Nursing Informatics – Transition Module

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Nursing Informatics Transition Module

• Jennifer Hardy

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Overview

• Definition
• NSW Health IT Strategy

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Definition/s

• Nursing informatics is the integration of nursing
  (and midwifery), their information, and
  information management with information
  processing and communication technology, to
  support the health of people it has
  implications for health administration, nursing
  (and midwifery) clinical, research and education
  activities
• (Office of Nursing and Midwifery)

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Nursing Informatics Competencies

• NI competencies encompass many skills, not only
  computer-related skills, but knowledge and
  attitudes needed by nurses in relation to
  information and communication technologies.

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Information Technology used in the Health Care
Industry

• Current status of Informatics in NSW

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Clinical Information SystemsThe NSW Health
Strategy

• Dianne Ayres MInfoCommTech, BAdmin(Nurs), RN, RM
• Assistant Director, Clinical Systems Strategy Unit

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The Business Context for Clinical Systems

• Access to quality information at the point of
  care will
• improve patient safety and reduce adverse events
• reduce duplication and errors of omission,
  transcription and interpretation
• provide a framework for evidence based practice
• provide decision support at multiple levels
• improve accountability,legibility and avoid
  litigation
• provide integrated patient information at any
  clinical workstation

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Discharge Medications
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Clinical Systems Integrated Framework

Patient Administration and Unique Patient
Identifier
Point-of-Care Clinical System
Electronic Prescribing Decision Support
Discharge Referral System
Hospital Environment
Clinical Information Access Program (CIAP)
Allied Health Systems
Radiology
Pathology
Dietary
Pharmacy
Clinical Specialty Systems
Emergency Department
Community Health Information System (CHIME)
Electronic Health Record
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Clinical Systems Integrated Framework

Patient Administration and Unique Patient
Identifier
Point-of-Care Clinical System
Electronic Prescribing Decision Support
Discharge Referral System
Hospital Environment
Clinical Information Access Program (CIAP)
Allied Health Systems
Radiology
Pathology
Dietary
Pharmacy
Clinical Specialty Systems
Emergency Department
Community Health Information System (CHIME)
Electronic Health Record
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Why Decision Support Systems?
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Medication Error

• The National Coordinating Council for Medication
  Error Reporting and Prevention defines medication
  error as follows

A medication error is any preventable event that
may cause or lead to inappropriate medication use
or patient harm while the medication is in the
control of the healthcare professional, patient,
or consumer.

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In the USA

• Numerous studies have shown that
• 180,000 deaths a year were attributable to ADEs1
• Cost of ADEs is 76.6 billion a year2
• The number of deaths is equivalent to a jumbo jet
  crashing every day3
• Iatrogenic injury in US is higher than the annual
  motor vehicle accident mortality rate (45,000)4
• Deaths from medication errors increased 257
  between 1983 and 1993 (There are 8000 drugs on
  the market in 2002 compared to 656 in 1961)
• References
• 1 4 Bates et al 1995
• 2 Institute for Safe Medication Practice (ISMP)
  (2000)
• 3 Leape et al (1998)
• 4 Low and Belcher 2002

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In Australia

• Wilson et.al. Quality in Australian Health Care
  Study (28 hospitals/14,000 admissions)found that
• 16.6 suffered an adverse event
• 18,000 Australians died each year
• 8 of hospital bed days were attributable to ADEs
• 2.4-3.6 of all hospital admissions were
  medication related.
• The cost to the Australian Health Care System was
  4.7B per annum

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Where Medication Error Occurs
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Type of Administration Error

• Missed doses of medication
• Wrong time of administration of medication
• Wrong medication administered
• Wrong medications due to misidentifying the
  patient
• IV rate too fast, delivering too much medication
• Wrong concentration/dosage of medication
  delivered IV
• Wrong route of administration (eg, oral solution
  given IV)

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Prescribing Errors

• Prescribing wrong drug, wrong dose, wrong route
• Disregarding altered physiology e.g. liver
  impairment, pathology results etc
• Disregarding allergies or previous drug reactions
• Illegible orders
• Unaware of best practice recommendations
• Poor communications with patient or health care
  team

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The Solution to Adverse Events

• A Point-of-Care Clinical System
• Order Management
• Results Reporting
• Clinical Documentation
• Electronic Prescribing Decision Support System
• Clinical Information Access Program

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Features of Clinical Systems

• Assist with decision making tasks by
• Generating alerts and reminders
• Providing diagnostic assistance
• Identifying errors and omissions
• Retrieving information from credible sources
• Automatically interpreting images (ECG, X-Rays CT
  Scans etc.

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The Care Process

• Patient history and examination
• Review past history
• Record medical alerts/allergies
• Order tests and treatment
• Review results reports
• Initiate care pathway/plan
• Commence discharge planning
• Record observations
• Record interventions
• Evaluate care manage variances
• Educate the patient
• Generate reports
• Discharge patient

Assess
Evaluate
Plan
Implement
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Information to Support the Care Process

• Patient history and examination
• Review past history
• Record medical alerts/allergies
• Order tests and treatment
• Review results reports
• Initiate care pathway/plan
• Commence discharge planning
• Record observations
• Record interventions
• Evaluate care manage variances
• Educate the patient
• Generate reports
• Discharge patient

• Clinical Documentation
• Clinical Documentation/EHR
• Rules - Alerts and Prompts
• Order Management
• Results Reporting/EHR
• Clinical Pathways
• Discharge Plan
• Charting
• Progress Notes
• Clinical Reports
• CMIs/ Protocols/Guidelines
• Clinical Reports
• Discharge Referral/ EHR

Decision Support (e.g.CIAP, E-PDS, Rules,
Alerts, Prompts, Clinical Practice Guidelines)