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NURSING INFORMATICS and the Foundation of Knowledge Introduction Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (McGonigle, 2009). Most hospitals now utilize computer systems to track patient health information. The purpose of this paper is to show how a computerized system can help the health care worker provide the best care for the patient by utilizing available programs that when implemented will aide staff in detecting weight gain in a patient with a diagnosis of heart failure.

Concept Map The patient comes to the unit where admission history information is gathered, vital signs obtained and a head to toe assessment is completed. The patient has a diagnosis of hypertension and diabetes which is currently be treated with medication and is now having signs and symptoms of congestive heart failure (CHF). Nurses may generate and record the data from their own observations or with the assistance of various devices. In this way, data (often qualitative data that cannot be traditionally measured) can be organized and processed (McGonigle 2009).

More information is needed so the nurse logs onto the hospital computer system and checks the patient’s previous admission history, including previous vital signs, lab results, and any testing that has been completed in the past few months for comparison. She also reviews physician notes, dietary, and social services for education given related to diagnosis of hypertension and diabetes. The nurse sorts through useful information that pertains to the patient’s current condition and complaints. The nurse notes the patient has gained some weight, her blood pressure is higher than previous readings and her mother ecently died from complications of CHF. The computer system allows the nurse to see results along a linear time line during any specific time chosen. This gives the nurse a clear picture of trending. The data is interpreted, organized and structured into useful information (McGonigle, 2009). The knowledge the nurse has acquired during her educational years combined with life experience allows her to put the signs and symptoms together to formulate the next step of action. She knows that the patient meets common criteria for CHF; the patient has a diagnosis of diabetes and hypertension, is overweight, an older female, is aving fluid retention in the lower extremities, shortness of breath and noted crackles in the lungs. The nurse anticipates the doctor will order various labs to check current levels of lipids, enzymes, BNP, liver, kidney and thyroid function that will be used to compare against past results, stored in the computer system for easy access. The doctor may also order chest x-ray, echocardiogram, check ejection fraction, and EKG/ECG to verify suspected diagnosis. All results are entered into the computerized system by each area of discipline and transferred into the a review results “tab” for easy access.

The information gained from testing will be synthesized so that relationships are identified and formalized (McGonigle, 2009). All disciplines have access to patient testing results via the computerized charting system, to assist them in formulating a plan of care for the patient while in the hospital and upon discharge to home. Wisdom is sometimes thought of as the highest form of common sense resulting from accumulated knowledge or erudition (deep, thorough learning) or enlightenment (education that results in understanding and the dissemination of knowledge) (McGonigle, 2009).

A plan of action is formulated at this point based in knowledge. Daily weights are ordered and recorded, IV or oral diuretics, cardiotonics, vasodilators, and/or angiotensin inhibitors are ordered from pharmacy and sent to the unit via a house wide tube system. Medications are administered to the patient and routine labs obtained to monitor patient reaction to interventions. Other disciplines dietary, physical therapy, respiratory, and social services will meet with the patient to discuss patient care plan. Education will be provided to the patient and family members in relation to decreasing isk factors and barriers for compliance. Patient will have access to a computer educational program called, EMMI Manager. It is a website that addresses a variety of diagnosis in common language.

INNOVATIONS Background In today’s world of technology, it is imperative that health care facilities stay current with the ever changing electronic health record (EHR) systems. EHR a computer- based data warehouse or repository of information regarding the health status of a client, replacing the former paper based medical record; it is systematic documentation of a lient’s health status and health care in a secured digital format, meaning that it can be processed, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high quality health care across the client’s healthcare continuum (McGonigle, 2009). The one that is utilized in the IU Health care system is called Cerner. Cerner has consistently been ranked among the nation’s leading information technology providers and the company’s healthcare products have won numerous awards (Answers, 2012). It has layer after layer of programs and connective ites that are not, nor probably ever will be, fully utilized. It is possible to add task and warnings to the system to meet the needs of the hospital and staff.

The EHR system helps move simple data into the information realm and converts it into usable knowledge based on the input which allows the system to send a pop-up notice directing the staff member to utilize their wisdom to notify the doctor because the patient’s condition has changed. Projected costs The Cerner system is currently in use but, any changes that are made to the system needs to be approved. In this instance a pop-up tab is requested by nursing that ill automatically alert the nurse of weight gain within specified parameters for the patient with heart failure (HF). An example of how it will work is, the patient is weighed daily and the program will keep a running total of any weight gained or lost and show the total based on a three and five day course that will signal a pop-up if the patient’s weight is 3 or more pounds in 3 days or more than 5 pounds in 5 days. The nurse will see the pop-up tab and notify the doctor, so an intervention, usually a diuretic can be administered. The floor nurses will bring their idea to the Unit Based Council (UBC) it is pproved and moves on to the Professional Nursing Council (PNC) for approval. It is then taken to the Clinical Information System (CIS) team. If they feel it is a worth while project they in turn take it to the IU Health board of directors for approval. P. Smith head of the CIS team claimed the basic cost for the added feature is approximately $9,600, broken down as follows; it will require 4 computer technicians working for approximately 48 man hours each at $50. 00 an hour, before it is available to use (personal communication, March 12, 2012).

S. Holloway head of the Education epartment at the hospital added that the nurses will need to be in-serviced relating to its features and use. With approximately 2800 nurses using the system at IU Health Ball Memorial Hospital, it will require 15 minutes of individual training via a learning module system (LMS) to understand how to apply and utilize the tab for the designated patients. The average pay for nurses is $22. 00 an hour which works out to a cost of $15,400 provided all of them stayed after their shift to complete the 15 minute LMS. The technical support and maintenance would be included in the current system contract personal communication, March 13, 2012). Projected Benefits This technology impacts the quality of care at the bedside by increasing response to a possible critical health value. A timely intervention to the patient may mean a difference in length of stay in the acute care setting. The projected benefits are an increase in positive outcomes to the patient with HF with fewer set backs. Stakeholders The biggest stakeholders are the nurses. By having a system in place to calculate weight gain on a continuing day by day bases, it reduces the time spent changing the ates and scrolling back and figuring the changes with paper and pencil from the values in the computer. The pop-up warning will assist the nurse by decreasing the chance of error related to miscalculations or oversights and notifying the doctor of changes sooner. Gaining the nurses buy-in is relatively easy, by pointing out the benefits they will gain by not having to take the time to figure the weight for three and five days every day. The nurses would be asked to participate in the build to offer suggestions as to where the tab will pop-up, on the task list or right on the screen where the weights are recorded.

Evaluation The Heart Failure Team at the hospital has a subgroup that is monitoring patients with HF diagnosis who readmit for HF in less than 30 days. They discovered during a random chart check that 4 out of 36 patients in post acute care, had a weight gain greater than the set parameters and the doctor was not notified in a timely manner, to order a diuretic. The four patients were sent to cardiac care for treatment related to complications that could have been avoided with a timely administration of a diuretic. An increase in positive outcomes for HF patients would significantly increase our patient rust and satisfaction scores. The Heart Failure Team subgroup will continue to monitor timely notifications to doctors, of HF patients who have weight gain outside the parameters and report back to the Team on monthly bases to evaluate its effectiveness.

The lead CIS nurse P. Smith also added that she is taking our idea a step further by checking into the possibility of the Cerner system being able to “shoot” a notice to the attending doctor via the Cerner system, letting him know that his patient has had a weight gain outside the set parameters. So if the nurse forgets or gets busy he will still be otified and can act on the changes (personal communication March 13, 2012). Competencies How Nursing Informatics competencies impact the use of technology for transforming data to wisdom. The concept map moves data to wisdom on a patient who presented with signs and symptoms of congestive heart failure (CHF). Heart failure is a serious medical condition where the heart does not pump blood around the body as well as it should. This means your blood can’t deliver enough oxygen and nourishment to your body to allow it to work normally. It also means that you can’t eliminate waste products roperly leading to a build up of fluid in your lungs and other parts of your body, such as your legs and abdomen (Heart Failure Matters, 2012).

A build up of fluid increases weight and may indicate worsening of condition Data to Information Data is raw information gathered objectively without interpretation. (McGonigle, 2009). The data collected from the concept map is entered into the patient’s electronic health record (EHR) by the nurse. Being able to input data into the EHR correctly is imperative for patient safety and positive patient outcome. The nurse inputs vital signs, ssessments, medical history, and medication orders. The results of ordered patient testing example; chest x-ray, echocardiogram, lab results ordered is interred by the appropriate departments. All the data migrates to corresponding tabs in the patients EHR. Past medical history can also be found here, so if the patient leaves out information from previous visits, it is still available to the care giver. This is the essential information that must be available in a common data base to support patient care (QSEN, 2009). The nurse must be educated on the use of the EHR so she will be able to place meaning to all he information contained there and be able to pull that information upon request.

Information to Knowledge Information is data that are interpreted, organized or structured. The data derived from direct care of an individual may then be complied across persons and aggregated for decision-making by nurses, nurse administrators, or other health processionals (McGonigle, 2009). Navigate the electronic health record (QSEN, 2009). By assessing the patient EHR the care giver can compare past values with present values. In a patient with CHF it is imperative that the patient be weighed accurately every day. The nurse eeds to know how to calibrate and zero out a free standing or bed scale for an accurate daily weight. This is just as important as knowing the patient should be weighed at the same time of day, wearing the same type of clothing or that the bed should contain the same amount of bedding for a more accurate weight. A weight gain of 2-3 lbs. per day or more than 5 lbs. in 5 days should be reported to the physician immediately as it could indicate a decrease in the heart function. An alert feature that will notify the nurse of a weight gain, over the recommended period of time would assist the nurse in physician otification in a timely manner, leading to a more positive patient outcome.

Knowledge to Wisdom Knowledge is information that has judgment applied to it or meaning extracted from it. Wisdom is knowledge applied in a practical way or translated into actions; uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters (McGonigle, 2009). Value technologies that support clinical decision-making, error prevention and care coordination (QSEN, 2009). The EHR is a form of technology that is invaluable to the health care field. All of the patient nformation is a click away for the care giver. The timeline side by side comparison for information necessary to make an informed decision related to patient care increases response time. Front line users are the first line of defense as to what types of programs could be added on to current systems to prevent errors, and should be included in meetings for system updates. Care coordination can be better utilized using the EHR when access to the system is so easy and all discipline notes migrate to the patient record. Conclusion The benefits of having a pop-up warning system, to alert the nurse when a atient has had a weight gain outside the set parameters, will increase efficiency related to doctor notification. When the doctor is notified sooner an intervention can be implemented sooner to improve patient outcome. Quicker intervention may lead to faster recovery, shorter hospital stay, improved quality of care, patient satisfaction, and reducing cost to patient and/or the insurance provider. With a growing focus on patient satisfaction, medical intervention that will support better patient outcomes and better care will improve patient satisfaction scores as they relate to direct nursing care and satisfaction with the doctors.

All patients expect and deserve the best care every day. References Answers. com. Cerner Corporation, 2012. Retrieved March 11, 2012 from; http://www. answers. com/topic/cerner-corporation. Heart Failure Matters, 2012. Retrieved March 21, 2012 from; http://www. heartfailurematters. org. McGonigle, D. & Mastrian, K. , (2009). Nursing Informatics and the Foundation of Knowledge (pp. 85,450, 459, 480). Sudbury, MA. Jones and Bartlett Quality and Safety Education for Nurses (QSEN), (2009). Quality and safety competencies. Retrieved March 1, 2012 from: http://www. QSEN. org/competencies.

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