What is one new thing you learned in this module, or something that you knew but had forgotten?
Well, there is definitely more than one thing that I learned in this module. One point that stands out is in regards to the email use at the University of Utah. I did not realize that email was not considered to be a secure way to share information; who knew that by putting “phi” in the subject line you could send email through a system that is secure and encrypted.
In scanning the article “10 Tips to secure your Laptop”, I realized how little I knew about the safety and security of laptops and computers (Strom, 2007). I believe that this article has taught me several tools and given me resources to secure the use of my computer both at home and on the go. The tips and tools that I was unfamiliar with included securing my connection and using a frequency that is not being used by others (Strom, 2007).
A last piece of information that I learned throughout this module was in regards to Electronic Health Records. I never realized that it was in fact President Bush who mandated a plan that would allow all Americans to access their electronic health record. To implement this plan, he appointed an official at the Department of Health and Human Services to digitalize the United States health care industry (Schwartz, 2004).
References
Strom, D. (2007). Ten Tips to Secure your Laptop. Information Week. Retrieved from
http://www.informationweek.com/story/showArticle.jhtml?articleID=203102748.
Schwartz, N. (2004). A prescription for electronic health records. The Information
Management Journal, July/August 2004, 20-26.
Tuesday, March 29, 2011
Tuesday, March 22, 2011
Module Five
1. How did the readings influence your perception of your own clinical decision-making?
Clinical decision support systems are a tool designed to help improve accuracy with patient diagnoses (Courtney, Alexander and Demiris, 2008). Clinical decision support systems exist in four different ways in terms of providing patient care; systems use alerts to respond to clinical data, respond to decisions to alter care by critiquing decisions, suggest interventions at the request of care providers and conduct retrospective quality assurance reviews. Clinical decision support systems exist for diagnosing chest pain, ventilator management and HIV treatment and guidelines (Courtney, Alexander and Demiris, 2008).
The readings helped me to realize the widespread use of clinical decision support systems used in my own clinical decision making. The readings allowed me to appreciate the systems that were in place to help in patient care activities. Before the readings, I never put two and two together that there was such an abundance of clinical decision support systems in use at my work place.
Starting in triage, we have a sepsis alert system that with uses the collection of danger vital signs and complaint category to notify the nurse of the possibility of sepsis and to consider drawing blood cultures, a serum lactate, fluid resuscitation and antibiotics within three hours. This system prints out an extra triage sheet to bring attention about the possibility of sepsis to the other caregivers, including the physician.
Also in triage, we have a clinical decision support system in place to evaluate any of our patients that present with the chief compliant of ‘overdose’, ‘psych’ or ‘depression’. With any of these chief complaints, the system automatically asks the nurse three questions in relation to safety of the patient; a yes to any one of the three questions directs the nurse to implement a patient safety attendant to ensure the safety of the patient and the staff.
The last clinical support system through triage is our fall risk protocol. At the end of each triage process, criteria come up on the screen to help the nurse determine the fall risk of the patient. If it is chosen that the patient is a fall risk, interventions such as a sign on the patients door are displayed for the nurse to implement.
During direct patient care, we have a critical lab value alert system that allows us to be notified of critical values that our patients have in their results. This system is easily noticed, demonstrated by a black box on the tracking system. Lab alerts must be accepted with comments noted prior to any disposition of a patient, ensuring that the nurse and doctor communicate about these values.
Prior to discharge, we have a system through tandem that forces us to review medications and vital signs. This system helps us with patient care in two ways. First, it allows us to review all medications that were given to the patient, it ensures that we put stop times on all fluids and antibiotics, and it allows us to evaluate as to whether the patient is ready for discharge or within the hour monitoring window of narcotic administration. Second, the system serves as a reminder to document a discharge set of vital signs, and to notify the physician if those vital signs are abnormal in any way.
In addition to these ‘cues’ that are present in my clinical decision making, support systems are also in place for other reasons. We have an antibiotic helper that can guide physicians through the selection and dose of antibiotics. We also have an Emergency Department sepsis protocol that can help guide both physicians and nurses to the interventions required on septic patients. Clinical decision support systems are there to provide help and resources to care givers. Through the readings, I have realized how important these support systems are. In today’s busy healthcare world, support systems are vital to ensure that important information does not go unnoticed.
References
Courtney K. L., Alexander G.L. & Demiris, G. (2008). Information technology from novice to expert: Implementation implications. Journal of Nursing Management, 16(6), 692-699.
Clinical decision support systems are a tool designed to help improve accuracy with patient diagnoses (Courtney, Alexander and Demiris, 2008). Clinical decision support systems exist in four different ways in terms of providing patient care; systems use alerts to respond to clinical data, respond to decisions to alter care by critiquing decisions, suggest interventions at the request of care providers and conduct retrospective quality assurance reviews. Clinical decision support systems exist for diagnosing chest pain, ventilator management and HIV treatment and guidelines (Courtney, Alexander and Demiris, 2008).
The readings helped me to realize the widespread use of clinical decision support systems used in my own clinical decision making. The readings allowed me to appreciate the systems that were in place to help in patient care activities. Before the readings, I never put two and two together that there was such an abundance of clinical decision support systems in use at my work place.
Starting in triage, we have a sepsis alert system that with uses the collection of danger vital signs and complaint category to notify the nurse of the possibility of sepsis and to consider drawing blood cultures, a serum lactate, fluid resuscitation and antibiotics within three hours. This system prints out an extra triage sheet to bring attention about the possibility of sepsis to the other caregivers, including the physician.
Also in triage, we have a clinical decision support system in place to evaluate any of our patients that present with the chief compliant of ‘overdose’, ‘psych’ or ‘depression’. With any of these chief complaints, the system automatically asks the nurse three questions in relation to safety of the patient; a yes to any one of the three questions directs the nurse to implement a patient safety attendant to ensure the safety of the patient and the staff.
The last clinical support system through triage is our fall risk protocol. At the end of each triage process, criteria come up on the screen to help the nurse determine the fall risk of the patient. If it is chosen that the patient is a fall risk, interventions such as a sign on the patients door are displayed for the nurse to implement.
During direct patient care, we have a critical lab value alert system that allows us to be notified of critical values that our patients have in their results. This system is easily noticed, demonstrated by a black box on the tracking system. Lab alerts must be accepted with comments noted prior to any disposition of a patient, ensuring that the nurse and doctor communicate about these values.
Prior to discharge, we have a system through tandem that forces us to review medications and vital signs. This system helps us with patient care in two ways. First, it allows us to review all medications that were given to the patient, it ensures that we put stop times on all fluids and antibiotics, and it allows us to evaluate as to whether the patient is ready for discharge or within the hour monitoring window of narcotic administration. Second, the system serves as a reminder to document a discharge set of vital signs, and to notify the physician if those vital signs are abnormal in any way.
In addition to these ‘cues’ that are present in my clinical decision making, support systems are also in place for other reasons. We have an antibiotic helper that can guide physicians through the selection and dose of antibiotics. We also have an Emergency Department sepsis protocol that can help guide both physicians and nurses to the interventions required on septic patients. Clinical decision support systems are there to provide help and resources to care givers. Through the readings, I have realized how important these support systems are. In today’s busy healthcare world, support systems are vital to ensure that important information does not go unnoticed.
References
Courtney K. L., Alexander G.L. & Demiris, G. (2008). Information technology from novice to expert: Implementation implications. Journal of Nursing Management, 16(6), 692-699.
Monday, March 14, 2011
Module Four
The Emergency Department is a source of teaching in many ways. The Emergency Department is a portal to health care for many patients, including those who do not have a primary care physician, those who do not have insurance, those with disease processes and those seeking crisis support or services.
In terms of patients without insurance or without a primary care doctor, the Emergency Department can be a valuable tool for education purposes. We as providers can educate patients on preventative measures, care resources and the importance of primary care. We can also teach patients about free resources available in the community such as low cost health and dental clinics and medication resources.
In terms of patients who already suffer from specific disease processes and consequences, we can educate them about life style modifications that can help alleviate symptoms of the disease process. We can educate them about the importance of following their specific medication regiment, about the importance of following physician recommendations and about signs and symptoms to report immediately to their physician or Emergency Department.
In terms of patients seeking crisis support or services, we can educate them about the availability of mental health professionals, about the importance to seek help immediately about any thoughts of self harm and about the resources and support groups available to these patients.
In general, patients in the Emergency Department should be taught at all points of their visit. Patients can be taught about medication side effects, precautions of medications given in the department and signs and symptoms to look out for demonstrating a need to return to the department. Emergency Department patients are very vulnerable, and every attempt should be made to provide them with education and resources.
I believe that every nursing and health care provider role involves some aspect of teaching. Whether it is the endoscopy nurse doing discharge teaching to a patient or the nurse educator of a hospital unit providing education to employees, every health care professional should include teaching in their daily regiments.
I feel that if nursing and health care providers are not involving teaching in their roles, they are providing a disservice to their patients. Having a patient in an office, clinic or hospital provides a great opportunity for teaching and education. When people are sick, they are looking for tools to help them improve their health, and health professionals are ideal people for that job.
In terms of patients without insurance or without a primary care doctor, the Emergency Department can be a valuable tool for education purposes. We as providers can educate patients on preventative measures, care resources and the importance of primary care. We can also teach patients about free resources available in the community such as low cost health and dental clinics and medication resources.
In terms of patients who already suffer from specific disease processes and consequences, we can educate them about life style modifications that can help alleviate symptoms of the disease process. We can educate them about the importance of following their specific medication regiment, about the importance of following physician recommendations and about signs and symptoms to report immediately to their physician or Emergency Department.
In terms of patients seeking crisis support or services, we can educate them about the availability of mental health professionals, about the importance to seek help immediately about any thoughts of self harm and about the resources and support groups available to these patients.
In general, patients in the Emergency Department should be taught at all points of their visit. Patients can be taught about medication side effects, precautions of medications given in the department and signs and symptoms to look out for demonstrating a need to return to the department. Emergency Department patients are very vulnerable, and every attempt should be made to provide them with education and resources.
I believe that every nursing and health care provider role involves some aspect of teaching. Whether it is the endoscopy nurse doing discharge teaching to a patient or the nurse educator of a hospital unit providing education to employees, every health care professional should include teaching in their daily regiments.
I feel that if nursing and health care providers are not involving teaching in their roles, they are providing a disservice to their patients. Having a patient in an office, clinic or hospital provides a great opportunity for teaching and education. When people are sick, they are looking for tools to help them improve their health, and health professionals are ideal people for that job.
Monday, February 28, 2011
Module Three
The electronic index that I used was the Cumulative Index to Nursing and Allied Health Literature, or CINAHL. CINAHL and other electronic indexes are effective to find journal articles on specific topics. In order to use these indexes appropriately, one must have an idea as to what they wish to research and the ability to use tools within the index to narrow down the idea to specific research topics. The electronic indexes are useful for several reasons. CINAHL allows the user to search major headings and terms and then explode those major headings to include subheadings and ideas. By scanning articles within CINAHL, the user can identify major terms that are used within the articles that pertain to the research topic. Once terms are identified, the user can go back and forth between searches and results lists to further narrow down their topic. In addition, the electronic indexes allow the user to easily organize and save journal articles. Finally, the electronic indexes, when accessed through the University VPN, allows for access to full text articles at no cost.
A guideline index such as the National Guideline index by Clearinghouse allows the user to research specific guidelines on treatment and disease processes. This was the first time that I researched using a guideline index and I thought that it was a very valuable and useful tool. The information on the guideline index was up to date, and provided a public resource for evidence based clinical practice guidelines. The site also allowed for comparison between different treatment guidelines and outcomes. This site is very specific to clinical practice, and would be very useful in addressing specific topics in relation to clinical practice and patient treatment regimens.
The web search engine that I used was Google. Web search engines allow the user to search on any topic of choice. Results within the web search engine include Books, Journal articles, and web pages for organizations, private web pages, facebook entries, personal opinions and blog entries. I feel that the web search engines are useful in simple searches such as definitions and allow access to specific organization sites such as the American Heart Association and drug search indexes. The web search engines help the user to expand ideas about a specific search and allow the user to see related terms and suggestions. There are several downsides to search engines. First of all, results can include public opinion and may not be based on evidence based practice. Second, journal articles may not be available for public use without a steep purchase price. Finally, search engines may provide the user with information that is not relevant to the search at hand.
I think that in performing searches in relation to clinical practice and research topics, the use of multiple sites and search engines provide the user with the broadest coverage of the topic at hand. By using a combination of resources, all research in relation to the topic can be accessed.
A guideline index such as the National Guideline index by Clearinghouse allows the user to research specific guidelines on treatment and disease processes. This was the first time that I researched using a guideline index and I thought that it was a very valuable and useful tool. The information on the guideline index was up to date, and provided a public resource for evidence based clinical practice guidelines. The site also allowed for comparison between different treatment guidelines and outcomes. This site is very specific to clinical practice, and would be very useful in addressing specific topics in relation to clinical practice and patient treatment regimens.
The web search engine that I used was Google. Web search engines allow the user to search on any topic of choice. Results within the web search engine include Books, Journal articles, and web pages for organizations, private web pages, facebook entries, personal opinions and blog entries. I feel that the web search engines are useful in simple searches such as definitions and allow access to specific organization sites such as the American Heart Association and drug search indexes. The web search engines help the user to expand ideas about a specific search and allow the user to see related terms and suggestions. There are several downsides to search engines. First of all, results can include public opinion and may not be based on evidence based practice. Second, journal articles may not be available for public use without a steep purchase price. Finally, search engines may provide the user with information that is not relevant to the search at hand.
I think that in performing searches in relation to clinical practice and research topics, the use of multiple sites and search engines provide the user with the broadest coverage of the topic at hand. By using a combination of resources, all research in relation to the topic can be accessed.
Tuesday, February 1, 2011
Module Two
According to Hebda and Czar, an information system can be defined as the use of computer software to process data into organized information to solve a common problem (2009). When specific to a hospital setting, the information system can be referred to as a hospital information system and can be further divided into two systems including a clinical information system and an administrative information system. A clinical information system is used to directly manage patient care and can include nursing, lab, radiology, pharmacy, medical information and physician practice management systems. An administrative information system is used to provide support and resources to patient care and can include patient registration, payroll, scheduling, human resources, risk management and quality assurance systems (Hebda and Czar, 2009).
Many information systems are currently in use in the Emergency Department at Intermountain Medical Center. We use a nursing information system to chart patient care and responses. We use an order entry system for lab, radiology and pharmacy orders and we use an Emergency Department system to allow for patient tracking and discharge and follow up instructions. On the administrative side, information systems that are used include patient registration, scheduling systems, human resources and payroll.
There are several ways that I could become involved in designing, selecting, evaluating or implementing an information system in the Emergency Department at Intermountain Medical Center. First of all, designing a monitoring system for patients within the Emergency Department would be a project that would save time and improve patient care and documentation. In the department, we currently have monitors in each of the rooms. The monitors may be programmed to automatically check certain patient measurements such as heart rate, respiratory rate and blood pressure. It is the responsibility of the nurse to manually type in each measurement every time that it is checked. By having a system that automatically uploads these measurements to the patient’s computer chart, it would ensure that measurements were not forgotten, it would allow for a more precise documentation and it would guarantee that the measurements are part of the patient’s chart, regardless of how busy the nurse is. By having a complete list of these measurements in a patient chart gives physicians remote access to the measurements and allows for admitting physicians to see trends within the measurements.
Second, designing an information system within the patient chart that allows the computer to ‘remember’ patient history would save time and money. In the Emergency Department, we triage each patient as they come in to be seen. This can sometimes be a tedious process as we must enter past medical history, medications and allergies each time the patient comes in to be seen. For some patients, a list of medications is unheard of and this triage process can turn from 3 minutes to 15 minutes, wasting valuable time that could be spent talking to the physician. By having a system that ‘remembers’ patient history, the only necessary information on subsequent visits would be the reason for the visit and an update to the medication list. This would ultimately shorten patient length of stays and improve door to doctor times in the Emergency Department.
Finally, an information system that could be evaluated in the Emergency Department is the sepsis alert system that notifies the nurse based on triage vital signs as to whether the patient may be at an increased risk for sepsis. I believe that this system could be evaluated for several reasons. The alert system does not take into account the age of the patient, so often times we get a sepsis alert on pediatric patients with normal vital signs. Second, the alert system only makes the alert during the triage process; it would be interesting to audit the charts that did get the alert to see if the patient did in fact have sepsis and to see if the patients did in fact get treated within the three hour time frame. Finally, a test system could be put into effect to have the sepsis alert come up in both triage and for the patient care nurse. This could serve as a reminder to the patient care nurse about the sepsis protocol and we could evaluate if the treatment of sepsis happened more consistently.
There are many places for information systems within the hospital setting. Information systems can allow for better communication, better patient tracking and ultimately safer patient care.
References
Hebda, T. & Czar, P. (2009). Handbook of informatics for nurses and healthcare professionals (4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Many information systems are currently in use in the Emergency Department at Intermountain Medical Center. We use a nursing information system to chart patient care and responses. We use an order entry system for lab, radiology and pharmacy orders and we use an Emergency Department system to allow for patient tracking and discharge and follow up instructions. On the administrative side, information systems that are used include patient registration, scheduling systems, human resources and payroll.
There are several ways that I could become involved in designing, selecting, evaluating or implementing an information system in the Emergency Department at Intermountain Medical Center. First of all, designing a monitoring system for patients within the Emergency Department would be a project that would save time and improve patient care and documentation. In the department, we currently have monitors in each of the rooms. The monitors may be programmed to automatically check certain patient measurements such as heart rate, respiratory rate and blood pressure. It is the responsibility of the nurse to manually type in each measurement every time that it is checked. By having a system that automatically uploads these measurements to the patient’s computer chart, it would ensure that measurements were not forgotten, it would allow for a more precise documentation and it would guarantee that the measurements are part of the patient’s chart, regardless of how busy the nurse is. By having a complete list of these measurements in a patient chart gives physicians remote access to the measurements and allows for admitting physicians to see trends within the measurements.
Second, designing an information system within the patient chart that allows the computer to ‘remember’ patient history would save time and money. In the Emergency Department, we triage each patient as they come in to be seen. This can sometimes be a tedious process as we must enter past medical history, medications and allergies each time the patient comes in to be seen. For some patients, a list of medications is unheard of and this triage process can turn from 3 minutes to 15 minutes, wasting valuable time that could be spent talking to the physician. By having a system that ‘remembers’ patient history, the only necessary information on subsequent visits would be the reason for the visit and an update to the medication list. This would ultimately shorten patient length of stays and improve door to doctor times in the Emergency Department.
Finally, an information system that could be evaluated in the Emergency Department is the sepsis alert system that notifies the nurse based on triage vital signs as to whether the patient may be at an increased risk for sepsis. I believe that this system could be evaluated for several reasons. The alert system does not take into account the age of the patient, so often times we get a sepsis alert on pediatric patients with normal vital signs. Second, the alert system only makes the alert during the triage process; it would be interesting to audit the charts that did get the alert to see if the patient did in fact have sepsis and to see if the patients did in fact get treated within the three hour time frame. Finally, a test system could be put into effect to have the sepsis alert come up in both triage and for the patient care nurse. This could serve as a reminder to the patient care nurse about the sepsis protocol and we could evaluate if the treatment of sepsis happened more consistently.
There are many places for information systems within the hospital setting. Information systems can allow for better communication, better patient tracking and ultimately safer patient care.
References
Hebda, T. & Czar, P. (2009). Handbook of informatics for nurses and healthcare professionals (4th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Monday, January 24, 2011
Module One
Information technology can help with the management and processing of patient information. As a graduate nurse, it is important to know about information technology for several reasons. In clinical practice, information technology is vital to help organize patient care, keep patients safe and track trends in monitoring parameters. Information technology can also be important in auditing previous patient charts to collect data for process development and establishing new patient guidelines.
Tuesday, January 11, 2011
Module One
Hi Everyone! My name is Jen and I am in the Acute Care Nurse Practitioner Program. I currently work as a Registered Nurse in the Emergency Department at Intermountain Medical Center where I have been for almost three years.
I was born and raised in Timmins, Ontario, Canada. I blame my Northern Canada heritage for being a 'social networking' newcomer. I look forward to becoming more proficient at understanding the true importance of social networking and it's role with information technology in the health care system.
In my current practice, information technology plays a large role. We use computer charting on a daily basis. Programs are constantly being developed to have the computer 'remember' information from patients from visit to visit. Past visit radiology studies and laboratory results can be accessed at all times within the Intermountain Healthcare computer system in order to provide the best patient care.
An area in which information technology is trying to make a difference is in the auditing of patient charts in order to improve patient care. Charts can be organized and analyzed in terms of patient acuities, length of stay in the Emergency Department, danger vital signs and ultimately patient outcomes.
I was born and raised in Timmins, Ontario, Canada. I blame my Northern Canada heritage for being a 'social networking' newcomer. I look forward to becoming more proficient at understanding the true importance of social networking and it's role with information technology in the health care system.
In my current practice, information technology plays a large role. We use computer charting on a daily basis. Programs are constantly being developed to have the computer 'remember' information from patients from visit to visit. Past visit radiology studies and laboratory results can be accessed at all times within the Intermountain Healthcare computer system in order to provide the best patient care.
An area in which information technology is trying to make a difference is in the auditing of patient charts in order to improve patient care. Charts can be organized and analyzed in terms of patient acuities, length of stay in the Emergency Department, danger vital signs and ultimately patient outcomes.
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