Transcript Nursing Informatics – Transition Module

Nursing Informatics – Transition
Module
Jennifer Hardy
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
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(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 Systems
The 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
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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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Problem
Single Health Record On-line
The Future
The Present
Accessible to
Authorised
Care Providers Across
the Continuum of Care
Multiple Health Records Across All Care Settings
Health Care Providers Across the Continuum of Care
Primary Health
Care
•General Practitioner
•Allied Health
•Medical Centre
•Alternative Therapists
•Ambulance/Paramedics
Specialist Care
Hospital System
•Paediatrics
•Specialist Services
•Orthopaedics
•24 hour Nursing Care
•Surgery
•Therapists
•General Medicine
•Pharmacists
•Gerontology
•Dietitians
•Dermatology
•Social Workers
•Respiratory
•Psychologists
•Cardiology
•Diagnostic Services
•Gynaecology
•Administrators
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•Obstetrics etc.
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Community
Health Services
•Education
•Drug and Alcohol
•Mental Health
•Sexual Assault
•Home Help
•Meals on Wheels
•District Nursing
•Health Promotion
•Child Protection
• Baby Health etc.
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Discharge
Medications
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Hospital Environment
Clinical Systems Integrated Framework
Patient Administration and Unique Patient Identifier
Point-of-Care
Clinical System
Electronic
Prescribing
Decision Support
Clinical
Specialty
Systems
Radiology
Clinical Information
Access Program
(CIAP)
Pathology
Emergency
Department
Discharge Referral
System
Pharmacy
Dietary
Allied
Health
Systems
Community Health Information System (CHIME)
Electronic Health Record
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Hospital Environment
Clinical Systems Integrated Framework
Patient Administration and Unique Patient Identifier
Point-of-Care
Clinical System
Electronic
Prescribing
Decision Support
Clinical
Specialty
Systems
Radiology
Clinical Information
Access Program
(CIAP)
Pathology
Emergency
Department
Discharge Referral
System
Pharmacy
Dietary
Allied
Health
Systems
Community Health Information System (CHIME)
Electronic Health Record
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Why Decision Support Systems?
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
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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:
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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
6%
34%
56%
4%
Prescribing
Dispensing
Administration
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Type of Administration Error
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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:
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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
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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
Evaluate
Record observations
Record interventions
Evaluate care & manage variances
Educate the patient
Generate reports
Discharge patient
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Assess
Plan
Implement
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Information to Support the Care Process
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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
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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)
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