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Informatics Project

Emily Rittenhouse

Delaware Technical Community College

NUR 410 Nursing Informatics

Ms. Melissa Brown

October 1, 2023
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Informatics Project

Informatics is a core competency of the nursing profession that involves the nurse being

competent and proactive with technology. Healthcare is always changing and seeking to improve

the workflow environment as well as enhance patient care. Technology development and

innovation are ways nurses can encourage efficiency and process changes in the nursing practice.

The perioperative environment in a hospital necessitates an efficient system to ensure patients are

seen for their scheduled procedures on time. Implementing an iPad to improve the preoperative

check-in process and the postoperative discharge process can be an area for work efficiency and

patient satisfaction improvement. Dykes and Chu (2020) discuss how the use of technological

innovation can greatly impact healthcare due to the challenges it has faced with a lack of

resources, short staffing, and the increased volume of the older population of patients. This paper

will discuss the research behind iPad implementation in the hospital, ethical and legal issues,

discussion of the new process through workflow maps, evidence-based practice utilization in the

process, and finally, the development of a policy.

It is crucial to back up and support any new process with research. Several research

articles are available that discuss the many benefits of implementing an iPad in various units to

enhance communication, education, and efficiency. One article discusses how many patients in

an intensive care unit have struggles communicating with the staff (Dind et al., 2021). When

implementing an iPad on an endoscopy unit in the hospital, it is crucial to factor in that many

outpatients and inpatients, including critical ICU patients, are seen on the endoscopy unit for

urgent or scheduled procedures. The article discusses the benefits for patients because the

applications on the iPad offer specific features that promote patient-centered care, such as
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different language options, pictures that are informative, different text sizes, and an option to

write in text (Dind et al., 2021).

Another article was completed on providing education to parents on a unit in the hospital.

It was proposed that iPads are a great way to communicate with patients, especially easily and

clearly in the hospital (Pavuluri et al., 2021). The authors continue to promote the iPad over

other forms of discharge education, stating that iPad education outranks paper educational

handouts and is equal to verbal education from the nurse (Pavuluri et al., 2021). In this study, the

nurses were able to document in the electronic health record that the discharge instructions and

video were completed on the iPad (Pavuluri et al., 2021). The implementation of an iPad was

considered successful in this study, showed increased compliance with the education provided,

and was greatly successful due to the support that came from drawing in the staff in this new

process (Pavuluri et al., 2021).

One article of research also supports the use of an iPad to assist nurses and patients in the

hospital setting. The iPads were trialed at two different hospital sites for professional and patient

use. Healthcare providers and patients were surveyed to determine how the iPads were being

used as well as concerns for cleanliness and privacy (McLean et al., 2018). Since the iPads for an

endoscopy unit would be shared between patients and utilized during check-in and discharge, it

is imperative that privacy and cleanliness is maintained. It was found that when an iPad was

available, nurses commonly used it for reviewing patient’s health history, updating their current

medications, and using it for educational purposes (McLean et al., 2018). It was also determined

that patients overall were not worried about their privacy and the cleanliness of the iPads,

whereas the providers were overall not worried about privacy issues with the iPads but were

even between some concern and no concern for cleanliness of the iPads (McLean et al., 2018).
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The use of technology is very useful and effective in the overall workflow of nursing.

However, it is critical to consider the ethical and legal issues that are presented with technology.

There are many components of patient privacy and information security that the nurse needs to

be aware of. Nurses need to be on the lookout for cybersecurity needs as it has become a recent

issue in the last several years (Margam, 2023). The authors list four ways cybersecurity is

important in healthcare, including storage of data, accessing data through databases, data being

exchanged, and compliance with the established regulations and protocols (Margam, 2023). It is

encouraged for hospitals and large organizations to have security teams or groups responsible for

ensuring the proper procedures and policies are adhered to and assess for any risk for beaches

(Margam, 2023). HIPPA was established for nurses to be an advocate for patients by ensuring the

protection and privacy of their personal health information (Margam, 2023). Poorchangizi et al.

(2019) discuss that nurses have an innate sense of responsibility to care for patients by protecting

their confidentiality and maintaining privacy. When using an iPad between multiple patients, it is

vital for the nurse to ensure that all patient information or browsers have been closed out when

the patient has completed the check-in or discharge process. It is also imperative for the nurse to

ensure the iPad is not left unattended for anyone to pick up the iPad to use or look at.

Workflow maps are crucial in nursing informatics when implementing a new process. It

gives a visual picture of the current work process and how the new and improved process will be

after implementation. Below are the first two maps that identify the current process of

preoperative check-in and postoperative discharge process without the implementation of the

iPad.
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The charts for the preoperative and postoperative workflow process with an iPad are

noted in the section below. One source notes that exceptional patient care and improved

workflow have been improved due to the innovations and advancements that have come with

technology development (Ang, 2019). In the new process with the implementation of an iPad,
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the preoperative check-in is made more efficient with an iPad. The patient is able to complete

check-in questions on the iPad after registration. The nurse is still responsible for critical

thinking and reviewing the patient's answers on the iPad, but the total time will be decreased and

more time is allotted for the nurse to perform the tasks needed and the Anesthesiologist is also

able to review the patient’s answers and address any additional concerns. Virkstis and Drenkard

(2022) also discuss this need to take some of the workload off the nurses when possible to

improve patient care and decrease nursing burnout which allows the nurses to focus on the other

tasks required in patient care.

In the perioperative environment, saving time is also saving money due to the fact that

nurses are able to work more efficiently and keep procedures on time. On the discharge side, the

nurses are freed up from having to take time to print and make copies of the discharge

instructions and medication list. The nurse is essentially able to skip and be able to review the

discharge instructions on the iPad with the patient and the family. The instructions would be able

to be emailed to the patient or uploaded to the portal. Nurses and other healthcare workers are

empowered to be a part of the improvement of the design process of care being provided to

patients as well as the workflow process (Virkstis & Drenkard, 2022).

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Before any process can truly be implemented and accepted into healthcare, it must

undergo the process of evaluation through evidence-based practice and quality improvement.

Then, a policy is set to reflect these research and evidence-based guidelines. When looking at
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evidence-based practice in regard to healthcare, it is crucial to assess how the change works in

the nursing practice, as well as look at whether the desired results are being achieved (Rigby et

al., 2016). One evidence-based practice study of iPad implementation was utilized to improve

overall patient satisfaction as well as productivity (Howell et al., 2017). This was completed over

a week and involved a questionnaire at the end that the patients were encouraged to complete

(Howell et al., 2017). It was found that it is beneficial to staff to have the completed questions

prior to meeting with the patients (Howell et al., 2017). It was also noted at the end of the article

that the implementation of an iPad would save time for staff and enhance the workflow (Howell

et al., 2017). Nurses have an unique opportunity to support evidence-based practice through

technology innovation and utilization.

Preoperative and Postoperative iPad Implementation Policy

I. Purpose: The purpose of this policy is to improve preoperative and postoperative

workflow and promote better patient care.

II. Policy: All nurses will receive assigned electronic education and in-service to be able to

utilize an iPad for check-in and discharge as well as to assist patients with the use of an iPad for

check-in and discharge.

III. Procedure

A. Preoperative Process
1. The patient will check in with registration and be given an iPad to
complete check-in questions.
2. RN to verify patient has completed questions and bring the patient back to
begin the preoperative check-in process.
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3. The answers to the questions will be reviewed by the nurse and the
Anesthesiologist. Follow-up questions will be asked, or information will be
clarified if needed.
4. The RN will indicate in the EHR that the information is preoperative
process is complete.
5. Overall timing and efficiency of the preoperative process will be improved
to help with procedures on-time starts and increase staff and patient satisfaction.
B. Postoperative Process
3. The patient will arrive to the postoperative bay from the procedure and
begin the discharge phase.
4. After the physician is able to speak with the patient and family, the RN
will assess readiness for discharge.
5. The RN will review discharge instructions with the patient and family and
verify understanding and any follow-up care needed.
6. The patient will be asked in regard to preference of obtaining a copy of the
discharge instructions through the patient portal or an emailed copy of discharge
instructions.
7. The RN will ensure patient has met the criteria for discharge.
8. The discharge process will be more efficient and result in better workflow
and patient satisfaction.

II. Responsibilities

A. Preoperative Process
3. The RN is responsible for reviewing check-in questions for completeness.
4. The RN is to determine if additional questions are needed for the
preoperative process and clarify answers with follow-up questions.
5. The RN is to maintain confidentiality and privacy with iPad use.
6. It is the nurse’s responsibility to ensure the iPad is logged out when the
patient is finished using it and that the iPad has been cleaned appropriately.
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B. Postoperative Process
3. The RN is responsible for reviewing the discharge instructions on the iPad
with the patient and family.
4. The RN is to verify understanding of the discharge instructions with the
patient and ask if the patient or family has any additional questions.
5. The RN is to ensure that completed discharge instructions are uploaded to
the portal and sent to the patient’s email if desired.
6. The RN is to maintain patient confidentiality and privacy. The iPad is to
be logged out of when finished and appropriately cleaned for the next patient.
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References

Ang, R. J. (2019). Use of content management systems to address nursing workflow.

International Journal of Nursing Sciences, 6(4).

https://doi.org/10.1016/j.ijnss.2019.09.012

Dind, A. J., Starr, J. S., & Arora, S. (2021). iPad-based Apps to Facilitate Communication in

Critically Ill Patients with Impaired Ability to Communicate: A Preclinical

Analysis. Indian Journal of Critical Care Medicine, 25(11), 1232–1240.

https://doi.org/10.5005/jp-journals-10071-24019

Dykes, S., & Chu, C. H. (2020). Now more than ever, nurses need to be involved in technology

design: lessons from the COVID‐19 pandemic. Journal of Clinical Nursing, 30(7-8).

https://doi.org/10.1111/jocn.15581

Howell, M., Jayne, D., Hood, A., Hood, A. J., & Jayne, D. G. (2017). Use of a patient completed

iPad questionnaire to improve pre-operative assessment. Journal of Clinical Monitoring

& Computing, 31(1), 221–225.

https://doi-org.libproxy.dtcc.edu/10.1007/s10877-015-9818-0

Margam, R. (2023). Importance of Cybersecurity in Electronic Health Records. International

Journal of Innovative Science and Research Technology, 8(7).

McLean, K., Killian, L., & Quinn, K. (2018). Did You Remember to Wipe? An iPad-Lending

Pilot Project in Two Hospital Settings. Journal of Hospital Librarianship, 18(1), 81–94.

https://doi-org.libproxy.dtcc.edu/10.1080/15323269.2018.1400838

Pavuluri, H., Grant, A., Hartman, A., Fowler, L., Hudson, J., Springhart, P., & Kennedy, A. B.

(2021). Implementation of iPads to Increase Compliance With Delivery of New Parent

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Education in the Mother–Baby Unit: Retrospective Study. JMIR Pediatrics and

Parenting, 4(2), e18830. https://doi.org/10.2196/18830

Poorchangizi, B., Borhani, F., Abbaszadeh, A., Mirzaee, M., & Farokhzadian, J. (2019).

Professional Values of Nurses and Nursing Students: a comparative study. BMC Medical

Education, 19(1). https://doi.org/10.1186/s12909-019-1878-2

Rigby, M., Magrabi, F., Scott, P., Doupi, P., Hypponen, H., & Ammenwerth, E. (2016). Steps in

Moving Evidence-Based Health Informatics from Theory to Practice. Healthcare

Informatics Research, 22(4), 255–260. https://doi.org/10.4258/hir.2016.22.4.255

Virkstis, K., & Drenkard, K. (2022). It Is Time to Focus Digital Strategy on Supporting Nurse

Workflow. JONA: The Journal of Nursing Administration, 52(12), 634–635.

https://doi.org/10.1097/nna.0000000000001223‌