Nursing Informatics – Transition

Module
Jennifer Hardy
Overview

• Definition
• NSW Health IT Strategy

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Definition/s

• Nursing informatics is the integration of

nursing (and midwifery), their information,
and information management with
information processing and communication
technology, to support the health of people
– it has implications for health
administration, nursing (and midwifery)
clinical, research and education activities
• (Office of Nursing and Midwifery)

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Nursing Informatics Competencies

• NI competencies encompass many skills,

not only computer-related skills, but
knowledge and attitudes needed by nurses
in relation to information and
communication technologies.

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Information Technology used in the
Health Care Industry

• Current status of Informatics in NSW

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Clinical Information Systems

The NSW Health Strategy

Dianne Ayres MInfoCommTech, BAdmin(Nurs), RN, RM

Assistant Director, Clinical Systems Strategy Unit

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The Business Context for Clinical Systems

Access to quality information at the point of care will

• improve patient safety and reduce adverse events
• reduce duplication and errors of omission, transcription and interpretation
• provide a framework for evidence based practice
• provide decision support at multiple levels
• improve accountability,legibility and avoid litigation
• provide integrated patient information at any clinical workstation

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 Problem

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. Transition•Module
etc. 2006 Hardy • Baby Health etc. 8
 Discharge
Medications

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 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

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 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

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Why Decision Support Systems?
 Medication Error

The National Coordinating Council for Medication Error Reporting

and Prevention defines medication error as follows:

“A medication error is any preventable

event that may cause or lead to
inappropriate medication use or patient
harm while the medication is in the control
of the healthcare professional, patient, or
consumer.”

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 In the USA
• Numerous studies have shown that
– 180,000 deaths a year were attributable to ADEs1
– Cost of ADEs is $76.6 billion a year2
– The number of deaths is equivalent to a jumbo jet crashing every day3
– Iatrogenic injury in US is higher than the annual motor vehicle accident
mortality rate (45,000)4
– Deaths from medication errors increased 257% between 1983 and 1993
(There are 8000 drugs on the market in 2002 compared to 656 in 1961)
References
1 & 4 Bates et al 1995
2 Institute for Safe Medication Practice (ISMP) (2000)
3 Leape et al (1998)
4 Low and Belcher 2002

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 In Australia

• Wilson et.al. Quality in Australian Health Care Study (28

hospitals/14,000 admissions)found that:
– 16.6% suffered an adverse event
– 18,000 Australians died each year
– 8% of hospital bed days were attributable to ADEs
– 2.4%-3.6% of all hospital admissions were medication related.
– The cost to the Australian Health Care System was $4.7B per
annum

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Where Medication Error Occurs
6%

34%

56%

4%
Prescribing Dispensing Administration Other
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 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, delivering too much medication
• Wrong concentration/dosage of medication delivered IV
• Wrong route of administration (eg, oral solution given IV)

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 Prescribing Errors

• Prescribing wrong drug, wrong dose, wrong route

• Disregarding altered physiology e.g. liver impairment,
pathology results etc
• Disregarding allergies or previous drug reactions
• Illegible orders
• Unaware of best practice recommendations
• Poor communications with patient or health care team

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

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

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The Care Process
• Patient history and examination
• Review past history Assess
• 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

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Information to Support the Care Process
• Patient history and examination • Clinical Documentation
• Review past history • Clinical Documentation/EHR
• Record medical alerts/allergies • Rules - 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
(e.g.CIAP, E-PDS, Rules, Alerts, Prompts, Clinical Practice Guidelines)
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