Lessons Learned

Lessons Learned

I have learned so much over the past 5 weeks in regards to technology that can be incorporated into my practice. There is endless amounts of education regarding Health information technology (HIT) and what better way to deliver the education than being able to use various forms of technology itself. I have a deeper understanding of meaningful use and the triple aim. How technology will help make patient care better and safer as a patients care has more continuity. The interviews conducted for my power point were very educational and our privacy officer especially piqued my interest in how we ensure patient health information (PHI) is protected. It made me realize that I am fascinated by the government portion. Regulations and laws are something I never thought I would be so intrigued with. AONE is a great place to learn about new legislation. I just learned that the government will be providing $14.9 million via OMNIBUS to support telehealth and increase accessibility to care...This is huge!!!

Nurse Leaders need to be the advocates for the front line Nurses. They need to remove barriers and make current technological processes better. Data mining can be used to look for areas of opportunity. An effective Nurse Leader will know how to utilize a data base to improve patient outcomes and benchmark. The National Database of Nurse Quality Indicators (NDNQI) site is a great resource. It is important that Nurse Leaders can help connect to purpose and give meaning to this information. This course will help all of us to be the change agents when working to increase synergy of nurses and IT.

Is your work Flowing?

Is Your Work Flowing?

            Workflows are the steps taken in order to complete a task. Steps should be taken to reduce repetitive workflows and make the workflows more automated and user friendly (Amorosano, 2014). One opportunity that I helped to identify in our organization was that of correct Medical Orders for Life-Sustaining Treatment (MOLST) forms and code status. When this was brought to light, unfortunately I learned of past incidents where the Electronic medical records (EMR) did not have the correct code status. So long story short, we resuscitated patients when it was not their wish. I felt very passionately about this and did not want another patient to suffer from our process flaw. Working with our performance improvement, we gathered a group of clinicians to formulate a process map of our current state. From this process map, we identified areas of the workflow that were a point for possible error. We are working to collaborate with our physician group as they are the group to order code status which therefore populates the status in the EMR. We did find some nursing opportunities also and are looking into standardization and what we call “Best Practice Advisories” or “BPA’s” that will pop up in the MAR if a step is missed or if information is conflicting. A clinical decision support system is also being evaluated as it helps to combine clinical knowledge with patient specific data to help guide the practitioner (Nelson & Staggers, 2014). Another new initiative that is emerging is the E-MOLST which is an electronic MOLST form where patients would E-sign and the MOLST would automatically be in the EMR rather than depending on a paper copy that needs to be scanned in (Aultman, 2014). Our organization does not use this technology just yet.

This infographic illustrates a simplified work flow. The patient arrives in the Emergency department, The MD gathers his information by asking questions and doing an assessment as illustrated by the clipboard. The provider then enters that information into the EMR and orders treatment. Part of the orders must include a code status. My next step proposal is a hardstop (represented as the magnifying glass) that would make the provider do a deeper dive and be able to answer questions regarding the patients wishes and if they have discussed them or if the patient has current MOLST scanned into their chart to ensure that the wishes matches the order.

References

Amorosano, D. (2014). Document management gets personal. Streamline your healthcare workflow. Health Management Technology, 35(6), 12-15.

Nelson, R. & Staggers, N.(2014). Health Informatics

Aultman, J. (2010). Ethics of translation: MOLST and electronic advance directives... Medical Order of Life Saving Treatment. American Journal Of Bioethics, 10(4), 30-32. doi:10.1080/15265161003633003

A Call to Action for Nurse Leaders

Be the Nurse Leader you would want to follow

     

     The American Organization of Nurse Executives (AONE) puts forth recommendations regarding competency standards for the nurse leader that range from being able to email to possessing knowledge on the newest technologies. This is quite the spectrum and how do you define knowledge? Is it that the Nurse Executive (NE) knows of the technology or that they are able to navigate smoothly through it? The current state shows that many Nurse Executives are not able to lead projects regarding Nursing technology (Simpson, 2013). This is a sad statistic because if the NE is not able to lead the project, many times another discipline will take over when it should be nursing at the helm.Nurses have the ability to reshape healthcare. We are not able to do so by taking a back seat or worse not even being on board the bus. Nurses are accountable to using all resources available to provide the best care to their patients and they use their knowledge and wisdom to drive change and develop new structures to enhance care delivery (AONE, 2010). Nurses make up the largest number of healthcare workers. If Nurse leaders do not push themselves to learn and become competent with the technology, the leaders and front line team following them will not take it seriously or not feel empowered/inspired to speak up and make changes.

AONE

     Nurse Executives need to be able to apply the Nursing process to all things. They need to be able to Develop, Implement, and Evaluate in all areas that need improvement (Cropley, 2014). This thought process and critical thinking needs to occur if we are to have a major contributing factor on the triple aim and improving nursing processes supported the Electronic Medical Records (EMR) and other technology. I would like to see AONE update their suggested competencies regarding technology because knowing how to email will just not cut it any longer. Nurse Leaders need to unite and advocate for more education and not wait to be educated. They must seek out these opportunities if they want to succeed. There are too many Nurses and patients depending on us and we cannot fail them.

FON
The Future of Nursing site is great as it speaks of what it will take to be successful and what initiatives are being worked on.

The Future of Nursing site is great as it speaks of what it will take to be successful and what initiatives are being worked on.

     

References

Simpson, R.L.(2013). Chief Nurse Executives need contemporary informatics competencies. Nursing Economy$, 31(6), 277-288.

AONE guiding principles for the rle of the nurse in future patient care delivery. (2010). Nurse Leader, 8(4), 21-25.

Cropley, S. (2014). Essential skills for Nurse Executives. Texas Nursing, 88(4), 18-19.



Tele-Health- Transforming Care Through Interfacing

What is Tele-medicine?

I am very proud to highlight Rochester General Hospital (RGH) when it comes to utilizing technology interfacing to achieve better patient outcomes and accessibility. In 2008, The program was started using video conferencing where patients are able to interface with the provider/specialist they need consulting from (Nelson & Staggers, 2014). Rochester General Hospital is part of Rochester Regional Health System which is an Accountable Care Organization (ACO). Currently Newark Wayne Community Hospital and United Memorial Hospital in Batavia utilize tele-medicine. Intensivists located at RGH interface with patients in the ICU at the rural hospitals to review care with Nurse, Doctor, patient, and families to make sure the best care is being provided. If you have ever worked in a rural setting, you can appreciate how overwhelming it is to drive to a big city to receive a specialty consult. Newark Wayne has a tele-medicine department that schedules patients as an out-patient to either follow up or perform initial consults. Patients in these setting are more apt to keep these appointments. The future of healthcare will be an increased need for accessibility to care. This is one proven way to do just that.


Tele-Health


Ohio passed a bill where The Centers for Medicare/Medicaid  would be required to cover tele-health. They were hesitant to cover this emerging technology but it is the wave of the future and much needed as resources are limited (Fraley, 2014). As Nurse Leaders, this is where we come in to push for legislation like this that helps support our communities and their health.

    This video amazes me and is the future. It personally touches me because my father suffered a stroke two summers ago and luckily his symptoms were identified early and he was able to receive TPA and had little residual. Not everyone is so fortunate. This emerging field will help those who should not have to suffer their lack of resources based on where they live.

References

Nelson, R. & Staggers, N. (2014) Health Informatics: An Interprofessional Approach. 

     Elsevier:St.Louis, Missouri

Fraley, A. (2014). Telehealth Service: Health Care from Afar. Ohio Nurses Review, 89(6), 8.

       Standardized Nursing language is designed to eliminate confusion and mitigate risks caused by errors or ambiguity. It has only been in recent years that the hospital has switched over to "plain language" when paging overhead. For example, a "code red" would be paged overhead. Now this happened to mean a fire alert but perhaps that did not mean fire in another organization which has the potential to lead to disaster. So now the overhead announcement states "fire alert on second floor....". No confusion there. That was an organizational example but the example is relevant as the standardization of nursing language means that we all talk the talk and understand the language fluently to perform our work more concisely.


Patient Care Data Set

There are two data sets that are accepted by the ANA. The first is the Nursing Minimum Data Set (NMDS) which helps to standardize how nursing data is collected. The second is the Nursing Management Minimum Data Set (NMMDS) which helps to structure for data elements that are specific to nursing (Nelson & Staggers, 2014).

NMDS- consists of required information such as patient information/demographics, Nursing assessment, patient diagnosis, expected outcomes, and nursing interventions

NMMDS- Made up of 18 nursing elements such as financial and nursing resources, environment, and decision making.

Ireland performed a study on an NMDS that was specific to mental health. The study showed that this particular NMDS showed reliability and validity so the set specific to mental health is an evidence based set. This supports that nurses increase the impact of healthcare delivery through documentation (Morris, Macneela, Scott, Treacy, Hyde, Matthew, & Byrne, 2010).

NMDS Comparison

References

Nelson, R. & Staggers, N. (2014) Health Informatics: An Interprofessional Approach. 

     Elsevier:St.Louis, Missouri

Morris, R., MacNeela, P., Scott, A., Treacy, M., Hyde, A., Matthews, A., & ... Byrne, A. (2010). The 

     Irish nursing minimum data set for mental health -- a valid and reliable tool for the collection of  

     standardised nursing data. Journal Of Clinical Nursing, 19(3-4), 359-367. 

     doi:10.1111/j.1365-2702.2009.02995.x