Foundations Exam 1

Informatics

-encompasses more than just healthcare (all of online systems)

-medical informatics- looking at how technology affects healthcare

• where documentation goes, guidelines from medical systems

• mobile tech: laptops, iPads, computer workstations, smartphones

• bedside tech: hemodynamic monitors (BP, HR), handheld testing (US, glucose monitoring), bar code tech, IV pumps

• communication tech: voice-activated systems, Google Glasses, electronic prescriptions, smart cards

• robotics: hospital delivery, surgery

• telehealth- tech that allows healthcare at a distance

  • remote monitoring- hospital, home care

  • telemedicine- provider-based

  • telenursing- education, results

• wearable and implantable tech: heart monitoring, sleep apnea, glucose management, track compliance

-nursing informatics- where nurses interact with technology to provide care for their patients

Informatics Concerns

-legal, ethical, professional, and practice concerns

• verbal orders (take order from provider over phone, not put into writing)- not used much anymore bc of advanced technology

  • creates higher error probability

• privacy and confidentialty- make sure patient info is kept safe

  • HIPAA- breach (has significant sanctions

  • eliminate password sharing

• social media

-technology limitations

• work-arounds- eliminate some standards that are followed to reach end point to allow tasks to be done faster

  • often bypass safety checks and can lead ot more patient harm

• health disparity- technology can be expensive

• information control

• expensive

• adaptation to new- creates a learning curve

• over reliance

  • down time- updating servers, fix bugs (time without access to health records)

Benefits of Informatics in Healthcare

-acccess and security

• single sign on- speed up ability to provide care and keeps security

• badge access

• biometrics- use fingerprinting

• tracking- can see who took meds, opened system, and who was in rooms

-improves healthcare efficiency

• bed management systems

• scheduleing systems

• how to: decrease costs, spread resources, increase satisfaction

-improved quality and safety

-standardized terminologies

Electronic Health Record

-health record- entire chart of patient with all information over lifespan

-medical record- specific for each time going to doctor/hospital

• add up together to create health record

-documentation

• who

• what

• when- should be immediately after it occurs (med administration!!)

• why- to communicate with other members of health care team

-healthcare documentation

• charting by exception (chart what is outside of normal)

• eMAR- contains medication, allergy alerts

  • scanning for safety

• General EHR benefits: visible to all, data trending, lab value interpretation, computerized provider order entry

Electronic Health Record Purpose

-patient care and assessments (tracking)

-Medication Administration Record (MAR)

-orders and results- new orders and results

-notes and consults- forn other specialties

-care plans

-discharge documents

Written Medical Records (pen and paper)

-benefits (independent)

• can be used to look at flow of patient from one area to another

• VS, consults

• can be more descriptive about patient

• not dependent on technology (can be used in downtime)

-tradeoffs

• time consuming

• hard to collect data to trend

Nurse Role in Medication Administration

-knowledge

-clinical judgment- questioning why certain medications are ordered (should you give them?)

-safety- correct dose calculation, 6 ‘rights’

-education

-evaluation

Preparing to Administer:

• assess patient

• ensure adequate knowledge (of nurse and patient)

• triple check for safety (check med 3x) 3 P’s

  • when med is pulled, prepared, and presented (scanned)

Pharmacokinetics

-how medications enter the body and how they reach where they need to be (site of action) before being excreted out of the system

• dictates how: meds should be given, when to give, and how to evaluate

-absorption- from when person takes med until it hits the bloodstream

• lots of variability based on route given

• orally (takes ~ 1hr vs. IV (nearly instant) vs. inhalation

-distribution- bloodstream to where it needs to go

• ie. sit of infection

• this is when you evaluate

-metabolism- how quickly does it metabolize/break down

• days, weeks, months, etc.

-excretion- medicaiton is out of body

• matters heavily for timing/frequency of doses

Medication Order

Components: (need all to give medication)

• patient’s full name

• date and time written

• dose

• route

• frequency

• signed by provider

• sometimes specific instructions

Interpretation

1. name of medication (colace)

2. dose (100mg)

3. route (po- by mouth)

4. frequency (tid- three times daily)

Types of Medication Orders

Inpatient Medicaiton Orders:

• standing/routine- for admitted patients, have order their entire stay, longstanding

• prn- given as needed, for a reason (always have extra instructions)

• single/one time- taken once

• STAT- immediately (ie epipen)

• Now- a little more time than STAT (given within the hour)

Outpatient Medication Orders:

• have prescrptions (Rx)- after discharge, picked up and pharmacy and give medications to themselves

Components of Drug Label

-drug name

-form- determined by route and how medication is packaged

• solid- tablets, capsule, powder, suppository, extended release

• liquid- solution, syrup, suspension, spray, sterile liquid injection

• semisolid- cream, lotion, ointment

-dosage strength- amount in each unit of measurement (ie. 250mg capsule)

• vs. dose- ordered amount

-route- how it’s administered (need to know if can be crushed/split)

• enteral (oral, buccal (in cheek), sublingual (under tongue)

• topical

• inhalation (spray, mist, nebulizer)

• mucus membrane (optic, otic, intranasal, vaginal, rectal)

• parenteral (IV, IM, subcut)

-instructions and warnings

-expiration and lot number

-manufacturer

Generic vs. Branch Name

• Generic- universal name that is legally required

  • less expensive

  • only one ie. ibuprofen

• Brand- trade/proprietary name with multiple options

  • specific to that company

  • many ie. Advil, Motrin

‘Rights’ of Medication Administration

-right medication- given correct med

• med storage and distribution

  • medication rooms

  • automated medication dispensing systems (Pyxis)

  • carts

-right dose

• ensure correct amount for patient

• double check calculations

• confirm with another nurse (for higher risk meds)

• only given meds you have measured and prepared

-right patient

• 2 identifiers (name & DOB)

• visually look at arm band to confirm

-right route- cannot be changed without new order

• nonparenteral- eteral (GI), topical, mucous membranes, inhaled

• parenteral- IV, IM, subcut

-right time- between doses

• time-critical meds

• more frequently than once daily (must be given within hour of scheduled time)

• daily, weekly, monthly

-right documentation- everything scanned into computer system

Medication Saftey

Strategies

• higher alert medications (have higher side effects)

• sound alike/look alike

  • Tallman lettering to differentiate

• do not use list

  • Abbreviations identified with medication errors

  • always have leading zero (0.8) but never trailing (8.0)

• BEER’s list- medications that should be avoided or have dosage considerations for older patients

Barcode Medication Administration (BCMA)

• reduce errors

• included in final check

• process- scan patient and 2 identifiers, scan medications, open and give, document

Age-related concerns

• infants/children

  • verify calculations (typically based on weight)

  • developmental stage- syringe (baby) vs cup (older child)

  • involve parents

• older aults

  • polypharmacy

  • slowed processing of meds

  • functional status

Medication Errors

-potental causes

-prevention- one patient at a time

• verify order and ensure knowledge

• adminitration concerns

• documentation!

-actions following an error

Incident Reports

• report sentinel events (things that shouldn’t have happened did) and near misses

• purpose- to better track possible system/hospital-wide flaws

• what do you do?

  • first ensure patient is okay

  • then contact provider about occurrence and go up chain of command

• prevention

Medication Administration Process

-preparation

• assessment

• pateitn and nurse knowledge

• dosage calculations

• obtain meds and do check

• 6 rights

• second check as preparing

-administration

• third check when scanning and giving meds

-dcoument- when and what given

-evaluation- medication effects

• therapeutic

• adverse- side effects, toxicity, allergic reaction

• ability to self administer

Med Calculations

-practice problems 🙂