DiversityNursing Blog

Med/Surg Nurses Use Informatics To Save Time, Enhance Patient Safety

Posted by Erica Bettencourt

Mon, Apr 20, 2015 @ 11:08 AM

By Tracey Boyd

http://news.nurse.com

describe the imageInformatics programs that allow med/surg nurses to cut down on documentation and increase patient safety at the touch of a button are becoming more essential in today’s fast-paced healthcare environment.

“Most all nurses use the electronic health record in their daily practice,” said Jill Arzouman, MSN, RN, ACNS-BC, CMSRN, president of the Academy of Medical-Surgical Nurses and clinical nurse specialist in surgical oncology at the University of Arizona Medical Center, Tucson. The university has computer stations inside each patient room for access to charting, she said, and some hospitals are investing in iPads to facilitate charting. Arzouman is a DNP candidate.

Med/surg nurses at New York’s Montefiore Health System in the Bronx use informatics throughout the day to document patients’ electronic medical records and provide direct care to patients, said Maureen Scanlan, MSN, RN-BC, vice president, nursing and patient care services and former director of informatics for the health system. “Electronic documentation has provided us the ability to track and trend patient outcomes data in a more efficient manner. We have the added benefit of decision support alerts to guide practice and documentation. We then can leverage information collected from the records to streamline workflows and improve patient safety.” 

According to a HealthIt.gov study “Benefits of EHRs,” (www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes), having quick, up-to-date access to patients’ information can also reduce errors and support better patient outcomes by keeping a record of a patient’s medications or allergies, checking for problems whenever a new medication is prescribed and alerting the clinician to potential conflicts. 

“The ability to clearly read a medication order printed from a computer is vastly different than trying to decipher a handwritten order,” said Arzouman.

In addition, staff can revisit patient information at any time. 

“Many of the systems are very intuitive and allow the entire interdisciplinary team to document and communicate with precision and ease,” she said “A medical/surgical nurse may be busy with another patient but she or he can go back and read documentation from the dietitian who may have visited the patient at the same time.“

A reduction in medication errors was the catalyst for a project using computerized EHRs at Abington (Penn.) Health. When staff realized that patients with heart failure were being readmitted largely because of incorrect medication lists upon discharge, Diane Humbrecht, MSN, RN-BC, chief nursing informatics officer, devised a plan to evaluate the accuracy of such lists. 

Humbrecht, a DNP candidate who is also a chapter director for the American Nursing Informatics Association, has worked in both cardiac and home care during her career and said she had experienced heart failure patients going home with medication lists that were either incorrect or missing information. 

“It was very frustrating for both the patient and the nurse who is trying to follow up,” she said.

As part of her DNP program, Humbrecht decided to focus on transitions of care for this vulnerable population to help correct their discharge medication instructions and reduce their risk for readmission.

“As I began researching, I saw medication errors on medication discharge lists were the main reasons patients were readmitted to the hospital,” she said. •

Her findings were validated, she said, when the transition nurses who were involved in the postop discharge process informed her of problems with patients going home with incorrect medication lists. “Medication reconciliation and discharge instructions are done by the physician, but the nurses are the ones who review them and they were finding these errors after discharge,” she said. 

Humbrecht implemented three changes to remedy the situation. The first step was to bring the pharmacists in on the front end. Pharmacists already performed patient rounding on units, but they were not involved in medication reconciliation at all, she said. The new protocol called for pharmacists to come in within 24 hours of a patient’s admittance to review the co-medications. The input from the pharmacists on the front end was crucial. “The pharmacists had to change about 80% of the lists,” Humbrecht said.

Next, upon discharge, the nurses perform a thorough review of the co-medications list that was corrected by the pharmacist. “If anything needed to be corrected, the nurse then called the physician to tell them they need to change a medication,” Humbrecht said. “Once that was done, it caused the physician to perform medication reconciliation again, automatically updating the entire medication list.” 

The transition nurses were the final piece to the puzzle. Prior to the new protocol, upon calling the discharged patient and finding any errors, the nurse would make notations on paper. If the patient was readmitted, and the change was not transferred onto the patient’s EHR, the incorrect information was still in the system. Now, using the computerized medication list, any errors are updated immediately in the system. 

The changes worked. Since implementation last fall, the transition nurses have found one error on the medication list of a discharged patient, Humbrecht said. 

“We figured if we can get the home medication list correct on the front end by using the pharmacists and double-checked and changed as needed by the nurses on the back end, then the transition nurses should find less errors,” she said.

Besides documentation and patient safety, med/surg nurses are using informatics to enhance patient care. “Our staff nurses provide expert advice when we are defining a new process for delivering patient care,” said Scanlan, who holds board certification in nursing informatics. “A recent implementation of a new lab system that changed the way specimens are collected was successful due to workflow and hardware recommendations from the frontline staff.” 

Scanlan said staff nurses recently have contributed to revising the electronic skin assessment template as well. 

“Although not a clear time saver,” she said, “it has significantly improved the ability to track, trend and communicate hospital-acquired pressure ulcers [and] has supported performance improvement efforts that are led by the nursing staff.”

Arzouman also noted innovative uses. “For a postoperative patient who needs to continue to ambulate and exercise while at home, a medical/surgical nurse can teach the patient how to track his activity using a smart phone app,” she said. “I have had the opportunity to trial an app on my smart phone that translates basic medical information into many different languages without needing to use a translator. For something simple like ‘Hi, my name is Jill and I will be the nurse coordinating your care today,’ it is a very helpful tool.” 

Topics: EHR, nursing, health, healthcare, nurse, nurses, data, electronic health records, med/surg, informatics

Implementing Electronic Health Records at Healthcare Organizations

Posted by Erica Bettencourt

Mon, Apr 13, 2015 @ 11:26 AM

Ohio University's Master's of Health Administration Online Program

http://healthadmin.ohio.edu

OU MHA EHR resized 600

Topics: EHR, health, healthcare, medical, infographic, electronic health records

Health Literacy And The Use Of The Internet Lacking Among Seniors

Posted by Erica Bettencourt

Mon, Nov 17, 2014 @ 12:17 PM

By  John DeGaspari

EHR Lead Art

Using the Internet to access health information may be out of reach for many older Americans, according to a study by researchers at the University of Michigan. According to the study, less than one-third of Americans age 65 and older use the Web. Within that age group less than 10 percent of those with low health literacy, or who lack the ability to navigate the healthcare system, go online for health-related matters.

The results of the study have been published in the Journal of Internal Medicine. Data was analyzed from the 2009 and 2010 Health and Retirement Study, a nationally representative survey of older adults; about 1,400 of the participants were asked about how often they use the Internet for any purpose, and, in particular, how often they search for health and medical information.

Health literacy was found to be a significant predictor or what people do once they are online. Elderly Americans with low health literacy are less likely to use the Internet at all, according to the researcher; and if members of this group do surf the Web, it is not generally to search for medical or health information.

“In recent years, we have invested many resources in Web-based interventions to help improve people’s health, including electronic health records designed to help patients become more active participants in their care,” according to lead author of the study Helen Levy, Ph.D., research associate professor at the University of Michigan Institute for Social Research, in a prepared statement. “But many older Americans, especially those with low health literacy, may not be prepared for these tools.”

Senior author Kenneth Langa, M.D., a professor of Internal Medicine at the University of Michigan Medical School, cautions that as the Internet becomes more central to health literacy, older Americans face barriers that may sideline them. He recommends that “Programs need to consider interventions that target health literacy among older adults to help narrow the gap and reduce the risk of deepening disparities in health access and outcomes.”

Source: www.healthcare-informatics.com

Topics: studies, EHR, technology, health, healthcare, patients, elderly, seniors, Internet

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