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Nursing Informatics – Transition

Module
Jennifer Hardy

Overview

• Definition
• NSW Health IT Strategy

Transition Module 2006 Hardy 2

Definition/s • Nursing informatics is the integration of nursing (and midwifery). to support the health of people – it has implications for health administration. nursing (and midwifery) clinical. research and education activities • (Office of Nursing and Midwifery) Transition Module 2006 Hardy 3 . and information management with information processing and communication technology. their information.

Transition Module 2006 Hardy 4 . not only computer-related skills.Nursing Informatics Competencies • NI competencies encompass many skills. but knowledge and attitudes needed by nurses in relation to information and communication technologies.

Information Technology used in the Health Care Industry • Current status of Informatics in NSW Transition Module 2006 Hardy 5 .

RM The NSW Health Strategy Assistant Director.Clinical Information Systems Dianne Ayres MInfoCommTech. RN. Clinical Systems Strategy Unit Transition Module 2006 Hardy 6 . BAdmin(Nurs).

The Business Context for Clinical Systems Access to quality information at the point of care will • improve patient safety and reduce adverse events • reduce duplication and errors of omission.legibility and avoid litigation • provide integrated patient information at any clinical workstation Transition Module 2006 Hardy 7 . transcription and interpretation • provide a framework for evidence based practice • provide decision support at multiple levels • improve accountability.

2006 Hardy • Baby Health etc. Problem Accessible to Authorised The Future Single Health Record On-line Care Providers Across the Continuum of Care The Present Multiple Health Records Across All Care Settings Health Care Providers Across the Continuum of Care Primary Health Specialist Care Hospital System Community Care Health Services •General Practitioner •Paediatrics •Specialist Services •Education •Allied Health •Orthopaedics •24 hour Nursing Care •Drug and Alcohol •Surgery •Therapists •Mental Health •Medical Centre •General Medicine •Pharmacists •Sexual Assault •Alternative Therapists •Gerontology •Dietitians •Home Help •Ambulance/Paramedics •Dermatology •Social Workers •Meals on Wheels •Respiratory •Psychologists •District Nursing •Cardiology •Diagnostic Services •Health Promotion •Gynaecology •Administrators •Child Protection •Obstetrics etc. 8 . Transition•Module etc.

Discharge Medications Transition Module 2006 Hardy 9 .

Clinical Systems Integrated Framework Patient Administration and Unique Patient Identifier Hospital Environment Point-of-Care Clinical System Electronic Discharge Referral Prescribing System Decision Support Clinical Information Access Program (CIAP) Clinical Allied Emergency Specialty Radiology Pathology Pharmacy Dietary Health Department Systems Systems Community Health Information System (CHIME) Electronic Health Record Transition Module 2006 Hardy 10 .

Clinical Systems Integrated Framework Patient Administration and Unique Patient Identifier Hospital Environment Point-of-Care Clinical System Electronic Discharge Referral Prescribing System Decision Support Clinical Information Access Program (CIAP) Clinical Allied Emergency Specialty Radiology Pathology Pharmacy Dietary Health Department Systems Systems Community Health Information System (CHIME) Electronic Health Record Transition Module 2006 Hardy 11 .

Why Decision Support Systems? .

Medication Error The National Coordinating Council for Medication Error Reporting and Prevention defines medication error as follows: “A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional.” Transition Module 2006 Hardy 13 . patient. or consumer.

000)4 – Deaths from medication errors increased 257% between 1983 and 1993 (There are 8000 drugs on the market in 2002 compared to 656 in 1961) References 1 & 4 Bates et al 1995 2 Institute for Safe Medication Practice (ISMP) (2000) 3 Leape et al (1998) 4 Low and Belcher 2002 Transition Module 2006 Hardy 14 .000 deaths a year were attributable to ADEs1 – Cost of ADEs is $76. In the USA • Numerous studies have shown that – 180.6 billion a year2 – The number of deaths is equivalent to a jumbo jet crashing every day3 – Iatrogenic injury in US is higher than the annual motor vehicle accident mortality rate (45.

al.7B per annum Transition Module 2006 Hardy 15 .000 admissions)found that: – 16. Quality in Australian Health Care Study (28 hospitals/14.000 Australians died each year – 8% of hospital bed days were attributable to ADEs – 2.6% suffered an adverse event – 18. In Australia • Wilson et.4%-3.6% of all hospital admissions were medication related. – The cost to the Australian Health Care System was $4.

Where Medication Error Occurs Transition Module 2006 Hardy 16 .

delivering too much medication • Wrong concentration/dosage of medication delivered IV • Wrong route of administration (eg. Type of Administration Error • Missed doses of medication • Wrong time of administration of medication • Wrong medication administered • Wrong medications due to misidentifying the patient • IV rate too fast. oral solution given IV) Transition Module 2006 Hardy 17 .

pathology results etc • Disregarding allergies or previous drug reactions • Illegible orders • Unaware of best practice recommendations • Poor communications with patient or health care team Transition Module 2006 Hardy 18 .g. liver impairment. wrong route • Disregarding altered physiology e. wrong dose. Prescribing Errors • Prescribing wrong drug.

The Solution to Adverse Events • A Point-of-Care Clinical System – Order Management – Results Reporting – Clinical Documentation • Electronic Prescribing Decision Support System • Clinical Information Access Program Transition Module 2006 Hardy 19 .

Transition Module 2006 Hardy 20 . X-Rays CT Scans etc.Features of Clinical Systems Assist with decision making tasks by: – Generating alerts and reminders – Providing diagnostic assistance – Identifying errors and omissions – Retrieving information from credible sources – Automatically interpreting images (ECG.

The Care Process • Patient history and examination • Assess Review past history • Record medical alerts/allergies • Order tests and treatment • Review results reports • Initiate care pathway/plan • Commence discharge planning Evaluate Plan • Record observations • Record interventions • Evaluate care & manage variances • Educate the patient • Generate reports • Discharge patient Implement Transition Module 2006 Hardy 21 .

CIAP. Clinical Practice Guideline Transition Module 2006 Hardy 22 . Rules.Information to Support the Care Process • Patient history and examination • Clinical Documentation • Review past history • Clinical Documentation/EHR • Record medical alerts/allergies • Rules . Prompts.Alerts and Prompts • Order tests and treatment • Order Management • Review results reports • Results Reporting/EHR • Initiate care pathway/plan • Clinical Pathways • Commence discharge planning • Discharge Plan • Record observations • Charting • Record interventions • Progress Notes • Evaluate care & manage variances • Clinical Reports • Educate the patient • CMIs/ Protocols/Guidelines • Generate reports • Clinical Reports • Discharge patient • Discharge Referral/ EHR Decision Support g. E-PDS. Alerts.