Ni Lab Midterm Exam Reviewer PDF

SBAR
Communication Model
Situation, Background,
Assessment, and
Recommendation
Objectives
Familiarize what SBAR stands for.

Establish reasononing why SBAR is
important to use.
Describe how SBAR affects patient
safety.
Describe the difference between
assertiveness and aggressiveness.
Verbalize appropriate responses in
practice scenarios.
SBAR
Ineffective communication poses a
significant threat to the safety of
hospitalized patients.
SBAR is a useful and effective
communication tool that allows
healthcare professionals to share
concise but important information in a
short amount of time.
Michael Leonard, physician leader for patient
safety at Kaiser Permanente introduced SBAR
that was modified for use in health care from the
method used in the aviation industry to reduce c
. Physicians
Nurses are often taught to
report in a narrative form
are taught to communicate
using brief “bullet points”
that provide key
information.
communication errors among crew members
SBAR – why it is important to use
According to the Joint Commission, communication
issues are the leading cause of sentinel events in
hospitals.
Improving the exchange of information between nurses
and physicians have been cited as a key element to
preventing medical errors and promoting a safe
environment.
(Manning, 2006)
Miscommunication leads to patient safety issues.
(HCPro, 2004)
SBAR Communication Model
Easy to remember tool that provides a
structured, orderly approach to improve
effective communication of accurate,
relevant information. The goal is to deliver
your message in 1 to 1 ½ minutes.
Helps limit the jargon, keeps the message
clear, and removes the influence of
hierarchy and personality.
SBAR broken down…
SITUATION: State what is happening at

the present time that has warranted the
SBAR communication. (State your name
& unit, what patient you are calling about,
& what the problem is)
SBAR broken down…
SITUATION:
Example:
Hello Dr. ______, this is ________, from ____unit. I
am calling about __(pt name & room #)___. The
patient’s code status is ____. I have just assessed the
patient myself. I am concerned about
________________. (Examples can be BP over or
under parameters, pulse over 140 or less than 50,
respirations less than 5 or over 40, elevated temp or
many other situations). Note: These are examples,
your hospital or physician may have established
parameters to call about.
SBAR broken down cont’d…
BACKGROUND: Explain circumstances

leading up to this situation. (State
admission diagnosis, date of admission,
brief pertinent medical history, and
treatment to date)
SBAR broken down cont’d…
BACKGROUND
Example:
The patient’s mental status is ______, vital
signs are _________, skin is _____, O2 is (not
on) or on at ___, oximeter reading is at ___,
the patient complains of _______.
SBAR broken down, cont’d….
ASSESSMENT: Indicate what you

think the problem is (Provide last vital
signs, oxygen if being used, & any
changes from prior assessment: vital
signs, heart rhythm, pain, wound
drainage, neuro changes, etc.
SBAR broken down, cont’d….
ASSESSMENT:
Example:
I believe the problem is: (state what you
believe the problem is, i.e. cardiac, infection,
neurologic, respiratory, other).
OR: I don’t know what the problem is but the
patient is deteriorating.
OR: The patient seems to be unstable.
SBAR broken down cont’d….
RECOMMENDATION: Express what you

believe the patient needs or what order
specifically you want i.e. give fluids, order
labs, x-ray, have the physician come see the
patient, transfer the patient to ICU, ask for
a consulting physician to see the patient,
etc.
SBAR broken down cont’d….
RECOMMENDATION: Example:
I suggest/request/recommend that you
__________ (see immediately, transfer the patient
to ICU, ask the hospitalist/resident to see the
patient now, talk to family about code status, etc.
OR: Suggest tests/interventions that would be
needed (Chest x-ray, ABG’s, EKG, CBC, BMP,
give additional fluids, pain meds, etc.) If no
improvement, when should we call again?
Sample of SBAR worksheet to use to
organize your thoughts
There are several examples of
SBAR worksheets that you can
find on-line that are designed
for calling a physician, and
others for use with change of
shift report. Some are even
specialty specific such as for
OB, NICU, ICU, and others.
Sample of SBAR worksheet to use to
organize your thoughts
Also recommend
viewing some of the
SBAR videos found on
Youtube for both good
and bad examples of
SBAR in use as another
learning tool for you.
Practice example of making a
recommendation: The “R” in
SBAR: Which is better?
A. The nurse picks up the B. The nurse says “I noticed
chart & notices that the that Mrs. Smith’s hct was
physician did not order 26 yesterday, what about
labs despite a low repeating the hematcrit?”
hematocrit. The nurse says
“excuse me, did you want
to order labs today?”
B is better
The “A” response is not specific enough
leaving some guesswork into what to order
and perhaps delaying the right
intervention/s or not getting it at all.
“B” offers a specific request eliminating a
missed intervention. This could also be
framed as “what do you think about
repeating the HCT?”
Practicing the “R” in SBAR, cont’d
Which is being a better?
A. “I noticed that this is the B. The nurse doesn’t mention

3rd day that the foley to the physician or mid-level
catheter has been in place & that it is the 3rd that the foley
believe the patient no catheter has been in and is
longer meets any of the hoping that they will
criteria to leave it in. Are remember to write an order to
you in agreement to remove take it out.
it?
A is better…
“A” is not only bringing something to
the physician/mid-level’s attention but
also makes the recommendation or
suggestion to remove in order to avoid a
potential UTI
Effective, Assertive Communication:
Good or Bad?
“I’m sorry to bother you but………..”
OR
Avoiding unpleasant doctors that are difficult to
communicate with.
Answer: Both are bad: apologizing for bringing forward
relevant information regarding a patient condition
portrays a lack of confidence and sets the tone for the
conversation. And while tough at times, you cannot avoid
a necessary conversation regarding a patient because a
physician is unpleasant.
Importance of Effective
Communication
Nurses are the front-line care givers
responsible for notifying physicians of
patient care issues, acting as the patient
advocate, & protecting the patient from
further harm, yet current nurse-physician
relationships & cultures often do not
empower nurses to communicate
effectively with physicians.
Ways to Improve Communication
Work at developing relationships with
a personal connection, ask about their
weekend, family, etc.
Don’t be afraid to use humor in your
communications as you develop
relationships based on mutual respect
Be prepared with all relevant
information before making the call or
starting the conversation
And, most importantly, utilize a
succinct communication model such as
SBAR when providing patient
information
Improving Communication, cont’d
Assume that you and the physician are on the

same team & that you have the same broad
goals for the patient.
Stressing again to be ready with patient data
before you call or communicate with the
physician.
Communicate clearly your title & your
relationship with the patient, example primary
nurse, wound care nurse, etc.
Improving Communication, cont’d
Connecting on a human level can be a powerful

catalyst.
Utilize appropriate assertiveness (not aggressive)
as you advocate for your patient.
Characteristics of an Assertive Nurse
(versus aggressive)
Appears self-confident & composed
Maintains eye contact
Uses clear, concise speech
Speaks firmly & positively
Is non-apologetic
Takes initiative to guide situations
Gives the same message verbally &
nonverbally
Speaks genuinely, without sarcasm
(Communication in Nursing, 2004)
Dealing with Difficult Physicians or Other
Healthcare team members
Connecting on a human level can be

a powerful catalyst.
Do not be afraid to express what you
think and believe about this patient.
Have a memorized response to fall
back on so you can respond when
caught off guard by an inappropriate
comment or behavior.
Examples of a response to have prepared in your
mind when caught off guard by rude behavior
“I am almost through, and would like to finish

my thought.”
“Please don’t yell at me, I am here to do what
is best for the patient.”
“You are being rude and inappropriate, it is not
helping us take care of the patient.”
Take 5 minutes right now and come up with a
comment that you can memorize and have
available
Dealing with difficult physicians &
others on the healthcare team
Remember:
Nobody benefits if the nurse
doesn’t assert themselves under
certain conditions.
This does get easier with practice
and being prepared!
Summary
Use of SBAR to organize the exchange of information has
demonstrated effectiveness in reducing communication errors
(Beyea, 2004)
Promoting nurses’ confident use of SBAR has great potential to
decrease miscommunication and increase patient safety
Nurses may experience discomfort using SBAR because it
moves beyond the traditional approaches of merely reporting
information into newer territory of joint decision making which
includes providing opinions and making recommendations
Summary, cont’d
Commit to practicing using the

SBAR model until it becomes your
normal routine
Role playing in the context of
communicating with a difficult
physician (and using your
memorized statement) may also be
helpful to improving your ability to
communicate effectively
Conclusion
STAND IN AWE OF WHAT YOU DO AND

RECOGNIZE YOUR TREMENDOUS VALUE
References
Beyea, S.C. (2004). Improving verbal communication in clinical care.
AORN Journal, 79(5), 1053-1057.
HCPro, (2004). Get in gear. Six road-tested ways to communicate critical test
results. Briefings on Patient Safety, 5(11), 2-6.
Manning, M.L. (2006). Improving clinical communication through

structured conversation. Nursing Economics, 24(5), 268-271.
Raica, D.A. (2009). Effect of action-oriented communication training on

nurses’ communication self-efficacy. MedSurg Nursing, 18(6), 343-356,
360.
Information Technology
System Applicable in Nursing
Practice
HOSPITAL AND CRITICAL CARE
APPLICATIONS
PHYSIOLOGIC MONITORING SYSTEMS
Physiological monitors were developed oversee the vital signs of the astronauts.
By the 1970’s these monitors found their way into the hospital setting. Physiologic
systems consist of 5 basic parts.
1. Sensors
2. Signal conditioners
3. File - rank and order information.
4. Computer processor - analyze data and direct reports.
5. Evaluation or controlling component - regulate the equipment
or alert the nurse.
Microprocessors.
Physiologic signals are typically of very small amplitude and must be
amplified, conditioned, and digitized by the device in preparation for
processing by its embedded microprocessors.
It analyzes information, store pertinent information in specific
places and controls the direction in reporting.
It also alerts nursing personnel through a report, an alarm, or a
visual notice.
Monitoring systems also store various data elements with a time

stamp derived from the monitoring system’s internal clock.
typically have modern platform allowing the selection of various

monitoring capabilities to match the needs of a variety of clinical
settings.
More specialized monitoring capabilities such as intracranial pressure
or bispectral index monitoring are also in modular format.
Physiologic monitors are usually built to incorporate both arrhythmia
and hemodynamic monitoring capabilities.
HEMODYNAMIC MONITORS
Machines under the human machine interface used specifically for the
following:
1. Measure hemodynamic parameters - closely examine cardiovascular
function.
2. Evaluate cardiac pump output and volume status.
3. Recognize patterns (arrhythmia analysis) and extract features.
4. Assess vascular system integrity - evaluate the patient’s physiologic
response to stimuli.
Machines under the human machine interface used specifically for the
following:
5. Continuously assess respiratory gases (capnography).
6. Continuously evaluate glucose levels.
7. Store waveforms.
8. Automatically transmit selected data to a computerized patient
database.
PULSE OXIMETRY
A critical piece of hemodynamic information involves the

availability of oxygen to bodily tissues. The standard for
measurement of blood’s oxygen saturation is co-oximetry.
Pulse oximetry is a noninvasive method of measuring oxygen
saturation that also uses spectrophotometry. Light is emitted
through a pulsatile arteriolar bed and then detected by
photosensor.
PULSE OXIMETRY
ANTICIPATED PROBLEMS
Largest contributor to alarms in the ICU caused by:
1. Blood pressure cuff
2. Tourniquet
3. Air splint that may cause venous pulsations.

A. Limits the sensors' ability to distinguish between
arterial or venous blood pressure while pulse oximetry
provides a measure of oxygen delivered to the tissue,
mixed venous oxygen saturation provides a measure of
the amount of oxygen used by the patient.
4. Limits the sensors' ability to distinguish between arterial or

venous blood pressure while pulse oximetry provides a measure
of oxygen delivered to the tissue, mixed venous oxygen
saturation provides a measure of the amount of oxygen used by
the patient.
These problems usually cause nurses to spend more time in
troubleshooting and can lead to less hours doing the necessary bedside
care.
To prevent these from happening, it is important for nurses to become
familiar with the user guide of the respective machines specifically on
the trouble shooting part.
Some pulse oximeters are more sensitive as compared to the others,
some need specific charging times, and some are more durable than the
others.
TELEMETRY
Hemodynamic monitoring can take place at the bedside of can
be conducted from a remote location via telemetry.
Telemetry allows for the continuous monitoring of patients
usually outside of the ICU.
Telemetry monitoring is susceptible to signal loss. Remember
that computer-based hemodynamic monitoring offers the
critical care nurse a wealth of information that does not
replace clinical judgment.
TELEMETRY
ARRHYTHMIA MONITOR
Computerized monitoring and analysis of cardiac rhythm have
proved reliable and effective in detecting potentially lethal
heart rhythms.
A key functional element is the system’s ability to detect
ventricular fibrillation and respond with an alarm. SYSTEM
TYPES: Detection Surveillance Diagnostic or Interpretive.
ARRHYTHMIA MONITOR
WHAT IS THE DIFFERENCE?
In detection system, the criteria for a normal ECG are programmed
into the computer.
Interpretive systems search the ECG complex for five parameters:
location for QRS complex; time from the beginning to the end of
the QRS; comparison of amplitude, duration, and rate of QRS
complex with all limb leads P and T waves; comparison of P and T
waves with all limb leads.
CRITICAL CARE INFORMATION SYSTEM (CCIS)
A system designed to collect, store, organize, retrieve, and
manipulate all data related to care of the critically ill patient.
the organization of a patient’s current and historical data
allows the free flow of data between the critical care unit and other
departments.
Provides a rich repository of patient information that can be
integrated for use in outcomes management.
CRITICAL CARE INFORMATION SYSTEM (CCIS)
Each patient’s data can be accessed from any terminal or
workstation. This capability can extend across units and departments
or be restricted to a single unit. CCIS include: Patient management
service, length of stay, mortality, readmission rates.
PROVIDER ORDER ENTRY
Electronic entry and communication of patient orders can help
clinicians improve communication, streamline processes, facilitate
care, and can help clinicians, all providers in managing quality.
COMMUNITY HEALTH
APPLICATIONS
COMMUNITY HEALTH APPLICATIONS
∙ Focuses on the health information system of the community,

it is centered on the majority part of the public.
∙ Emphasizes the prevention of the disease, medical
intervention, and public awareness.
∙ Fulfils a unique role in the community, promoting and
protecting the health of the community at the same time
maintaining sustainability and integrity of health data and
information.
GOAL OF COMMUNITY HEALTH INFORMATICS

Effective and timely assessment that involves monitoring and
tracking the health status of populations including identifying
and controlling disease outbreaks and epidemics.
PRIMARY FOCUS OF COMMUNITY HEALTH

INFORMATION SYSTEM
∙ Preventing, identifying, investigating, and eliminating communicable
health problems.
∙ Accessibility of data and information, through communication.
∙ Educating and empowering individuals to adopt health lifestyle.
∙ Facilitate the retrieval of data.
∙ Effective transformation of data into information.
PRIMARY FOCUS OF COMMUNITY HEALTH

INFORMATION SYSTEM
∙ Effective integration of information to other disciplined to
concretized knowledge and creates better understanding.
∙ Creation of computerized patient records, medical information
system
∙ Central repositions of all data such as data warehouse.
∙ Simple Graphical User Interface (GUI) for nurses and other
healthcare provider, patient, and consumer.
COMPUTER BASED SURVEY SYSTEM

Health Statistical Surveys
∙ Are used to collect quantitative information about items in a

population to establish certain information from the obtained data.
∙ Focused on opinions or factual information depending on its purpose
and many surveys involve administering question to individuals.
ADVANTAGES
∙ Consistent exchange of response
∙ Disease tracking
∙ Data and information sharing. Building strategies
∙ Early detection and monitoring of disease and sickness -
control of spread of disease.
∙ National alertness and preparedness - building strong
communication.
ADVANTAGES
∙ Maintaining strong relation between nurse and other healthcare
provider.
∙ Continuous coordination of the healthcare professionals -
synchronization of the decisions.
∙ Streamlining of the process.
∙ Effective management of data and information - optimal operation of
hospital and clinics.
PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND
RESPONSE (PIDSR)
A multi-faceted public health disease surveillance system that provides public
health officials the capabilities to monitor the occurrence and spread of
diseases.
Goal
Strengthen the surveillance and response capabilities at each level of the
health system by building local capacities and leveraging strengths and areas of
expertise through partnership and coordination.
PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND
RESPONSE (PIDSR)
Vision
To improve the availability and use of surveillance and
laboratory data so that public health managers and decision
makers can plan for and carry out more timely detection and
response to the leading causes of illness, death, and disability.
PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE
(PIDSR)
FUNCTIONS:
Information from PIDSR is expected to be used for the following purposes:
1. Facilitate collecting, managing, analyzing, interpreting, and disseminating health-related
data for diseases designated as nationally notifiable.
2. Develop and maintain national standards, such as consistent case definitions for nationally
notifiable diseases applicable across all the provinces and cities.
3. Maintain the official national notifiable diseases statistics.
PHILIPPINE INTEGRATED DISEASE SURVEILLANCE AND RESPONSE
(PIDSR)
FUNCTIONS:
Information from PIDSR is expected to be used for the following purposes:
4. Provide detailed data to control programs to facilitate the identification of specific disease
trends.
5. Work with cities and provinces and partners to implement and assess prevention and
control programs.
AMBULATORY CARE SYSTEMS
The ambulatory care nurse focuses on patient safety and the
quality of nursing care by applying appropriate nursing
interventions, such as :
identifying and clarifying patient needs,
performing procedures,
conducting health education,
promoting patient advocacy,
The ambulatory care nurse focuses on patient safety and the
quality of nursing care by applying appropriate nursing
interventions, such as :
coordinating nursing and other health services,
assisting the patient to navigate the health care system, and
evaluating patient outcomes.
The ambulatory care / out patient
covers a wide range of services that can be offered to patients
that needs medical attention.by integrating the ambulatory care
information system in the nursing practice will really help in
making the work easy like the processing of data and information
and the billing and charges etc.
There are advantages of the ambulatory care information like
first, the access of medical records of patients to health care
providers,
second, the nurses will be able to give quality care and improve
workflow, reduce medical errors, and lastly the management and
monitoring of the billing, doctor’s fees, prescriptions and many more.
There are advantages of the ambulatory care information like
One of the most important responsibility of a nurse is to make sure
that the patient receives the care that he/she needed and with the use
of this system I believe the quality of care can be given.
EMERGENCY PREPAREDNESS AND RESPONSE
Same with the objective in the application of informatics in
community health the over-all objective is public health. The only
difference is the focus and level of prevention.
In Community Health, the focus of the use of informatics is on the
promotive and preventive side, while in emergency preparedness and
response focus in the mitigation and control of emergencies.
EMERGENCY PREPAREDNESS AND RESPONSE
The use of informatics here is much wider and critical. The need for
information in real-time is very crucial in saving the lives of many.
TELEHEALTH
TELEHEALTH
According to Mayo Clinic (2020), telehealth is the use of
digital information and communication technologies, such
as computers and mobile devices, to access health care
services remotely and manage your health care.
These may be technologies you use from home or that
your doctor uses to improve or support health care
services.
TELEHEALTH
Consider for example the ways telehealth could help you if you
have diabetes. You could do some or all the following:
∙ Use a mobile phone or other device to upload food logs,
medications, dosing, and blood sugar levels for review for a
nurse who responds electronically.
∙ Watch a video on carbohydrate counting and download an app
for it to your phone.
TELEHEALTH
∙ Use an app to estimate, based on your diet and exercise level,
how much insulin you need.
∙ Use an online patient portal to see your test results, schedule
appointments, request prescription refills or email your
doctor.
∙ Order testing supplies and medications online.
TELEHEALTH
∙ Get a mobile retinal photo screening at your doctor’s office
rather than scheduling an appointment with a specialist.
∙ Get email, text, or phone reminders when you need a flu shot,
foot exam, or other preventive care.
TELEHEALTH
TELEHEALTH GOALS
Also called e-health or m-health (mobile health), include the following:
∙ Make health care accessible to people who live in rural or isolated
communities.
∙ Make services more readily available or convenient for people with
limited mobility, time, or transportation options.
∙ Provide access to medical specialists.
TELEHEALTH
TELEHEALTH GOALS
Also called e-health or m-health (mobile health), include the following:
∙ Improve communication and coordination of care among members of a
health care team and a patient.
∙ Provide support for self-management of health care.
TELEHEALTH
In the Philippines, we have also adopted telehealth and have become an
increasing necessity with the emergence of the pandemic and
implementing the community quarantine measures.
To promote safety among the public, telehealth has been adopted by
private and government hospitals.
TELEHEALTH
The University of the Philippines – Manila (UPM) is one of the earliest
in the Philippines who adopted the telehealth in 1998.
They established the UP National Telehealth Center with the
commitment is to engage people to use available technologies to
improve health care albeit distance barriers.
TELEHEALTH
Since its conception, it continues to develop telehealth applications
derived from people’s own problem-solving contributions.
Through research-cum-service activities, the center helps both
patients and health care providers maximize widely available and
cost-effective ICT tools to improve delivery of health
NETIQUETTE
RULES AND
GUIDELINES
By: Ariel Abenoja

Netiquette Rules and Guidelines
Netiquette is short for "Internet etiquette." Just like etiquette is a

code of polite behavior in society, netiquette is a code of good
behavior on the Internet. This includes several aspects of the
Internet, such as email, social media, online chat, web forums,
website comments, multiplayer gaming, and other types of online
communication.
Examples of rules to follow for good netiquette.

1. Avoid posting inflammatory or offensive comments online (a.k.a
flaming).
2. Respect others' privacy by not sharing personal information,
photos, or videos that another person may not want published
online.
3. Never spam others by sending large amounts of unsolicited email.
4. Show good sportsmanship when playing online games, whether
you win or lose.
5. Don't troll people in web forums or website comments by
repeatedly nagging or annoying them.
Examples of rules to follow for good netiquette.

6. Stick to the topic when posting in online forums or when
commenting on photos or videos, such as YouTube or Facebook
comments.
7. Don't swear or use offensive language.
8. Avoid replying to negative comments with more negative
comments. Instead, break the cycle with a positive post.
9. If someone asks a question and you know the answer, offer to
help.
10. Thank others who help you online.
10 Netiquette Guidelines Online Students Need to know

1. NO YELLING, PLEASE
There’s a time and a place for everything—BUT IN MOST
SITUATIONS TYPING IN ALL CAPS IS INAPPROPRIATE. Most readers
tend to perceive it as shouting and will have a hard time taking what
you say seriously, no matter how intelligent your response may be.
If you have vision issues, there are ways to adjust how text displays
so you can still see without coming across as angry or upset.

2. Sarcasm can (and will) backfire
Sarcasm has been the source of plenty of misguided arguments
online, as it can be incredibly difficult to understand the
commenter’s intent. What may seem like an obvious joke to you
could come across as off-putting or rude to those who don’t know
you personally. As a rule of thumb, it’s best to avoid sarcasm
altogether in an online classroom. Instead, lean toward being polite
and direct in the way you communicate to avoid these issues.
3. Don’t abuse the chat box
Chat boxes are incorporated into many online classes as a place for
students to share ideas and ask questions related to the lesson. It can
be a helpful resource or a major distraction—it all depends on how
well students know their classroom netiquette.“Rather than asking
relevant questions or giving clear answers, students might use the
chat box to ask questions irrelevant to the discussion, or to talk about
an unrelated topic,” says Erin Lynch, senior educator at Test
Innovators. The class chat box isn’t an instant messenger like you’d
use with friends. Treat it like the learning tool it’s meant to be, and
try not to distract your classmates with off-topic discussions. Use it
instead to ask relevant questions and participate in class when the
professor asks.

4. Attempt to find your own answer
If you’re confused or stuck on an assignment, your first instinct
may be to immediately ask your instructor a question. But before
you ask, take the time to try to figure it out on your own.
For questions related to class structure, such as due dates or
policies, refer to your syllabus and course FAQ. Attempt to find the
answers to any other questions on your own using a search engine.
If your questions remain unanswered after a bit of effort, feel free
to bring them up with your instructor.
5. Stop ... grammar time!
Always make an effort to use proper punctuation, spelling and
grammar. Trying to decipher a string of misspelled words with erratic
punctuation frustrates the reader and distracts from the point of
your message
6. Set a respectful tone
Every day may feel like casual Friday in an online classroom where
you don’t see anyone in person, but a certain level of formality is still
expected in your communication with instructors. In addition to
proper punctuation and spelling, it’s good netiquette to use
respectful greetings and signatures, full sentences and even the same
old “please” and “thank you” you use in real life.

7. Submit files the right way
You won’t be printing assignments and handing to them to your
teacher in person, so knowing how to properly submit your work
online is key to your success as an online student. Online course
instructors often establish ground rules for file assignment
submissions, like naming conventions that help them keep things
organized or acceptable file formats. Ignoring these instructions is a
common example of bad netiquette.

8. Read first
Take some time to read through each of the previous discussion post
responses before writing your own response. If the original post asked
a specific question, there’s a good chance someone has already
answered it. Submitting an answer that is eerily similar to a
classmate’s indicates to the instructor that you haven’t paid attention
to the conversation thus far.
Remember, discussions can move fairly quickly so it’s important to
absorb all of the information before crafting your reply. Building upon
a classmate’s thought or attempting to add something new to the
conversation will show your instructor you’ve been paying attention.

9. Think before you type
A passing comment spoken in class can be forgotten a few minutes
later, but what you share in an online classroom is part of a
permanent digital record.
Not only is it good practice to be guarded when it comes to personal
information, you always want to be just as respectful toward others
as you would be if you were sitting in the same room together. Zink
says a good rule of thumb to follow is if you’re comfortable standing
up in front of a classroom and saying your message, then it’s most
likely okay to share.

10. Be kind and professional
Online communication comes with a level of anonymity that doesn’t
exist when you’re talking to someone face-to-face. Sometimes this
leads people to behave rudely when they disagree with one another.
Online students probably don’t have the complete anonymity that
comes with using a screen name, but you could still fall prey to
treating someone poorly because of the distance between screens.
Make a point to be kind and respectful in your comments—even if
you disagree with someone.
UNIT 7
STANDARDS OF NURSING
INFORMATICS PRACTICE
Standards of Nursing Informatics Practice
According to American Nurses Association
•Significance of the Standards
The Standards are based on the Standard of Professional Nursing
Practice
• They are authoritative statements of the duties that all registered
nurses, regardless of role, population, or specialty, are expected to
perform competently.
• The standards published are utilized as evidence of the of care, with
the understanding that application of the standards is context
dependent.
The Standards are based on the Standard of Professional
Nursing Practice
•The standards are subject to change with the dynamics of
the nursing profession, as new patterns of professional
practice are developed and accepted by the nursing
profession and the public.
•In addition, specific conditions and clinical circumstances
may affect the application of the standards at a given time
(e.g., during a natural disaster).
The Standards are based on the Standard of Professional
Nursing Practice
•The standards are subject to formal, periodic review and
revision.
• The competencies that accompany each standard may be
evidence of compliance with the corresponding standard.
•The list of competencies is not exhaustive.
•Whether a particular standard or competency applies
depends on the circumstances.
Standard 1. Assessment
•The informatics nurse collects comprehensive data,
information, and emerging evidence
pertinent to the situation.
Competencies
The informatics nurse:
• Uses evidence-based assessment techniques,
instruments, tools, and effective communication
strategies in collecting pertinent data to define the issue
or problem.
Competencies
•Uses workflow analyses to examine current practice,
workflow, and the potential impact of an informatics
solution on that workflow.
•Conducts a needs analysis to refine the issue or
problem when necessary.
Competencies
•Involves the healthcare consumer, family,
interprofessional team, and key stakeholders, as
appropriate, in relevant data collection.
•Prioritizes data collection activities.
•Uses analytical models, algorithms, and tools that
facilitate assessment.
Competencies
•One example of an assessment algorithm is PIECES:
✔ Performance--throughput or response time;
✔ Information-outputs, inputs, and/or stored data;
✔ Economics-costs versus profits;
✔ Control-too little security or control or too much control or security;
✔ Efficiency-people, machines, or computers waste time, and;
✔ Service--inaccurate, inconsistent, unreliable, hard to learn, difficult to use,
inflexible, incompatible, not coordinated with other systems (Wetherbe,
1994).
Competencies
•Synthesizes available data, information, evidence, and
knowledge relevant to the situation to identify patterns
and variances.
•Applies ethical, legal, and privacy regulations and
policies for the collection, maintenance, use, and
dissemination of data and information.
•Documents relevant data in a retrievable format.
•Standard 2. Diagnosis, Problems, and Issues
Identification
•The informatics nurse analyzes assessment data to
identify diagnoses, problems, issues, and opportunities
for improvement.
•Competencies
•The informatics nurse:
•Derives diagnoses, problems, needs, issues, and
opportunities for improvement based on assessment
data.
Standard 2.
Competencies
• The informatics nurse:
• Validates the diagnoses, problems, needs, issues, and
opportunities for improvement with the healthcare consumer,
family, interprofessional team, and key stakeholders when
possible and appropriate.
• Identifies actual or potential risks to the healthcare consumer’s
health and safety, or barriers to health, which may include, but
are not limited to, interpersonal, systematic or environmental
circumstances.
Standard 2.
Competencies
•The informatics nurse:
•Uses standardized clinical terminologies, taxonomies,
and decision support tools, when available, to identify
problems, needs, issues, and opportunities for
improvement.
•Documents problems, needs, issues, and opportunities
for improvement in a manner that facilities the discovery
of expected outcomes and development of a plan.
Standard 3. Outcome Identification
•The informatics nurse identifies expected outcomes for a
plan individualized to the healthcare consumer of the
situation.
Competencies
•Involves the healthcare consumer, family, healthcare
provider and key stakeholder in formulating expected
outcome when possible and appropriate.
Competencies
•Involves the healthcare consumer, family, healthcare
provider and key stakeholder in formulating expected
outcome when possible and appropriate.
•Defines expected outcome in terms of the healthcare
consumer, health-care worker, and other stakeholder;
their values; ethical; and environmental, organizational,
or situational considerations
Competencies
•Formulates expected outcomes after considering
associated risks, benefits, costs, available, expertise,
evidence-based knowledge, and environmental factors.
•Develops expected outcomes that provide direction for
project team members, the healthcare team, and key
stakeholders.
Competencies
•Includes a time estimate for the attainment of expected
outcomes.
•Modifies expected outcome based on changes in the
status or evaluation of the situation.
•Documents expected outcomes as measurable goals.
Standard 4. Planning
•The informatics nurse develops a plan that describes
strategies, alternatives and recommendations to attain
expected outcomes.
Competencies
•Develops a customized plan considering clinical and
business characteristics of the environment and
situation.
Competencies
•Develops the plan in collaboration with the healthcare
consumer, family, healthcare team, key, stakeholders,
and others as appropriate.
•Establishes the plan priorities with key stakeholders and
others as appropriate.
•Incorporates strategies in the plan address each of the
identified diagnoses, problems, needs, and issues.
Competencies
•Incorporates planes strategies addressing health and
wholeness across life span.
•Incorporates an implementation pathway or timeline
within the plan
•Considers the clinical, financial, social and economic
impact of the plan on the stakeholders
Competencies
•Integrate current scientific evidence, trends, and
research into the planning process
•Utilizes the plan to provide direction for the healthcare
team and other stakeholders.
•Integrates current status, rules and regulations, and
standards within the planning process and plan.
Competencies
• Modifies the plan according to the ongoing assessment of
the healthcare consumer’s response and other outcome
indicators.
• Integrates informatics principles in the design of
interprofessional processes to address identified situations or
issues.
• Documents the plan in a manner that uses standardized
terminologies and taxonomies.
Standard 5. Implementation
The informatics nurse implements the identified plan
Competencies
•Partners with healthcare consumer, healthcare team, and
others, as appropriate, to implement the plan on time, within
the budget, and within plan requirements.
•Utilizes health information technology to measure, record,
and retrieve healthcare consumer data, implement and
support the nursing process, and improve overall healthcare
outcomes.
Competencies
•Partners with healthcare consumer, healthcare team, and
others, as appropriate, to implement the plan on time, within
the budget, and within plan requirements.
•Utilizes health information technology to measure, record,
and retrieve healthcare consumer data, implement and
support the nursing process, and improve overall healthcare
outcomes.
Competencies
•Uses specific evidence-based actions and processes to resolve
diagnoses, problems, or issues to achieve the defined
outcomes.
•Advocates for health care that is sensitive to the needs of
healthcare consumers, with emphasis on the need of diverse
populations and use of self-theory
•Applies available healthcare technologies to maximize access
and optimize outcomes for healthcare consumers.
Competencies
•Uses community and organizational resources systematically
to implement the plan.
•Collaborate with the healthcare team and other stakeholder
from diverse backgrounds to implement and integrate the
plan
•Accommodates different styles of communication used by
healthcare consumers, families, healthcare providers, and
others
Competencies
•Implements the plan using principle and concepts of
enterprise management, project management and system
change theory
•Promotes the healthcare consumer’s capacity for the optimal
level of participation and problem-solving.
•Fosters an organizational culture that support implementation
of the plan
Competencies
•Incorporates new information and strategies to initiate
change if desired outcomes are not achieved
•Documents implementation and any modifications, including
changes or omissions, of the identified plan
Standard 5a. Coordination of Activities
The informatics nurse coordinates planned activities
Standard 5b. Health Teaching and Health Promotion
The informatics nurse employs informatics solutions and
strategies for education and teaching to promote health and a
safe environment
Standard 5c, Consultation
The informatics nurse provides consultation to influence the
identified plan, enhance the abilities of others, and effect
change.
Standard 6. Evaluation
• The informatics nurse evaluates progress toward attainment of
outcomes
Competencies
• Conducts a systematic, ongoing and criterion-based evaluation of the
outcomes in relation to the structure and processes prescribed by the
project plan and indicated timeline.
• Collaborates with the healthcare consumer, health care team members
and other key stakeholders involved in the plan or situation in the
evaluation process,
Competencies
•Evaluates in partnership with the key stakeholders, the
effectiveness of the planned strategies in relation to
attainment of the expected outcomes.
•Evaluates the link between outcomes and evidence- based
methods, tools, and guidelines
•Documents the results of the evaluation.
Competencies
•Disseminates the results to key stakeholders and others
involved, accordance with organizational requirements and
federal and state regulations
•Standards of Professional Performance for Nursing
Informatics
•The standards of professional performance express the role
performance requirements for the informatics nurse and
informatics nurse specialist
Standard 7. Ethics
•Identifies the informatics nurse practices ethically, with
further detailing of associated competencies, such as the use
of the Code of Ethics for Nurses with Interpretive Statements
to guide practice
Standard 8. Education
•Addresses the need for the informatics nurse to attain
knowledge and competence, including the competency
associated with demonstration of a commitment to lifelong
learning
Standard 9. Evidence-based Practice and Research
•Confirms that the informatics nurse integrative evidence and
research findings into practice
Standard 10. Quality of Practice
•Describes the expectation for the informatics nurse’s
contribution related to the quality and effectiveness of both
nursing and informatics practice.
Standard 11. Communication
•Explains that the information nurse communicates effectively
through a variety of formats, with several accompanying
competencies delineating specific requisite knowledge, skills,
and abilities for demonstrated success in this area.
Standard 12. Leadership
•Promotes that the informatics nurse leads in the professional
practice setting, as well as the profession. Accompanying
competencies address such skills as mentoring,
problem-solving, and promoting the organization’s vision,
goals, and strategic plan.
Standard 13. Collaboration

•Encompasses the informatics nurse’s collaborative efforts
with the healthcare consumer, family, and others in the
conduct of nursing and informatics practice
Standard 14. Professional Practice Evaluation
•Identifies that the informatics nurse conducts evaluation of
their own nursing practice considering professional practice
standard and guidelines, relevant statutes, rules and
regulations
Standard 15. Resource Utilization
•Addresses that the informatics nurse uses appropriate
resources to plan and implement safe, effective, and fiscally
responsible informatics and associated services
Standard 16. Environment Health
•Close out the list of professional performance standards by
describing that the informatics nurse supports practice in a
safe and healthy environment.
Nursing
Information
System
Mark Zeus G. Abalos, MSN
INTRODUCTION
The information system is composed of the internet applications
that aid to facilitate faster operations of the healthcare setting.
Even though devices as simple as mobile phones can help nurses
and other healthcare professionals communicate with each other
to obtain a goal, and that is to have an effective health system for
clients. This unit focuses on the different applications that is part
of our system today in the practice of nursing in various settings.
It talks about the practical applications that we can use in the
performance of our duties.
At the end of this unit, students will be able to:
PURPOSE & 1. Ensure a working relationship with individual

and family based on trust, respect, and shared
OBJECTIVES decision-making using appropriate electronic

information system and technology.
2.Communicate effectively in speaking, writing,
and presenting using culturally appropriate
language.
INTERNET
APPLICATIONS
PERSONAL DIGITAL
ASSISTANT (PDA) &
WIRELESS DEVICES
Pocket-sized computers that can access the internet, sending and receiving data, and storing
textbooks worth of information. These tools have the potential to help nurses increase the
quality of care that they provide in the hospital setting. PDAs have been shown to increase
evidence-based practice and decrease medication errors by making relevant information
available right at the point-of-care. PDAs have also been shown to save nurses’ time by
increasing the efficiency and accuracy of electronic patient charting, and by decreasing the time
that it takes nurses to research medication information. The integration of PDAs into nursing
practice poses individual, technical and financial challenges, as well as patient confidentiality and
infection control concerns. However, as nurses and organizations begin to recognize the
potential for PDAs, and as more nursing-focused software and resources continue to be
developed, PDAs truly have the potential to revolutionize the way that nurses provide and record
care (Predhomme, 2009).
Personal The era of PDAs went for a while
Digital between 1992 to 2007 (Edwards,
Assistant 2018), PDA applications have
been slowly being incorporated
to today’s smart phones and
other mobile devices such as
tablets. Being more compact
and losing the stylus for it to be a
practical touch screen device,
smart phones and tablets have
definitely replaced the PDA.
EMAILS
Emails or electronic mails are ways to send messages
between one user to another or to multiple users. Most of
the companies today including hospitals provide work-
related email accounts to their employees for an efficient
communication within and outside the institution.
Requests and follow-ups are made faster and documented
as it is time-stamped, clutter-free, and traceable in terms
of message history.
Just as it is used in books for
BOOKMARKS
easy retrieval of the page you are
reading or for common
reference, it also has the same
function in the context of the
internet browsers and other
reading applications such as
Kindle and iBook to name a few.
In the practice of nursing, nurses
utilize bookmarks with its
intended purpose to quickly
retrieve information on drugs,
medical diagnosis, procedures,
and other necessary
information in planning and
implementing care to patients.
PERSONAL DIGITAL
WIRELESS PHONES
ASSISTANT (PDA) &
(MOBILE DEVICES)
WIRELESS DEVICES
Mobile devices as discussed previously have replaced the function
of PDAs. With its multi-function capabilities as a smart phone,
health care professionals can access information quickly and
communicate.
Nurses communicate with multiple members of the health

member team, often while maintaining heavy patient loads. Optimal
communication procedures can help nurses use their time more
efficiently to improve patient safety and outcomes. (VanDusen, 2017).
WIRELESS PHONES Healthcare personnel are often
in different locations when
(MOBILE DEVICES) collaboration is needed.
Maintaining safe patient care may
require fast, accurate
communication among mobile
staff. Delays in communication
have been identified by The
Joint Commission as significant
contributors to adverse events.
The Joint Commission has made
communication between
healthcare workers a patient
safety goal in an effort reduces
medical errors (VanDusen, 2017).
Nurses use many different methods of
WIRELESS PHONES electronic communication in the clinical
setting to coordinate patient care. This
(MOBILE DEVICES) includes e-mail, smartphone application,
and two-way or group texting options.
The Joint Commission standards have
been redefined, and they now allow
texting of orders and patient
information, if the clinician is the
compliant with a secure texting platform
and maintains safety measures to ensure
order accuracy. Texting lets members of
the healthcare team communicate and
collaborate effectively and among several
disciplines. These methods reduce
response time in emergencies and
increase the frequency of provider
responses to nurses (VanDusen, 2017).
When used appropriately, electronic
WIRELESS PHONES devices can improve the organization of
daily activities and administrative tasks.
Applications allow users to set
(MOBILE DEVICES) reminders for upcoming meetings or
deadlines. They can also speed up
patient data management, improve
staff cooperation, and provide
opportunities for more efficiency
(VanDusen, 2017).
Along with benefits, electronic

communication has some limitations
in the clinical setting. For example, it
can create additional interruptions
that decrease clinician’s presence in
other patient-care situations
(VanDusen, 2017).
WIRELESS PHONES
(MOBILE DEVICES)
Confidentiality is also a concern. Improved efficiency could be offset by
communication difficulties and loss of reliability and confidentiality. Several studies
have raised doubts about information security, inadequate technical skills, and poor
staff interrelations. Nurses may perceive a worsening of interprofessional
relationships due to an overreliance on text messaging and a subsequent lack of
verbal communication (VanDusen, 2017).
Smartphone applications should be carefully chosen for confidentiality as well as

efficiency. Peer-reviewed software allows date encryption of stored patient
information, remote wiping to destroy data in the event of loss or theft, secure
encrypted data transmission over Wi-Fi, and coordination with facility-specific
standardized clinical communication tools. Additional studies to examine the
clinical value of electronic communication systems are currently underway and
should provide further information about the effectiveness of this technology
(VanDusen, 2017).
TWO-WAY or
MULTI-PERSON VIDEO
TELECONFERENCING
Video conferencing is a visual communication session

between two or more users regardless of their
location, featuring audio and video content
transmission in real time. This platform became very
popular in the rise of COVID-19 pandemic because social
and physical distancing was instituted as part of the
health and safety protocols.
TWO-WAY or
MULTI-PERSON VIDEO
TELECONFERENCING
For effective video conferencing, business companies or organizations need to set up a
profiling conferencing software and hardware solutions for rooms, PCs, mobile devices,
and browsers. Video conferencing consists of an endpoint (ranging from a simple PC to
a telepresence system), video conferencing server (to run group videoconferencing),
peripherals (webcam, microphone, speakerphone, headset, etc.) and software
infrastructure (video processing, content transmission, integrations). Video
conferencing is modern high-tech communication tolls for increasing efficiency for
businesses, optimizing and accelerating decision-making processes, and cutting
customer’s and company staff travel costs. There are a lot of video teleconferencing
applications that people in various sectors utilized to continue their operations such as
Zoom, Microsoft Teams (between office 365 Users) Google Meet, and Facebook
Messenger Rooms to name a few. Each platform presented is various features and prices
from free to premium subscriptions. As we draw near the new normal, this video
conferencing platforms will remain to be used in various industries.
FACE TIME
For a more personal communication especially this time of pandemic,
which resulted to feelings of anxieties between patients and their families,
they found the significance of video calling mobile applications such as
Apple’s facetime, and Facebook Messenger to communicate safely yet
efficiently. Based on the study by Padala et al (2020) interaction with family
members using Face Time improved behavioral problems in a patient with
Alzheimer’s dementia during the COVID-19 pandemic. Use of such
applications need to be studied both for clinical and research care to be
prepared for future pandemics. As nurses caring for these patients, it is very
important that we support and value the use of such applications to aid in
the need for communication of our patients.
TEXT MESSAGING /
SHORT MESSAGING SYSTEM
Text messaging has already been normal to us for

communicating faster and clearer. Text messaging is the act
of sending short, alphanumeric communications between
cellphones, pagers or other hand-held devices, as
implemented by a wireless carrier. As discussed on Mobile
Phones, nurses and other healthcare professionals are
already using text messaging as a form of communication
and providing orders for treatment and care for the patient.
SOCIAL MEDIA
Social Media like Facebook, Twitter, and Instagram have been a
norm to all of us. Mostly this is our personal space in the online
world, where we can express our thoughts, appreciation,
achievements, sorrow, and many more. The way we share our
information depends on how we chose to share it. Either by the
public or anyone who is registered user or visitor of Facebook can
access the content; or by selected audiences such as users who are
on the friends list or more precise list such as those that the user
chose to share it with. In the healthcare setting, we take a look at
how social media can be used to benefit the practice.
Uses of Social Media according
to Ventola (2014):
1.Professional Networking
2.Professional Education
3.Organization Promotion
4.Patient Care
5.Patient Education
6.Public Health
The first three users are very common and
expected use of social media that can benefit
the healthcare professionals. Since the
intended use of social media is to connect
people, it is known that professional
networking can be establish using this
platform. Professional Education, likewise, can
be done using Social Media through hosting a
live event such as FB live or providing links in
the social media website where users or
participants can access the site directly
without typing the website address. Lastly,
Organization Promotion can be done
through social media by posting their
activities, services, awards, and other
relevant materials that can increase or
promote their organization. Many
organizations find the marketing aspect in
social media very cost-efficient as it reaches
out to millions of its users with a small fee per
posting.
PATIENT
Although there has been a
reluctance among HCPs to use
social media for direct patient
CARE
care, this practice is slowly being
accepted by clinicians and
healthcare facilities. For
example, Georgia Health
Sciences University has
provided patients with access to
a platform called Web View,
which allows the patient to
reach their doctors to ask
questions or request
prescription refills (Ventola,
2014).
Recent studies have found that physicians have
VENTOLA
begun to develop an interest in interacting with
patients online. Some physicians are using social
media, including Twitter and Facebook, to
enhance communication with patients.
(2014)
Approximately 60% of physicians were found to
favor interacting with patients through social
media for the purpose of providing patient
education and health monitoring, and for
encouraging behavioral changes and drug
adherence, with the hope that these efforts will
lead to “better education, increased
compliance, and better outcomes.” However,
other studies have shown that considerable
resistance still exists to using social media to
interact with patients. In a survey of
approximately 480 practicing and student
physicians, 68% felt it was ethically problematic
to interact with patients on social networks for
either personal or professional reasons.
PUBLIC According to Ventola (2014)
social media have created vast
global networks that can
HEALTH quickly spread information and

mobilize large numbers of
people to facilitate greater
progress toward public health
goals. Social media can
therefore be a powerful tool for
public education and advocacy
regarding public health issues.
Some states ‘public health
departments are using Twitter
and other social media for these
purposes.
Other public health organizations
use keyword content from Twitter
and other social networks, in
combination with location-tracking
technologies, to respond rapidly to
disasters and to monitor the health
and welfare of populations. The
CDC maintains an active presence
on Twitter and Facebook to track
tweets that might indicate a flu
outbreak and to share updates
about such incidents. The CDC has
also used social media to locate
and monitor sources and
suspected cases of Legionnaire’s
disease.
Organizations such as the Red Cross track
Twitter post during natural disasters, such as
hurricanes and earthquakes to gather
information about where the greatest needs
are. Citizen report blogs have also been
monitored by hospitals for information about
potential mass casualty events. When used in
this way, real-time social media sites provide
greater agility and enhanced preparedness
for responses to disasters and public health
emergencies. Social media sites also provide
disaster and emergency response personnel
with a means to rapidly share, and access
important information provided by agencies
such as the CDC and the U.S Preventive
Services Task Force.
The widespread use of social
media can also influence public
health behaviors and goals
through social reinforcement. 8
because human beings are a
highly social species, they are
often influenced by their friends,
as well as by friends of friends.
One example of the powerful
effect of social media was seen
after Facebook decided to allow
users to post their organ-donor
status in their profile. According
to Donate Life America, the week
after this feature was introduced,
online state organ-donor
registries experienced a 23-fold
surge in donor pledges that was
presumably due to this social
networking effect (Ventola, 2014).
Dangers of Social Media in the
Health Care Practice according to
Ventola (2014):
1.Poor Quality of Information
2.Damage to Professional
Image
3.Breaches of Patient Privacy
4.Violation of Professional-
Patient Boundary
5.Licensing Issues and other
Legal Issues
Professional Guidelines for the use of
Social Media based on the study by
Ventola (2014):
Context Concept
Share only information from credible
sources.
Content credibility
Refute any inaccurate information you
encounter.
Remember that the content you author
may be discoverable.
Legal concerns
Comply with federal and state privacy laws.
Respect copyright laws.
Licensing Know professional licensure requirements
concerns for your state.
Ventola (2014):
Context Concept
Do not contact patients with requests to join your network.
Networking policies Direct patients who want to join your personal network to a more
secure means of communication or to your professional sites.
Avoid providing specific medical advice to nonpatients.
Patient care Make appropriate disclosures and disclaimers regarding the
accuracy, timelines, and privacy of electronic communication.
Avoid writing about specific patients.
Make sure you are in compliance with state and federal privacy
laws.
Patient privacy
Obtain patient consent when required.
Protect patient information through “de-identification.”
Use a respectful tone when discussing patients.
Ventola (2014):
Context Concept
Use the most secure privacy settings available.
Personal privacy Keep professional and personal profiles separate.
Disclose any in-kind or financial compensation

Professional ethics received.
Do not make false or misleading claims.
Identify yourself in professional sites.
Make sure that your credentials are correctly stated.
Self-identification
Specify whether or not you are representing
employer.
WEB 2.0
BLOGS
WIKIS
WEB 2.0
Term devised to differentiate the post-dotcom bubble Word
Wide Web with its emphasis on social networking, content
generated by users, and cloud computing from that in which
came before. The 2.0 appellation is used in analogy with common
computer software naming conventions to indicate a new,
improved version. The term had its origin in the name given to a
series of Web conferences, first organized by publisher Tim O’Reilly
in 2004. The term’s popularity warned in the 2010s as the features
of Web 2.0 became ubiquitous and lost their novelty (Hosch, 2017).
WEB 2.0 In simple terms, Web 1.0
involves websites that are
not interactive or is not
based on contents being
posted or delivered by
user, whereas Web 2.0
are websites that are
interactive such as social
media website. Blogs
and wikis are also
samples of Web 2.0.
WEB 2.0
The use of Web 2.0 for the benefit of the healthcare
practice has wide variations from patient care
schedules e-consultation such as in private hospitals
where you can consult with a physician virtually,
patient information on diagnostic tests, its
preparation, what to expect, and other pertinent
details can be the variation of use.
RELEVANCE OF
INFORMATICS
SYSTEM TO
COMMUNICATION
IN NURSING
In the healthcare setting, patient safety is of
utmost priority among the healthcare
team. It is therefore imperative that we
practice effective communication
techniques to reach this goal. These
communication techniques can be found on
TeamSTEPPS by the Agency for Healthcare
Research and Quality (AHRQ). According to
AHRQ (2013) individuals can learn four
primary trainable teamwork skills. These
are:
▪ Leadership
▪ Communication
▪ Situation monitoring
▪ Mutual support
If a team has tools and
strategies it can leverage to
build a fundamental level of
competency in each of those
skills, research has shown that
the team can enhance three
types of teamwork outcomes:
▪Performance
▪Knowledge
▪Attitudes
Effective teamwork
is important not only
for an organization
to succeed but also
for its people's
wellbeing.
For example, if every member of
the team has basic competency
in situation monitoring and
communication, it is incumbent
upon them to build shared
mental models more effectively.
Improved outcomes beget
greater proficiency (improved
teamwork skills) and a desire to
be a part of the team (attitudes).
Such is the reciprocal
relationship between skills and
outcomes. Certainly, the
informatics system has a key role
in ensuring that communication
between the healthcare team will
be made possible whether from a
simple mobile device functions
to mobile applications.
Essential
Communication
Techniques
under
TeamSTEPPS
according to
AHRQ (2013)
SBAR
(Situation, Background,
Assessment, Recommendation)
A technique for communicating critical information that requires
immediate attention and action concerning a patient’s condition.
Situation - What is going on with the patient?
“I am calling about Mrs. Joseph in room 251. Chief complaint is shortness of breath of new onset.”
Background - What is the clinical background or context?

“Patient is a 62-year-old female post-op day one from abdominal surgery. No prior history of cardiac or lung
disease.”
Assessment - What do I think the problem is?

“Breath sounds are decreased on the right side with acknowledgement of pain. Would like to rule-out
pneumothorax.”
Recommendation and Request - What would I do to correct it?

“I feel strongly the patient should be assessed now. Can you come to room 251 now?”
CALL-OUT
Strategy used to communicate important or critical information.
• Informs all team members simultaneously during emergent situations.
• Helps team members anticipate next steps.
• Important to direct responsibility to a specific individual responsible for carrying out the task.
Example during an incoming trauma:
Leader: “Airway status?”

Resident: “Airway clear”
Leader: “Breath sounds?”
Resident: “Breath sounds decreased on right”
Leader: “Blood pressure?”
Nurse: “BP is 96/62”
CHECK-BACK
Using closed-loop communication to ensure that information
conveyed by the sender is understood by the receiver as intended.
The steps include the following:
1. Sender initiates the message.
2.Receiver accepts the message and provides feedback.
3.Sender double-checks to ensure that message was received.
Example:
Doctor: “give 25 mg Benadryl IV push”
Nurse: “25 mg Benadryl IV push”
Doctor: “That’s correct”
HANDOFF
The transfer of information (along with authority and responsibility)
during transitions in care across the continuum. It includes an
opportunity to asks question, clarify, and confirm.
Examples of transitions in care include shift changes; transfer of

responsibility between and among nursing assistants, nurses nurse
practitioners, physician assistants, and physician; and patient transfers.
Strategy designed to enhance information exchange during transitions

in care.
“I PASS THE BATON”
Introduce yourself and your role/job (include
I Introduction
patient).
P Patient Name, identifiers, age, sex, location.
Present chief complaint, vital signs, symptoms,
A Assessment
and diagnosis.
Current status/circumstances including code
S Situation status, level of (un) certainty, recent changes,
and response to treatment.
Critical lab values/repots, socioeconomic
S Safety
factors, allergies, and alerts, (falls, isolation, etc.)
THE
Comorbidities, previous episodes, current
B Background
medications, and family history.
Explain what actions were taken or are
A Actions
required. Provide rationale.
Level of urgency and explicit timing and
T Timing
prioritization of actions.
Identify who is responsible (person/team)
O Ownership
including patient/family members.
What will happen next?
Anticipated changes?
N Next
What is the plan?
Are there contingency plans?
EMAIL ADDRESS
markzeus.abalos@lorma.edu
MOBILE NUMBER
0915.061.2510
CONSULTATION HOURS
Wednesdays
12:30 PM to 3:30 PM
Reach out if you have comments, questions, and more.

Recommendations for Social Media Use in hospitals and health
Care Facilities
Social Media is the new avenue for creating connections and sharing of information. Through social
media, one can reach a global community. In recent years, we have seen how social media has changed
the way we do things. Social Media has been extensively utilized for health education and promotion,
proving itself to be an invaluable tool for public health, professional networking and patient care
benefit.
The challenge has been to use the power afforded by social media responsibly, and to define the line
between use and abuse. While there may be laws, implementation proves to be a challenge in the
digital age. Therefore, self-regulation and institutional policy remain a critical part. It is therefore urged
that hospitals and health care facilities adopt their own social media use policy appropriate for the
institution. Below are proposed rules that could guide institutions in developing their own policy for
social media use:
Sec. 1. Declaration of Policy. The health facility recognizes that the exercise of the freedom of
expression comes with a responsibility and a duty to respect the rights of others. The health facility
likewise acknowledges the fundamental right to privacy of every individual. This policy shall provide
rules for responsible social media use.
Sec. 2. Definition. For purposes of this policy, the following definitions shall be used:
a. Social Media refers to electronic communication, websites or applications through which

users connect, interact or share information or other content with other individuals, collectively part of
an online community. This includes Facebook, Twitter, Google+, Instagram, LinkedIn, Pinterest, Blogs,
Social Networking sites.
b. Health facility shall refer to the hospital or other health care facilities, including training and
educational institutions.
c. Individual shall refer to physicians, employees, other health facility staff, residents, or
students to which this policy would apply.
Sec. 3. Applicability. This policy shall apply to all physicians, health professionals, employees and other
health facility staff, including students or residents in training, practicing their profession, working, or
fulfilling academic and clinical requirements within the health facility, whether temporary or permanent.
Sec. 4. General Principles. Social media use shall be guided by the following principles:
a. In using social media, an individual should always be mindful of his or her duties to the patient
and community, his profession and his colleagues.
b. The individual should always be conscious of his or her online image and how it impacts his or
her profession, or the institution where he or she is professionally employed, affiliated or otherwise
connected.
c. Responsible social media use also requires the individual to ensure that in his or her social
media activity, there is no law violated, including copyright, libel and cybercrime laws. At all times, the
individual shall respect the right of privacy of others.
d. Use of social media requires a personal commitment to uphold the ethical standards required
of those providing health services, upon which patient trust is built.
Sec. 5. Social Media for Health Education or Promotion
a. The individual using social media for health education or promotion must be well-informed of
the matter subject of the social media post, comment or other activity. The individual shall refrain from
any activity which spreads or tends to spread misinformation.
b. An article written by an individual and posted in social media must be evidence-based and
disclose connections with pharmaceutical or health product companies or other sources of possible
conflict of interest.
c. Social media shall not be used to dispense specific medical diagnosis, advice, treatment or
projection but shall consist of general opinions only. Use of social media should include statements that
a person should not rely on the advice given online, and that medical concerns are best addressed in the
appropriate setting.
d. The individual shall be careful in posting or publishing his or her opinion and shall ensure that
such opinion will not propagate misinformation or constitute a misrepresentation. The individual shall
not make any misrepresentations in his or her social media activity relating to content, his or her
employment or credentials, and any other information that may be misconstrued or taken out of
context.
Sec. 6. Professionalism in Social Media Use
a. Individuals are discouraged from using a single account for both professional and private use.
Be mindful that an electronic mail address used professionally may readily be linked to a social media
site used privately.
b. The individual shall conduct himself or herself in social media or online the same way that he
would in the public, mindful of acting in a manner befitting his profession, or that would inspire trust in
the service he or she provides, especially if the individual has not separated his or her professional and
personal accounts in social media.
c. The individual shall likewise refrain from using the name, logo or other symbol of an
institution without prior authority in his or her social media activity. An individual shall not identify
himself or herself as a representative of an institution in social media without being authorized to do so.
d. Individuals shall not accept former or current patients as friends or contacts in their personal
accounts, unless there is justification to do so, such as a pre-existing relationship or when unavoidable
for patient care. In case of online interaction with patients, this should be limited to matters related to
the patient’s treatment and management, and which could be properly disclosed.
e. Informal and personal information concerning a patient, colleague or the health facility shall
not be posted, shared or otherwise used in social media.
f. Social media shall not be used to establish inappropriate relationships with patients or
colleagues, and shall not be used to obtain information that would negatively impact on the provision of
services and professional management of the patient.
g. An individual shall refrain from posting, sharing or otherwise using photos or videos taken
within the health facility, which would give the impression of unprofessionalism, show parts of the
health facility where there is an expectation of privacy, or those which includes colleagues, employees,
other health facility staff, or patients without their express consent. The consent requirement shall
apply even if the other individuals included are not readily identifiable.
Sec. 7. Responsible Social Media Activity
a. In using social media, the individual shall respect the dignity, personality, privacy and peace of
mind of another.
b. The individual shall not post, share or otherwise use social media with the intent of damaging
the reputation of any other individual or institution, especially if the subject is identified or identifiable.
c. Derogatory comments about patients, colleagues, employers and institutions or companies

should be avoided. An individual may “like” a defamatory post but he or she must use caution when
sharing, retweeting or contributing anything that might be construed as a new defamatory statement. A
post, comment or other social media activity is considered defamatory if:
1)The activity imputes a discreditable act or condition to another
2)The activity is viewed or seen by any other person
3)The person or institution defamed is identified or readily identifiable
4)There is malice or intent to damage the reputation of another.
d. He or she shall be careful of sharing posts or other contents that are unverified, particularly if
it discredits another person or institution, or imputes the commission of a crime or violation of law even
before trial and judgment, and violates the privacy of another. Fair and true reporting on matters of
public concern shall be allowed provided that the content was obtained lawfully and with due respect
for the right of privacy.
e. An individual shall not use copyrighted materials other than for fair use where there is proper
citation of source and author. Use of copyrighted material for purpose of criticism, comment, news,
reporting, teaching, scholarship, research, and similar purposes is compatible with fair use.
f. An individual is prohibited from:
1)Social media activities that defame, harass, stalk, or bully another person or
institution.
2)The use or access of personal social media accounts of others without authority.
3)Posting, sharing or otherwise using any information intended to be private or

obtained through access to electronic data messages or documents.
4)Posting, sharing or otherwise using recorded conversations between doctors,

individuals or patients, when such recording, whether audio or video, was obtained without
consent of all the parties to the conversation
g. Individuals should use conservative privacy settings in their social media account used
professionally. The individual should also practice due diligence in keeping their social media accounts
safe such as through regular password change and logging out after social media use.
Sec. 8. Health Information Privacy
a. The individual shall respect the right to privacy of others and shall not collect, use, access or
disclose information, pictures and other personal or sensitive information without obtaining consent
from the individual concerned. Physicians, health facility employees and other health staff shall have the
duty of protecting patient confidentiality in their social media activity.
b. Personal health information, including photos or videos of patients, shall not be posted,
shared or otherwise used in social media without consent of patient. Consent shall be obtained after
explaining to the patient the purpose of the intended collection, use, access and disclosure. Consent for
use of personal health information shall be written or evidenced by electronic means.
c. An individual shall not post, share or otherwise use any information which could be used to
identify patients without their consent, including patient’s location, room numbers, and photographs or
videos of patients or their body parts, including code names referring to patients.
d. The individual shall not post, share or otherwise use any other information acquired in
attending to a patient in a professional capacity, and which would blacken the reputation of the patient.
The duty of maintaining patient confidentiality remains even after patient’s death.
e.An individual shall not post, share or otherwise use any information relating to the identity, status and
personal details of persons with HIV, those who have undergone drug rehabilitation, and victims of
domestic violence, rape and child abuse.
Sec. 9. Compliance and Reporting.
a. An individual shall strive to develop, support and maintain a privacy culture in the health
facility. He or she shall abide by the social media use policy of the institution.
b. An individual who becomes aware of unprofessional behavior, misinformation or privacy
violations in social media shall report the matter to the hospital’s privacy officer or the proper office or
authority within the facility.
c. Health facilities shall in so far as practicable monitor the social media activity of all physicians,
employees and other health facility staff, including students or residents in training, practicing their
profession, working, or fulfilling academic and clinical requirements within the health facility, whether
temporary or permanent.
Sec. 10. Penalty. A violation of this policy may constitute a violation of the code of ethics of physicians
and other professions, and other applicable laws.
a. Health Professionals, employees and other Health Facility Staff. Any person found violating
this policy will be considered in violation of health facility rules and regulations, and shall be subjected
to health facility administrative proceedings, which after notice and hearing, and depending on the
severity of the violation, could result to termination of service or withdrawal of privileges. A lighter
penalty may likewise be imposed. In determining the severity of the violation, the following factors may
be considered: previous violation, if any, the nature of the violation, and the extent of injury or
damage.The penalty imposed by the health facility shall be without prejudice to the filing of a complaint
before the Civil Service Commission, the Professional Regulations Commission, the Office of the
Prosecutor or Ombudsman, or proper courts.
b. Students. In case of students, they shall be reported to the college wherein they are enrolled
and shall be subjected to disciplinary proceedings, which could result to expulsion, depending on the
severity of the violation, and in accordance with the applicable University and respective College rules. A
lighter penalty may likewise be imposed. The disciplinary proceedings shall be without prejudice to
other applicable legal remedies.
CLINICAL
◤
PATHWAY AND
CLINICAL
PRACTICE
GUIDELINES
OBJECTIVES:
At the end of this report, the student should be
able to:
1. Discuss the definition of clinical pathway and
clinical practice guidelines.
2. Identify all involved staff common goals and
helping them to understand their roles in the
entire care process.
Discuss◤ the framework for collecting and
analyzing data on the care process.
Explain how to improve patient satisfaction
through improved patient education e.g. better
care giver-to-patient communication on the
plan of care.
◤
INTRODUCTION:
▪ The application of computers to generate, validate, secure and

integrate healthcare data to support the decision making
activities of clinical and administrative professional has added an
entirely new dimension to the functioning of healthcare industry.
▪ Techniques of Quality Management Science are among the

newer approaches to managing the delivery of healthcare. One
such application of this science to healthcare is Clinical
Pathways.
◤
CLINICAL PATHWAYS
▪ Clinical Pathways (CP) is multidisciplinary plans of best clinical

practice for specified groups of patients with a particular
diagnosis that aid the coordination and delivery of high quality
care. They are both, a tool and a concept, which embed
guidelines, protocols and locally agreed, evidence-based,
patient- centered, best practice, into everyday use for the
individual patient”.
◤
CLINICAL PATHWAYS
▪ Clinical Pathways are structured, multidisciplinary plans of care

designed to support the implementation of clinical guidelines and
protocols.
▪ Introduced in the 1990’s in the UK and USA
▪ Improve the continuity of care across disciplines
▪ Step wise sequencing of care.

◤
WHY DO WE NEED CLINICAL
PATHWAYS?
▪ To improve patient care

To maximize the efficient use of
▪ resources
▪ To help identify and clarify the clinical processes
▪ To support clinical effectiveness, clinical audit and risk

management
◤
PURPOSE
▪ Facilitate introduction of guidelines to improve the quality of care
▪ Improve multidisciplinary communication
▪ Reach or exceed quality care standards
▪ Decrease unwanted practice variation
▪ Improve patient-clinician communication and patient satisfaction.
▪ Identify research and development questions

◤
AS ACTIVE MANAGEMENT TOOLS:
▪ Eliminate prolonged lengths of stay arising from inefficiencies,

allowing better use of resources
▪ Reduce mistakes, duplication of effort and omission
▪ Improve the quality of work for service providers
▪ Improve communication with patients as to their expected course of

treatment
▪ Identify problems at the earliest opportunity and correct these

promptly
▪ Facilitate quality management and an outcomes focus

◤
DISTINGUISH CRITICAL PATHWAYS FROM CLINICAL
PROTOCOL
▪ Protocols are treatment recommendations that are often based
on guidelines. Like the critical pathway, the goal of the clinical
protocol may be to decrease treatment variation.
▪ Protocols are most often focused on guideline compliance rather

than the identification of rate-limiting steps in the patient care
process.
▪ In contrast to critical pathways, protocols may or may

not include a continuous monitoring and
data-evaluation component.
◤
FOUR COMPONET OF CLINICAL OF A
CLINICAL PATHWAY
▪ A Timeline,
▪ Categories of care or activities and their interventions,
▪ Intermediate and long-term outcome criteria,
▪ Variance record
◤
CLINICAL PATHWAY DEVELOPMENT
PREREQUISITES
▪ Succeed when the decision to develop is taken on an organizational basis.
▪ Senior management commitment and a strong medical and nursing lead
▪ are essential.
▪ Pathway documentation is more likely to be used if it is simple, clear and

user friendly.
▪ The process of pathway development considers why tasks and

interventions are performed, and by whom; since it promotes greater
awareness of the role of each professional involved in the care cycle.
◤
BASIS OF CRITICAL PATHWAY
TECHNIQUE
▪ DEFINE THE PROCESSESS
▪ TIMING OF THESE PROCESSES
▪ NOTE TARGET AREAS THAT WERE CRITICAL
▪ MEASURE VARIATION,AND MAKE IMPROVEMENTS
▪ REMEASUREMENT
◤
VARIATION
▪ SYSTEMS VARIATION
▪ HEALTH AND SOCIAL CARE VARIATION
▪ PATIENT VARIATION
◤
GUIDELINES FOR THE IMPLEMENTATION
AND DEVELOPMENT
▪ Educate and obtain support from physicians and nurse, and establish a multidisciplinary
team.
▪ Identify potential obstacles to implementation.
▪ Use Quality improvement methods and tools.
▪ Determine staff interest and select Clinical Pathways to develop.
▪ Collect Clinical Pathway data and medical record reviews of practice patterns.
▪ Conduct literature review of clinical practice guidelines. Develop variance analysis

system and monitor the
▪ compliance with documentation on Clinical Pathways.
▪ Use a pilot Clinical Pathway for 3 to 6 months; revise as needed.

◤
CONSTITUENTS OF CLINICAL
PATHWAYS
▪ Multi-disciplinary, multi-agency, clinical and administrative activities
▪ Structured Variance Tracking

Local and National standards
Evidence based, locally agreed, best practices
Tests, charts, diagrams, information leaflets, satisfaction questionnaires, etc.
▪ Scales for measurement of clinical effectiveness
▪ Outcomes
Freehand notes
▪ Scalability to add activities to a standard CP for
▪ individualized care for a particular patient
▪ Problem, Plan, Goal and Notes or similar structured freehand area

◤
OPTIMUM DEVELOPMENT AND
IMPLEMENTATION STRATEGIES:
▪ SELECT A TOPIC
▪ Topic of high-volume, high-cost diagnoses and procedures.

For example:- Critical pathway development for cardiovascular diseases and procedures
▪ SELECT A TEAM
▪ Active physician participation and leadership is crucial
▪ Representatives from all groups
▪ EVALUATE THE CURRENT PROCESS OF CARE
▪ Key to understanding current variation
▪ A careful review of medical records
▪ Identify the critical intermediate outcomes, rate-limiting steps, and high-cost areas on which to focus.
▪ EVALUATE MEDICAL EVIDENCE AND EXTERNAL PRACTICES
▪ Evaluate the literature to identify evidence of best practices
▪ In the absence of evidence, comparison with other institutions, or "benchmarking," is the most reasonable method to use.
◤
DETERMINE THE CRITICAL PATHWAY
FORMAT
▪ The format of the pathway include a task- time matrix
▪ spectrum of pathways of the medical record used as a simple

checklist
◤
DOCUMENT AND ANALYZE VARIANCE
▪ The most important processes in the critical pathway
▪ Identification of factors the key features in process improvement
▪ Variance in clinical pathways is a result of the omission of an

action or the performance of an action at an inappropriate (often,
a late) time period.
▪ Team to concentrate on a few critical items in the pathway that

have been identified in advance
▪ For example: length of stay in the intensive care unit

▪ Support the introduction of evidence-based medicine and use of clinical guidelines
▪ ◤risk management and clinical audit

Support clinical effectiveness,
▪ Improve multidisciplinary communication, teamwork and care planning

BENEFITS
▪ Can support continuity and co-ordination of care across different clinical disciplines and sectors;
▪ Provide explicit and well-defined standards for care
▪ Help reduce variations in patient care (by promoting standardization)
▪ Help improve clinical outcomes; Help improve and even reduce patient documentation
▪ Support training
▪ Optimize the management of resources
▪ Can help ensure quality of care and provide a means of continuous quality improvement
▪ Support the implementation of continuous clinical audit in clinical practice
▪ Support the use of guidelines in clinical practice
▪ Help empower patients; Help manage clinical risk
▪ Help improve communications between different care sectors
▪ Disseminate accepted standards of care
▪ Provide a baseline for future initiatives
▪ Expected to help reduce risk; Expected to help reduce costs by shortening hospital stays
◤
POTENTIAL PROBLEMS AND BARRIERS
TO CLINICAL PATHWAYS:
▪ May appear to discourage personalized care
▪ Risk increasing litigation
▪ Don't respond well to unexpected changes in a patient's condition
▪ Suit standard conditions better than unusual or unpredictable ones
▪ Require commitment from staff and establishment of an adequate organizational structure
▪ Problems of introduction of new technology
▪ May take time to be accepted in the workplace
▪ Need to ensure variance and outcomes are properly recorded, audited and acted upon
◤
CLINICAL PRACTICE GUIDELINES
▪ are statement that include recommendations intended to

optimize patient care that are informed by systematic review of
evidence and an assessment of the benefits and harms of
alternative care options.
▪ Committee on Standards for Developing Trustworthy CPG’s

(IOM-AHRQ)
◤
WHY DO WE NEED GUIDELINES?
▪ Growing evidence of unexplained and inappropriate variations in
clinical practice patterns.
▪ Concern that further limitations in resources will affect the
delivery of high quality health care.
▪Clinicians have difficulty assimilating evolving scientific evidence
into practice
◤
RATIONALE
▪Worldwide concerns about:
▪° Unexplained variations in clinical practice ° Rising health
care costs ° Exponential growth of information
▪Aim of Clinical Practice Guidelines:
▪To facilitate more consistent, effective and efficient practice

and improve health outcomes for patients
Evidence-Based CPGs
Current Best
Practice Guidelines Practice
Who needs guidelines?
THE PROCESS FOR CLINICAL PRACTICE
GUIDELINE CONTENT DEVELOPMENT
Step 1 Determine topic Identify author/s
Author discusses proposed topic with Guideline development team (Renata Kukuruzovic & Jody Smith).
Step 2
Download the 'Clinical Guideline Development Tools' including: a guide for clinicians, guideline template, evidence table,
Step 3 checklist for the guideline development and implementation.
Step 4 Consult with appropriate key stakeholders (medical, allied health, nursing and consumers). Involve them in the revision
of drafts and consensus of opinion where there is a lack of evidence
Step 5 Review guideline websites and current practice.
Contact RCH library complete a literature search.

Step 6
Author meets with Guideline Team to present evidence Attend next
Step 7
available guideline development workshop
Step 9
Formulate draft, utilising feedback from key stakeholders, evaluate evidence using
Step 10
Guideline team review draft content using PAED agree tool
Step
Step 11
12 Clinical Guideline approval once suggested changes are made to satisfactory level.
Clinical Guideline Approved (Signed off by relevant Dept Heads and CQS guideline team)
Guideline published on the intranet
Review of implementation and dissemination of the guideline (approximately 3 months post

implementation)
Author conducts a post implementation evaluation at 12 months evaluating health outcomes

patients and changes in clinical practice
Guideline to be reviewed every 3 yrs +/- audit

How do we react to
guidelines?
THANK YOU FOR
LISTENING!☺
SURGICAL SAFETY CHECKLIST
Objectives of this presentation
1. This topic will explain what a surgical safety checklist is and
2. Why it is important.
Wrong kidney removed
Ohio Surgeon Performs at Medical Center in New
Wrong-Site Surgery on York City
Four- Year-Old
Trail of errors led to 3 wrong

brain surgeries. Surgeons' ego at
Doctors R.I.P. hospital may have led to
amputate the carelessness.
wrong leg
Background
• Surgery has become an integral part of global health care, with
an estimated 234 million operations performed yearly.
• Each week in the US wrong-site surgery occur over 40 times.
• Foreign objects are left inside patient’s body 39 times, and
these mistakes and their associated complications are common
and preventable.
• A surgical safety checklist was designed to improve team
communication and consistency of care would reduce
complications and deaths associated with surgery.
Background cont…
• Surgery is performed in every community:wealthy and poor, rural
and urban, and in all regions.
• Although surgical care can prevent loss of life or limb, it is also
associated with a considerable risk of complications and
death.
• The risk of complications is poorly characterized in many parts of
the world, but studies in industrialized countries have shown a
perioperative rate of death from inpatient surgery of 0.4 to 0.8%
and a rate of major complications of 3 to 17%
• Data suggest that at least half of all surgical complications
Surgical Safety checklist
• In 2008, the World Health Organization (WHO) published
guidelines identifying multiple recommended practices to ensure
the safety of surgical patients worldwide.
• On the basis of these guidelines, a checklist intended to be
globally applicable and to reduce the rate of major surgical
complications .
• The implementation of this checklist and the associated
culture changes it signified would reduce the rates of death
and major complications after surgery in diverse settings.
The role of surgical safety checklist
• The checklist consists of an oral confirmation by surgical teams of
the completion of the basic steps for ensuring:
safe delivery of anesthesia,
✓ prophylaxis against infection,
effective teamwork,
and other essential practices in surgery.

Safe Site Surgery will help the surgical team to
avoid:
•Surgical deaths and errors

•The adverse legal issues
•Surgical infection
•Poor communication among surgical team
members
How the checklist is used.
• It is used at three critical junctures in care:
. Before anesthesia is administered,
.
Immediately before incision, and
Before the patient is taken out of the operating room.
• The WHO surgical safety checklist represent a simple set of
surgical safety operating room standards that are applicable in all
countries and settings.
• The checklist is not intended to be comprehensive . Additions
and modifications to fit local practices are encouraged.
A set of Safety Checks has been
assembled to reduce the number and
severity of adverse events involving:
•Surgeons
•Anesthesiologists
•Nurses
•Public health
experts
Three elements of the Surgical Safety
Checklist.
•
Sign In
•
Time Out
•
Sign Out
1 . Sign in (Briefing):
Before induction of anesthesia, members of the team (at least
the nurse and an anesthesia professional) orally confirm that:
•
The patient has verified his or her identity, the surgical site
and procedure, and consent
•
The surgical site is marked or site marking is not applicable
•
The pulse oximeter is on the patient and functioning
•
All members of the team are aware of whether the patient has
a known allergy
•
The patient’s airway and risk of aspiration have been evaluated
and appropriate equipment and assistance are available
•
If there is a risk of blood loss of at least 500 ml (or 7 ml/kg of
2 . Time out (Surgical pause):
• Before skin incision, the entire team (nurses, surgeons, anesthesia professionals, and
any others participating in the care of the patient) orally:
• Confirms that all team members have been introduced by name and role
• Confirms the patient’s identity, surgical site, and procedure
• Reviews the anticipated critical events
• Surgeon reviews critical and unexpected steps, operative duration, and anticipated
blood loss
• Anesthesia staff review concerns specific to the patient
• Nursing staff review confirmation of sterility, equipment availability, and other concerns
• Confirms that prophylactic antibiotics have been administered ≤60 min before incision
is made or that antibiotics are not indicated
• Confirms that all essential imaging results for the correct patient are displayed in
the operating room
The Wrong way to do a Time Out
Successful Time Out Process
3. Sign out
• Before the patient leaves the operating room:

• Nurse reviews items aloud with the team
• Name of the procedure as recorded
• That the needle, sponge, and instrument counts are complete (or
not applicable)
• That the specimen (if any) is correctly labeled, including with
the patient’s name
• Whether there are any issues with equipment to be addressed
• The surgeon, nurse, and anesthesia professional review aloud the
key concerns for the recovery and care of the patient
The WHO checklist format
Some important considerations for the nurse
• Is the patient fasting (Nil Per Oral – NPO)? When did the
patient eat last?
• Is the necessary imaging displayed?
• Are the surgical items that you have “pulled” what the
surgeon needs? Do you need to check with the
surgeon first?
• Is the patient situated on the table without unnecessary
pressure that could cause nerve damage? How long will the
procedure take?
• Are all members of the team ready to start?
Outcomes of the checklist
• Introduction of the WHO Surgical Safety Checklist into
operating rooms in various hospitals around the world was
associated with marked improvements in surgical outcomes.
• Postoperative complication rates fell by 36% on average, and
death rates fell by a similar amount.
• The reduction in the rates of death and complications suggests
that the checklist program can improve the safety of surgical
patients in diverse clinical and economic environments.
Conclusions
• A common theme in cases of wrong-site surgery involves failed
communication between the surgeon(s), the other members of the
health care team, and the patient.
• Communication is crucial throughout the surgical process, particularly
during the preoperative assessment of the patient and the
procedures used to verify the operative site.
• Effective preoperative patient assessment includes a review of the
medical record or imaging studies immediately before starting surgery.
• To facilitate this step, all relevant information sources, verified by a
predetermined checklist, should be available in the operating room
and rechecked by the entire surgical team before the operation
begins.
Conclusion cont…
• A briefing is important for assigning essential

roles and establishing expectations.
• Introduction of each person in the operating
room by name and role, even if team members
are familiar, is recommended for improved
communication. Whenever possible, the patient
(or the patient's designee) should be involved in
the process of identifying the correct surgical
site, both during the informed consent process
and in the physical act of marking the intended
surgical site in the preoperative area.
Conclusion cont…
• A formal procedure for final confirmation of the correct patient and
surgical site (a “time out”) that requires the participation of all
members of the surgical team may be helpful. Time outs may
include not only verification of the patient and the surgical site, but
also relevant medical history, allergies, administration of
appropriate preoperative antibiotics, and deep vein thrombosis
prophylaxis.
Conclusion cont…
• Use of the checklist involved both changes in systems and changes in
the behavior of individual surgical teams.
• To implement the checklist, all sites had to introduce a formal pause in
care during surgery for preoperative team introductions and briefings
and postoperative debriefings, team practices that have previously been
shown to be associated with improved safety processes and attitudes
and with a rate of complications and death reduced by as much as 80%.
• The philosophy of ensuring the correct identity of the patient and
site through preoperative site marking, oral confirmation in the
operating room, and other measures proved to be new to most of
the study hospitals.
REMEMBER
• EVERY CHECK CAN SAVE
LIFE
• THIS CHECKLIST IS A DOCUMENT BUT ALSO A MATERIAL (TOOL) FOR

OPERATING ROOMS, THAT CAN HELP US TO BE SAFE FOR OUR
WORK AND SAFE FOR OUR PATIENTS.
References
• http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Check
• http://www.acog.org/Resources-And-Publications/Committee-Opinions/Co
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SBAR

Familiarize what SBAR stands for.

SITUATION: State what is happening at

BACKGROUND: Explain circumstances

ASSESSMENT: Indicate what you

RECOMMENDATION: Express what you

A. “I noticed that this is the B. The nurse doesn’t mention

Assume that you and the physician are on the

Connecting on a human level can be a powerful

Connecting on a human level can be

“I am almost through, and would like to finish

Commit to practicing using the

STAND IN AWE OF WHAT YOU DO AND

Manning, M.L. (2006). Improving clinical communication through

Raica, D.A. (2009). Effect of action-oriented communication training on

Monitoring systems also store various data elements with a time

typically have modern platform allowing the selection of various

A critical piece of hemodynamic information involves the

Largest contributor to alarms in the ICU caused by:

1. Blood pressure cuff

3. Air splint that may cause venous pulsations.

4. Limits the sensors' ability to distinguish between arterial or

∙ Focuses on the health information system of the community,

GOAL OF COMMUNITY HEALTH INFORMATICS

PRIMARY FOCUS OF COMMUNITY HEALTH

PRIMARY FOCUS OF COMMUNITY HEALTH

COMPUTER BASED SURVEY SYSTEM

∙ Are used to collect quantitative information about items in a

By: Ariel Abenoja

Netiquette is short for "Internet etiquette." Just like etiquette is a

Examples of rules to follow for good netiquette.

Examples of rules to follow for good netiquette.

10 Netiquette Guidelines Online Students Need to know

10 Netiquette Guidelines Online Students Need to know

10 Netiquette Guidelines Online Students Need to know

10 Netiquette Guidelines Online Students Need to know

10 Netiquette Guidelines Online Students Need to know

10 Netiquette Guidelines Online Students Need to know

10 Netiquette Guidelines Online Students Need to know

Standard 13. Collaboration

PURPOSE & 1. Ensure a working relationship with individual

OBJECTIVES decision-making using appropriate electronic

Nurses communicate with multiple members of the health

Along with benefits, electronic

Smartphone applications should be carefully chosen for confidentiality as well as

Video conferencing is a visual communication session

Text messaging has already been normal to us for

HEALTH quickly spread information and

Disclose any in-kind or financial compensation

Background - What is the clinical background or context?

Assessment - What do I think the problem is?

Recommendation and Request - What would I do to correct it?

Example during an incoming trauma:

Leader: “Airway status?”

Examples of transitions in care include shift changes; transfer of

Strategy designed to enhance information exchange during transitions

Reach out if you have comments, questions, and more.

a. Social Media refers to electronic communication, websites or applications through which

Sec. 5. Social Media for Health Education or Promotion

Sec. 6. Professionalism in Social Media Use

Sec. 7. Responsible Social Media Activity

c. Derogatory comments about patients, colleagues, employers and institutions or companies

1)The activity imputes a discreditable act or condition to another