood product was stored at the optimum temperature for safe administration
Clinicians review patient data in real time and chart at the bedside using touch screen technology
Alert clinicians as they enter the room about procedures that need to be implemented for the patient and can track individual clinician efficiency and effectiveness by aggregating data over time
Wireless chip on a disposable band-aid with a 5-7 day battery promises to be able to monitor the patient’s heart rate and electrocardiogram, blood glucose, blood pH, and blood pressure, allowing for the collection of important clinical data outside the hospital