Nursing Informatics in Clinical Practice

Sources of Data

• Patient Monitoring

• Nursing-Generated Assessment Data

• Documentation

Types of Patient Monitoring

• Basic Vital Sign Monitors

• Advanced Multi-Paramenter Monitors

• Fetal Monitors

• Remote Patient Monitoring

Basic Vital Signs Monitors

• Pulse Oximeter

• Thermometer

• Blood Pressure Monitor

• Heart Rate Monitor

Advanced Multi-Paramenter Monitoring Device

• ECG

• CGM

Fetal Monitors

Used during pregnancy and labor to monitor fetal heart rate

Remote Patient Monitors

• Smart Scales

• Wearable Heat Monitors

• Bluetooth-Enabled Devices

• Implantable Cardiac Monitors

• Implantable Glucose Monitors

Source Data Capture

• Fathering Fata from the patient

• Reduces time spent om documentation of care & eliminated redundancies & inaccuracies

Electronic Source Data Capture

Accessing research data from Electronic Health Record

Source Data Verification

Used in research wherein data from clinical trial collections are compared to source information

Point of Care Information System

• Computer data entry must occur wherever patient is found

• Easy access of information to other healthcare providers involved

Automated Dispensing Cabinets

Lockable Drawers that staff members load dose-specific medications

MedLink Cart

Automatically records the action in the Patient’s EMR

Point of Care Information System Evaluation Points

• Allow Nurses t interact with the man info. system

• Interfaces with the existing hospital info. system

• Allows the open system concept (universally compatible”

• Small foot print

• Easy to use and adapt in a nursing environment

• East to disinfect and clean between patients

• multiple ways of data entry

• Portable and monile

• Quick and easy to understand

Ideal Nurses Notes

• Lengthy

• Problem-focued Narrative

• Handwritten

• Unbiased

Automated Documentation Methods

• Digital Library

• Branching Questionnaire

Digital Library

The nurse chooses phrases that best describe the patient’s condition

Branching Questionnaire

A Display of choices is shown by the terminal that displays a further list of choices when clicked; more customizable

Advantages of Automated Documentation

• Content standardization

• Improved compliance to standards

• Increased efficiency

• Enhanced timeliness

• Expanded accessibility

• Augmented data archive

Electronic Health Record

A digital version of patient data that his found in traditional health records (lifetime record)

Electronic Medical Record (EMR)

Legal record that describes a single encounter of visit created in hospitals and out-patient health care settings

Advantages of EHR

• Improved quality of patient care through inter professional collaboration with improved data availability & information synthesis

• Improved patient safety through the use of clinical decision supply

Risks of EHR

• Data Privacy

• Confidentiality

• Security

Types of Electronic Health Records

• Cloud-Based EHR Systems (SaaS EHR)

• Client-Server EHR Systems (On-premise EHR)

• Hybrid EHR System

• Standalone EHR System

• Open Source EHR System

Cloud-Based EHR System (SaaS EHR)

• Web-based

• Stores patient information on remote secure servers through the internet

• Access records anytime and anywhere

• Automatic backups and updates

Client-Server EHR Systen (On-Premise EHR)

• Software is installed on a local server within the organization’s premises

• Users accesses application through personal devices

• More local control on security issues

• Customizable options

Hybrid EHR System

• Combination of Cloud-based & Client-server systems

• Flexible access of patient records while having added security by storing some data locally

Standalone EHR system

• Software programs not integrated with/ any other healthcare technology

• offer basic functionalities like recording patient information, scheduling appointments, & generating reports

Open Source EHR systems

• Contains open-source codes that allow users to modify & customize software specific to their needs

• Updates and new features can be developed by a community of developers

Mobile EHR system

• Allow healthcare professionals to access patin records on mobile deives

• Provides care on-the-go

Privacy, Confidentiality & Security Mechanisms

• Protection of information & computer system is a priority

• Access & Confidentiality of Personal Health Information (PHI) is a shared Responsibility of the healthcare team

• Logical & Physical Restriction are needed to protect information

• Firewalls, antivirus, & spyware detection software are essential

• Physical Security measure must be installed

• Access or log-in codes along with/passwords must be used for authentication of users.

• Passwords should not ne shared

• Tracking of patient access should be done

• Consequences should occur to health care personnel that inappropriately access patient information.

Handling & Disposing Information

• Destroy anything with information when it is no longer needed

• De-identify all PHI, keep documents secure, and destroy documents by shredding or disposal in a locked receptacle ASAP

• Destroy all paper with PHI immediately after you use/fax/email them

Kardex System

• A desktop file system that gives a brief overview of each patient and is updated everyshift

• Usually outdated, illegible, irrelevant, inconsistent, and incomplete

Automated System

• involves designing care maps ro pathways for meeting patient needs, storing them in computer memory banks, then adapting them to individual patients.

Automated Care Planning Advantages

• Saves Time

• Increased accountability

• Increased consistency of care

• Decreased errors of omission and commission

• Judgment for nursing care is the responsibility of professional nurse who has tools of making judgments

Decision Support Systems

Computer applications designed to facilitate human decision-making processes

Clinical Decision Support Systems (CDSS)

A computer-based program designed to assist clinicians in making clinical decision by filtering or integrating a lot of information and provide suggestions for clinical intervention

Clinical Decision Support Systems (CDSS) Order

1. Encode assessment at bedside

2. Computer analysis

3. Recommendation of nursing diagnosis/care plan

4. Nurse accepts or rejects recommendations

Example of CDSS

• Computerized alerts and reminders

• Clinical guidelines

• Order sets/ Standing Orders

• Pre-defined sets of orders for particular conditions, ensuring consistency and efficiency

• Diagnostic support

• Therapeutic decision support

Decision Support System Advantages

• Supplements the nurses’ collection of interventions

• Addresses the nurses “Forgetting” curve by serving as a “reminding function”

Decision Support System Disadvantages

1. Not appropriate for emergencies & high complex patient problmes

2. Can never replace a nurses expert clinical & decision making skills

Implementation

Digital devices rarely help the nurse in the giving of care o nursing processes

Evaluation

Real-time auditing quality improvement and management

Methods of Implementation in Clinical Practice

1. Direct Approach

2. Parallel Apporoach

3. Modular Approach

Direct Approach

• Direct installation of new system with immediate discontinuance of the old existing system

• “cold turkey approach”

Direct Approach

• New system does not replace the old system

• Old system is regarded absolutely of no valuue

• New system is compact and simple

• Design of nEw system is cheap and has more advantages and less risk

Parallel Approach

• New system is installed and operate with current system

• Expensive method due to maintaining two systems

• Fixed Target date to fully replace old system with new system

Modular Approach

• “pilot approach”

• Implementation of a system in the organization on a piece-meal basis”