Nursing Informatics in Medication Administration

      Bar Code Medication Administration (BCMA) is a point-of-care software solution that addresses the uncompromising issue of medication errors by electronically validating and documenting medications for patients. It ensures that the correct patient receives the correct medication, the correct dose, at the correct time, via the correct route, and visually alerts nursing staff when the proper parameters are not met (United States Department of Veteran Affairs, 2006a). The primary cause of error-related in patient deaths is adverse drug events such as medication errors that result in patient harm.

      Another advantage of this software is that when the user hovers the cursor over the text a hover hint will appear that contains the complete text for the order. A Clinical Danger Level is set for each order check by the local site. Where the Clinical Danger Level is set determines whether or not the order check requires the clinician to enter a justification. For example, the pharmacy package determines if a drug-drug interaction is critical or significant. Each site then determines whether the provider must enter a reason for override.This is done by setting a Clinical Danger Level in CPRS for the Critical Drug Interaction and Significant Drug Interaction order checks. If the Clinical Danger Level is set to High for an order check, the clinician must enter a justification for overriding the order check. If the order check has a lower Clinical Danger Level, CPRS does not require the clinician to enter a justification.
      Allergy assessments also use order checks. If the site has set the No Allergy Assessment order check Clinical Danger Level to High and the patient does not have an allergy assessment, the order will require a justification for override. If the site has set the Clinical Danger Level to Moderate, no reason for overriding the order is required. When a user enters a high clinical danger level override justification, the justification for override is sent with the orders to ancillary packages that are integrated into the CPRS system so that the information is available to their users. For example, a user of the clinical dietetics package would see the justification for an allergy order to be overridden.
      The printout of the order is generated on the pharmacy printer, and the pharmacist verifies the medication order as well as the result of all the order checks. Then the pharmacy Robot retrieves the correct medication and places it in the patient’s medication drawer. The pharmacy technician then places the medication drawer on the medication cart and delivers the cart to the medication room on the unit where the patient is located.
      At the time that a printout of the order is generated to the pharmacy printer, another printout is also generated to the ward printer. This happens in order to alert staff that there are new medications ordered by the physician on one of their patients. The physicians generating these orders can be anywhere in the facility where they have access to a VA computer.The RN verifies the medication order in CPRS which then places the verifying RN’s initials on that medication order on the BCMA screen. When a nurse administers medication using BCMA, the first step is to log onto a laptop which has BCMA loaded onto it.

to be continued...Medication Administration of BCMA CLICK HERE!

Nursing Informatics in Prescribing Medications

      Medication errors became front page news with the November 1999 release of a compelling report from the Institute of Medicine (IOM). The public may have been surprised to learn that errors involving prescription medications kill up to 7,000 Americans a year, according to the IOM, and that the financial costs of drug-related morbidity and mortality may run nearly $77 billion a year. But the problem of medication errors is not new. In fact, research demonstrates that injuries resulting from medication errors are not the fault of any individual healthcare professional, but rather represent the failure of a complex healthcare system. System failures can be analyzed and prevented, many through emerging information technology (I.T.) solutions.

      In the medication management system, errors can be introduced at multiple points. Numerous problems are related to the naming, labeling, and/or packaging of drugs or to inefficient distribution practices. Patients often contribute to errors by failing to comply with instructions. Many errors occur as prescriptions are written; these tend to be failures of communication and, in far too many cases, the underlying problem is clinicians' handwriting.
      The healthcare industry has been slow to adopt new technologies, although these tools hold promise for enhancing the delivery of healthcare. Prescription writing is perhaps the most important paper transaction remaining in our increasingly digital society; it seems simplistic to note that electronic prescribing tools could minimize medication errors related to handwriting. Yet even though such devices are available for use in hospitals, ISMP estimates that less than 5% of U.S. physicians currently "write" prescriptions electronically.
      The hurdles until very recently have been clinicians' reticence about computers, a lack of hardware and software that would conveniently allow prescribers to select medications electronically, and fear of the costs associated with such technology. Fortunately, the advent of wireless hand-held devices is making it increasingly possible to solve the "handwriting crisis," perhaps on all 3 counts.
      Easy-to-use point-of-care systems, some that offer comprehensive applications in real time, are becoming available from a number of manufacturers-and at perhaps a surprisingly low cost of entry. Such integrated programs may provide benefits for cost and risk management as well as for clinical care, and they may enhance the prescribing process beyond addressing penmanship alone. For example, hand-held devices can alert practitioners to potential drug or allergy interactions via up-to-date databases of medications that are connected with patient records. That kind of functionality should help to rapidly expand adoption of electronic prescribing among practitioners. Of course, computerized medication management systems certainly are not a panacea. Moreover, clinicians' use of hand-held technology will not solve the broad spectrum of medication errors, for technology is but one part of a larger solution that includes such simple and low-tech strategies as separating look-alike medications in a dispensing cabinet. Hand-held Technology at the Point of Care
      Still, electronic prescribing has not yet become standard operating procedure in offices and clinics, partly because clinicians have been notoriously slow to embrace digital applications for any purpose and partly because providers have feared the high costs typically associated with technology. In addition, until very recently, appropriate hardware and software simply did not exist to allow practitioners to electronically select medications as a natural part of their workflow. However, that has changed with the advent of wireless technologies.
      The hand-held electronic prescribing units that now are available typically utilize radio frequency, cellular, or infrared signals to communicate with an on-site server or a PC-based Internet connection. Patient and drug information is available confidentially to practitioners in real time. An electronic prescription can be entered directly into a computer, then electronically transmitted to a pharmacy-at the hospital, in a local retail store, to a mail order outlet, or to a virtual pharmacy on the Internet-or perhaps be provided right in physicians' offices. The entire process is far less time-consuming than the current paper-based system.
      Portability is a distinct benefit of such devices. Physicians, in particular, are mobile, so they need a system that allows them to input prescriptions at the point of care. Wireless devices allow clinicians to bring computers into their workflow, as opposed to reengineering the workflow to suit the technology. It also helps that most of the units are easy to use. Electronic tools are being put to use for all manner of clinical tasks, including but not limited to automating and integrating the prescription-generating process. Other applications include provisions for medical histories, ICD-9 coding, clinical alerts, drug utilization reviews, and formulary compliance. Some programs allow prescribers to order laboratory tests, capture charge information, or refer patients to specialists, while ensuring security and privacy of records.
      That kind of functionality should help to rapidly expand adoption of electronic prescribing among practitioners. ISMP is heartened by recent estimates from industry analysts that suggest 10% to 15% of physicians are trying hand-held computers, with the number higher (perhaps 60% to 70%) among doctors in training who have come of age in a computer-oriented culture.

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Nursing Informatics in Discharge Planning

      Nursing Informatics is taking patient care to new levels. The Kessler Institute for Rehabilitation prides itself for quality care, sound education, providing comprehensive information for patients and families, and innovative rehabilitative techniques that provide the best possible outcome. The collaborative approach used enhances patient care by including patients and their families in their discharge plan. Ideally, this provides greater patient satisfaction, patient compliance, safer discharges, and better follow-up care.

      The Kessler Healthcare Management System (HMS) system provides staff with a database to access patients’ charts, medication lists, audits, and monitoring. The intra-computer system includes programs to aid staff in supplying information, illustrating documentation, maximizing quality care, and minimizing human error. Furthermore, it can provide the clinical data required for evidence-based practice, which is critical in research and in ensuring quality patient care. At Kessler Institute for Rehabilitation, management analyzes findings in the literature and adjust the systems of care accordingly, aiming to provide safety, institute teaching techniques for staff, and provide a stepping stone for better care.

      Secondly, the nurses utilize the Data Logic scan to ensure patient safety when giving medications. The medication system is integrated within the HMS and tracks errors, time, missed doses, near misses, and discontinued medications. The system works by scanning the patient identification band which prompts the loading of his/her health record screen for a current medication list. According to health statistics, there are about 7,000 deaths a year due to medication errors alone. Furthermore, hospitals spend millions in law suits and prevention programs due to error. The bar coding system prevents human error by ensuring the right drug and dosage is given to the right patient.

      Another function of the HMS is an application that provides a dynamic way to guide patient teaching and learning. This system can provide the elderly with boundless information that is essential to follow-up care. The interdisciplinary team initiates a plan of care that is followed by the patient and family. The patient is taught about their medication regimen, dosages, side-effects, and alternatives. The nurses also teach the patients and families about self-care, monitoring trends, and seeking outside information as necessary.

The Future of Patient Education
      Patient care and education will continue to evolve and most institutions will need to keep up with technology to assure quality patient care. Our patients suffer from many debilitating physical ailments ranging from stroke, spinal cord injuries, and multiple sclerosis just to name a few. Unique computer applications (Apps) and touch-tone screens both show promise in providing more patient autonomy when using technology.

Re-Engineer Discharge Processes and Enhance Transitional Care: READ CLICK HERE!

Nursing Informatics in Documentation

      “Data that are captured in a standardized, automated fashion can help in identifying trends and benchmarking, which are powerful tools in identifying areas for process improvement and making the case for increased resource allocations,” Clayton says.

      The new healthcare-delivery model revolves around the electronic health record (EHR), a one-stop documentation system that fosters safer handoffs, communication between providers, informed decisions, accurate discharge plans, and other benefits. Aggregated across multiple healthcare organizations, patient data can serve to pinpoint important healthcare trends and spawn system-wide ideas for cutting costs, improving efficiency, and managing chronic disease.

      In the past, computers in healthcare facilities have been used largely to capture nonclinical data such as room turnover times or total orthopedic cases, says Denise Downing, RN, MS, a clinical informatics specialist for the Association of periOperative Registered Nurses. But with new systems focused on patient care, “now you can drill down and see what kind of orthopedic cases were done; the patient population in which a particular procedure is done; the positioning aids that were used, which ties into pressure ulcer outcomes; and comorbidities such as diabetes,” she says. “This will all provide data for development of best practices.”

      In part because electronic health records can require that each section of a document be filled out, patient safety also can be improved, says Patricia Hinton Walker, RN, PhD, FAAN, PCC, vice president for nursing policy at the Uniformed Services University of the Health Sciences in Bethesda, Md. “If I have to check off every box before I sign off, I will not miss an allergy,” she says. “In the paper record it could be unreadable or forgotten or put somewhere people don’t look.”

      Electronic records also can include tools to support clinical decision-making. “All of us can’t be as up on every single diagnosis or the interaction of every drug,” Hinton Walker says, but technology can keep that information handy. “It’s not going to be right there at the front of my brain, but it is there at my fingertips.”

      Although the benefits of digitizing healthcare records and processes had long been recognized, President George W. Bush gave the national effort a boost in 2004 by establishing the Office of the National Coordinator for Health Information Technology and setting 2014 as a target date for the widespread adoption of electronic health records. Since then, the Obama administration has endorsed the 2014 timeline and added funding, as well as specific interim steps to get there, Hinton Walker says.

Nurse-Driven EHR Optimization: READ CLICK HERE!