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