Ateneo de Naga University

COLLEGE OF NURSING

4400, Naga City, Philippines

Nursing Informatics (Lecture)

Chapter Summary

Submitted by:

Gabrielle Angela B. Evangelista

RR22

Submitted to:

Dennis A. Locsin, RN, MN, MAN

Clinical Instructor
 Chapter 23
Structuring Advanced Practice Knowledge:
An Internet Resource for Education and
Practice

A. Improving Health and Healthcare through Nursing

1) Advanced practice nurses manage information
 Information comes from various shapes and forms
 Most of informatics involves reflection
 Structuring also occurs once we recognize or name clusters within an actual or
mathematically imposed space; The ANA structures nursing practice with its
standards
 Evaluating performance, using United Nations Development Program terminology,
associated with results-based management (RBM)
Input → Activities → Output → Outcome → Sustained impact

B. Knowledge structures facilitate the creation of Advanced Practice Internet

Databases

1) Healthcare technology domains:

 Healthcare technology domain
 Health technology research, development and entrepreneurship.
2) Structuring knowledge-based data does not guarantee that the structure or information
will change practice or patient outcomes; If structured information is to be used, it
needs to be available, its usage tracked within-system patient outcomes, and ultimately
population-based impact evaluated.

C. The DNP student is introduced to, is immersed in, and progresses through an
advanced practice program of learning.
 Chapter 26
Foundation of a Nursing Plan of Care Standard

A. Background/Overview

1) Importance of communication integrity and continuum of care during patient/client

transfers:
 Highest risk of errors affecting patients occur at the point of care transfer.
 In 2010, a nursing plan of care (PoC) profile standard was balloted as a patient
plan of care (PPOC).
 Medical diagnoses cannot be expected to explain the nursing care of patients.
 Florence Nightingale founded nursing as a theory-based, scientific profession
with an independent body of knowledge and wisdom.
 As computer technology advanced so did nursing’s awareness of the need for
structured documentation of nursing practice.
 The ANA developed the Scope and Standards of Nursing Informatics Practice,
which endorsed the nursing process’ six standards (phases) for Nursing
Informatics Practice.
 The fundamental building block of any high-performance health system is
reliable information about the effectiveness of care.

B. Introduction

1) Federal Initiatives
 The federal government began to focus on computer-based healthcare
technology with the Institute of Medicine (IOM).
 In analyzing the “Use Cases” for Biosurveillance, nurses noted terminology.
 The HITECH Act allocated $19 billion to hospitals and physicians who
demonstrate the ‘meaningful use’ of electronic medical records.
2) Development of a Nursing Plan of Care
 Formalization of the data requirements of nurses by PPOC.
 The CCC System was used as an exemplar of structured, coded, nursing
terminology.
 3) Meaningful Use
 Currently in the Meaningful Use (MU) requirements is the term Eligible
Professionals (EPs).
 The definition in the regulation encompasses traditional nursing practice
responsibilities
 Professional nurses are also responsible for the implementation of medical
provider orders and the collaboration with allied health professionals
4) Meaningful Use Stages 1 & 2
 Initially, one of the denominators in the Stage 1 MU objectives omitted and
excluded the eligible providers of patient care and/or the caring process.
5) How a Nursing Plan of Care Could Impact Meaningful Use
 In the public comment period, recommendations were made to CMS for
endorsement of the IHE Nursing PoC standard
6) Meaningful Use Stage 3
 Poised to spot the necessities for care coordination and sharing of
knowledge across multiple provider groups
 The identification and harmonization of standards for the longitudinal
coordination of care will improve efficiencies.

C. Nursing Plan of Care Framework & Nursing Process

1) Overview
 “the essential core of practice for the registered nurse to deliver holistic, patient-
focused care”
 The Nursing Process encompasses all significant nursing actions
 The nursing (PoC) using the nursing process provides a clinical decision support
tool to enhance patient care outcomes.
 The Nursing Process is the standard of practice.
 The Nursing Process focuses on patient care processes provided by nurses.
 The Nursing Process provides the framework for the Nursing PoC and requires
continual assessment and reassessment.
 Other characteristics of the Nursing PoC and Nursing Process framework include:
- Universally Applicable
 - Goal-oriented
- Cognitive Process

D. Descriptions of ‘Other Plans of Care’

Overview

“A Nursing PoC is an information standard ‘blueprint’ for nursing and serves nurses
and allied health professionals.”

E. Care Planning Proponents

1) Health Level Seven International (HL7)

 Health Level Seven International (HL7) states “care planning is a conceptual
framework with many interrelated dependencies and antecedents”
2) Standards & Interoperability Framework
 The Standards & Interoperability (S&I) Framework is another initiative to create
better care, better health, and cost reduction by care delivery improvements.
 “A Care Plan integrates multiple interventions proposed by multiple provider and
disciplines for multiple conditions”

F. Healthcare Informatics Standard Groups

1) Background
 Office of the National Coordinator for Health Information Technology.
 ONC developed the Nationwide Health Information Network (NHIN) to advance
the nation’s health information infrastructure.
2) Standards & Interoperability Framework
 Formed to enable healthcare stakeholders to improve the quality of healthcare
through greater health information exchange.
 The S&I Framework has two key initiatives involving care plans:
 The S&I Longitudinal Coordination of Care (LCC)
 The S&I Transition of Care (ToC) initiative
3) Longitudinal Coordination of Care Initiative
  The S&I Framework Longitudinal Coordination of Care (LCC) Initiative provides
an infrastructure to standardize transitions of care and care plan exchange
across the continuum of care.
4) Transitions of Care Initiative
 “The mission of the ToC Initiative is to improve the exchange of core
clinical information among providers”
 The S&I LCC Initiative “builds on the ToC Initiative standards and aims to
address identified gaps in transitions of care and care planning”.
 Chapter 29
Health Information Technology:
Striving to Improve Patient Safety

A. Introduction

 The first Electronic Health Record (EHR) with Computerized Provider Order Entry (CPOE)
was introduced in 1971
 With the increase of adoption, issues from the rapid implementation arise including
several issues related to patient safety.

B. National Health IT Safety Initiatives

 (ONC) requested that the IOM form a team of experts to assess the current state of
EHRs and their ability to improve patient safety.
 The IOM panel of experts found little published evidence to quantify the magnitude of
the risk
 It is clear in this report that the need to develop strategies that will standardize the
reporting of health IT related errors is needed
 The ONC’s Action and Surveillance plan has two main objectives:
 Use health IT to make care safer
 Continuously improve the safety of health IT
 The plan revolves around three key areas: Learning, Improving and Leading.
 Driving safety improvements requires leadership and the ONC spells out a number of
strategies.
 Encouraging state governments to get involved and incorporate health IT into their
patient safety oversight program is included in this plan.
  Agency for Healthcare Research and Quality- Common Formats
 The AHRQ has taken a significant interest in the area of health IT over the last
several years in partnership with the ONC.
 The Health IT Hazard Manager gives health care providers a method of capturing
hazard data in software that includes near miss errors and actual errors
 Food and Drug Administration
 In July of 2012, Congress enacted the Food and Drug Administration Safety and
Innovation Act (FDASIA)
 The Institute for Safe Medication Practices
 ISMP is devoted entirely to medication error prevention and safe medication use.
 The ISMP’s Guidelines for Standard Order Sets provides a five-page checklist that
allows organizations to evaluate the safety of their CPOE systems.
 ECRI Institute
 For 45 years, ECRI Institute has focused on discovering the effectiveness of
medical procedures, devices, drugs, and processes.
 Leapfrog group
 Represents a coalition of healthcare purchasers that has been a driving force in
the improvement of healthcare quality

C. Health IT Safety Tools and Resources

1) AHRQ’s Guide to Reducing Unintended Consequences of Electronic Health Records

2) SAFER guides
 Chapter 31
The Magnet Model

A. Introduction

 The nursing practice environment is being challenged too rapidly respond to internal and
external demands
 New models of care are emerging
 New models will not be accomplished without the use and integration of
informatics

The Magnet Model

 Transformational Leadership
 Structured empowerment
 Exemplary professional practice
 New knowledge and innovation
 Empirical outcomes

Transformational leadership

 A strategic vision practice supported by informatics that promotes the development of

innovative approaches to care.
 All health systems today are being influenced by the growth in technology

Structural empowerment and exemplary professional practice

 The voice, autonomy and decision-making authority of direct care nurses are at the core
of these components.
 Magnet organizations are required to demonstrate improvements in practice settings
across the continuum.
 It is supported through a professional practice model and care delivery system.
 The core of achieving exemplary professional nursing practice the ability to monitor care
for effectiveness
 The use of technology to provide access to information will assist in the development of
new knowledge.

New knowledge, innovation and empirical quality outcomes

 The demand for exceptional performance and continuous improvement requires Magnet
organizations to integrate the current evidence into practice.
 Organizations must demonstrate activities to support research and innovation, and that
nurses are involved with the design and implementation of technology to enhance the
patient experience and nursing practice.