Archive for the ‘Health information technology (HIT)’ Category

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Health Technology Hazards, 2016: Inadequate Disinfection of Flexible Endoscopes Tops ECRI List

January 14, 2016
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

The ECRI Institute has released its Top 10 Health Technology Hazards for 2016 report, highlighting health technology hazards for health care facilities and nurses to focus on this year.

Although alarm hazards, which topped the list for the past four years, still pose a significant threat, topping the list at number two, a different repeat offender has claimed the number one spot: inadequate cleaning of flexible endoscopes before disinfection.

Proper reprocessing and cleaning of biologic debris and other foreign material from instruments before sterilization is key, according to the report. And flexible endoscopes, especially duodenoscopes, are difficult to clean because of their long, narrow channels. Failure to clean properly can result in the spread of pathogens. The report points to a series of fatal carbapenem-resistant Enterobacteriaceae infections in the last two years to illustrate this particular threat, and recommends that facilities emphasize to their reprocessing staff that inattention to proper cleaning steps can lead to deadly infections.

Some hazards, such as those arising from health information technology (HIT) issues, insufficient training of clinicians in operating room technologies, and failure to appropriately operate intensive care ventilators, have been touched on in previous years. (See our past posts on ECRI top 10 health technology hazards from 2013, 2014, and 2015.) Here is a brief overview of other hazards that made the cut.

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Electronic Health Records: Still-Evolving Tools to Help or Hinder Nurses

December 14, 2015

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Photo by Marilynn K. Yee/New York Times/Redux

Photo by Marilynn K. Yee/New York Times/Redux

One of my earliest memories of electronic health records (EHRs) is the day I had to review a chart at another hospital in the city. As I headed over to medical records, I expected at worst a “big” chart—one of those 15-inch stacks of multiple folders from a long hospitalization. I wasn’t allowed access to their system to view the chart online, so I was escorted into a separate room, in which the printed-out chart was waiting for me.

But their electronic chart wasn’t “printer-friendly,” and the hard copy version now consisted of thousands of pages of documentation spread out over a nine-foot long table. Many of the pages included only a line or two of print. Making sense of this chart was a nightmare.

My own (large, well-resourced) hospital had been one of the early adopters of an extremely clinician-friendly system, and I was shocked over the next few years when I encountered the many unwieldy, maddening charting systems that have been rushed into use at many hospitals.

In this month’s AJN, nurse and technology expert Megen Duffy gives us a clear-eyed look at the state of electronic health records today in “Nurses and the Migration to Electronic Health Records.” She is realistic about the pros and cons of electronic charting, pointing out the limitations of (for example) drop-down menus and forced choices in lieu of narrative notes, while offering a glimpse of what a well-designed system can do for us. Read the rest of this entry ?

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AJN in December: Inside an Ebola Unit, Acupressure, Early Mobility, EHRs, More

November 30, 2015

AJN1215.Cover.OnlineOn this month’s cover, nurse Elie Kasindi Kabululu cares for a patient at Centre Médical Evangélique in Nyankunde, Beni, Democratic Republic of Congo. Originally, this location served a population of 150,000 and also housed a nursing school; but in 2002, during war in the region, the facility was attacked. About 1,000 people were killed—including patients and staff—and the center was looted and destroyed.

Providing medical assistance in the world’s war-torn and neediest areas is commonplace for health care providers like Kabululu, just as it is for humanitarian organizations such as Médecins Sans Frontières (MSF), which works in 70 countries worldwide—nearly half of these in Africa. Shortly after the recent outbreak of Ebola in West Africa, MSF sent close to 300 international workers to help combat this public health emergency. To read one nurse’s experience traveling to Liberia for MSF to work in a treatment center, see “Inside an Ebola Treatment Unit: A Nurse’s Report.”

Some other articles of note in the December issue:

Original Research: Implementation of an Early Mobility Program in an ICU.” This article, from our Cultivating Quality column, recounts how the effects of an early mobilization program delivered to critically ill patients at a community hospital by an independent ICU mobility team contributed to fewer delirium days and improvements in patient outcomes, sedation levels, and functional status.

CE Feature: Incorporating Acupressure into Nursing Practice.” The effects of acupressure can’t always be explained in terms of Western anatomical and physiologic concepts, but this noninvasive practice involves minimal risk, can be easily integrated into nursing practice, and has been shown to be effective in treating nausea as well as low back, neck, labor, and menstrual pain. The author discusses potential clinical indications for the use of acupressure, describes the technique, explains how to evaluate patient outcomes, and suggests how future research into this integrative intervention might be improved.

From our iNurse column: Nurses and the Migration to Electronic Health Records.” In many settings, the clock has been ticking for providers to switch to electronic health records (EHRs). Most U.S. hospitals are now using some form of EHR system, as are a smaller majority of physicians’ offices. This article presents the challenges and benefits of using electronic health records and provides tips for adapting to EHR systems.

There’s much more in our December issue, so click here to browse the table of contents and explore the issue on our Web site.

 

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A Tech-Savvy Nurse’s Initial Take on Uses for the Apple Watch

August 5, 2015

Megen Duffy, RN, BSN, CEN, is currently working in hospice case management and writes AJN‘s iNurse column, which focuses on technology and nursing.

AppleWatchMegenPhotoBPMI’ve had my Apple Watch for several months now. I ordered it at 12:01 the morning they went on sale, and it arrived the Saturday after its Friday release. I was fairly certain I’d return it or sell it for a profit, but I still have it and keep finding new uses for it. I also have ideas for how it could be handy for a variety of fitness and health care scenarios.

Health tracking. Even at this early stage, though, patients and their families are using Apple Watches to track and enhance their health. The Watch tracks your heartbeat—not every second, but often enough that a useful bank of data results. Rumors say that a mystery port on the back of the watch will allow SpO2 tracking soon. I have already busted out my phone to show my cardiologist my heart rate trends, and it saved me from wearing a Holter monitor. That kind of thing is exciting!

Fitness wearables (e.g., Fitbit) and smart watches (e.g., Pebble) have been around for a few years, with sharply increasing popularity. The (often) colored plastic bands people wear around their wrists are the kind of wearable I mean. Pedometers (included in the wearables category) also come in small clips that attach to pockets or bras, but those typically have fewer features than are relevant medically. These bracelets/watches track some or all of the following: steps taken, calories burned, distance covered, heart rate, and weight.

Wearables have ways of nudging people along in their fitness goals. They tap, send inspirational messages, and even post movement statistics on social media.

Peer pressure works, even in adults. Reaching the daily step goal becomes oddly alluring. Americans are sedentary people, and we like our gadgets and video games. Gamifying fitness could be a winning strategy for getting people up off the couch—both nurses and patients. It is not unusual to see bands of roving nurses in hospitals, walking the halls on break to get their steps in. Every little bit helps.

So far, the Apple Watch does not have any third-party applications, and, though it can do a number of things on its own, its main users for now will be those who already have late-model iPhones (which can pair with the Apple Watch to share data and some functionality). Other devices, such as the Pebble, have a huge library of third-party applications, but they still require proximity to a cell phone. Fitbits do not allow software installation.

Apps for medication tracking, etc., with more likely to come. The Watch has a number of applications that integrate usefully with iPhone applications. Patients and caregivers will have another option for keeping track of medications and treatments because of this integration. An application on your wrist saying “it’s time for your Cardizem” is much more insistent than a phone alarm, for example. An update to the Watch operating system is supposed to occur this fall, and I am excited about what developers will have come up with. Wouldn’t it be fantastic, for example, to have a CPR application on your watch that taps your wrist at the appropriate tempo?

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Never Too Late: One Family Practice’s Shift to EHRs after 50 Years of Paper

April 16, 2015

Editor’s note: We hear a lot about the stress and lack of time for direct patient care that nurses (and physicians) have experienced with the movement to EMRs or EHRs. We’re in a transitional period, and in some instances the use and design of these systems has a long ways to go. But here’s a story with a positive slant, written by someone who might easily have responded very differently, given the circumstances. Change is inevitable; how we react to it throughout our lives, less so. 

By Marilyn Kiesling Howard, ARNP

Niklas Bildhauer/ Wikimedia Commons

Niklas Bildhauer/ Wikimedia Commons

I am a nurse practitioner and my husband of 60 years is a family practitioner. We still work full time in our Gulf Breeze, Florida, practice. About five years ago, we first learned that our paper records were becoming archaic and that Medicare was planning to penalize providers who didn’t switch to the use of electronic health records (EHRs) by a certain date.

It was terrible news—we had 50 years of work in the paper chart genre, and were unsure about how to make the transition. Some who were in our position took the pending requirements as an opportunity to retire, but we weren’t ready for that.

Embracing a predigital innovation. In the 1960s, we started a small family practice in Indiana. As we requested our patients’ records from the files of their most recent physicians, it was not unusual to receive an index card that had the date neatly stamped on the left edge, with a handwritten note on the same line. (Needless to say, we’d already gone upscale, with a folder for each patient and a piece of white note paper.)

We quickly found that the medical record was our link to the prospective health of our patients, so we explored how we might make our records more useful. Joe read about a clinic in Bangor, Maine, where physicians were implementing the problem-oriented medical record (POMR) developed by Dr. Larry Weed, so we flew there to learn about this innovation. Dr. Bjorn and Dr. Cross were still developing their application of the model; their favorite medical secretary was a ‘bored bright housewife,’ and the entire clinic had an aura of excitement and discovery.

When we returned home, we quickly converted our folders to a proper chart with the ‘problem list’ fastened on the left and the progress notes on the right, using the new methodology. As we treated our new patients, we dutifully produced the ‘subjective, objective, assessment, and plan’ (SOAP) model we’d also imported from Maine.

This method sufficed for all the years between the first enlightenment and our leap in May 2011 into the world of pixels. It’s a challenge to get up and running with an EHR system. It was as if we were starting a new office with 2,000 patients to enroll. We had to had to translate and enter all of their old information into the new charting system. Two of our staff did not have computer knowledge and could not type. We went to half production, and our lost revenue was felt for months afterwards. (‘Meaningful use’ rules reimbursed us for about one-half of what the transition cost us.)

We’d decided on a cloud-based system because it was easy to access and the records would be safely stored on a server in Maine, an extra plus due to our propensity for hurricanes in the Florida Panhandle. The program was extremely user friendly. Given our level of expertise, this was a necessity. We took lessons online; the training included a live operator who was willing to stay on the line until the information was understood and applied. The company that runs the system keeps us compliant with meaningful use requirements and lets us know of impending changes.

We have, since we started using it at our clinic, found the EHR so far superior to our handwritten method that it would be impossible for us to return to the scribbled messes, as we see our old charts now. We still refer to them to garner important items such as consults, colonoscopies, surgeries, etc. Those reports are then neatly bar-coded into the EHR. It is no longer necessary to weed, retire, or store the charts. We did not abstract the old charts, simply moved important reports from them. We keep them in our office for quick historical reference. Read the rest of this entry ?

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Missed Empathy, Missed Care: Is It Time to ‘Reconceptualize Efficiency’?

March 23, 2015

A physician’s lament is nursing’s, too.

By Maureen Shawn Kennedy, AJN editor-in-chief

By Alan Cleaver/via Flickr

By Alan Cleaver/via Flickr

Last week, the New York Times Well blog published “The Importance of Sitting With Patients” by Dhruv Khullar, a Harvard medical resident. Khullar expressed regret over not spending more time with a patient who was near death, and then discussed how little time residents actually spend with patients—eight minutes, according to a Journal of General Internal Medicine study (2013) that analyzed the time of 29 interns over a month. (The study found that only 12% of the residents’ time was spent on direct patient care; 40% of their time was spent on computers.)

Khullar detailed the various activities that take him away from direct patient contact and noted as well that the shorter working hours mandated for residents had the unintended consequence of reducing time with patients. He wondered:

By squeezing the same clinical and administrative work into fewer hours, do we inadvertently encourage completion of activities essential in the operational sense at the expense of activities essential in the human sense?

The second part of the question seemed especially pertinent for nurses. Hospital nurses have long lamented that paperwork, insufficient staffing, and nonnursing tasks keep them from the bedside. The promise of computers to reduce documentation time has yet to be realized, as first-generation documentation systems are not necessarily designed from a nursing perspective and often lack the specificity and flexibility to truly capture nursing activities. Read the rest of this entry ?

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Color-Coded Wristbands and Patient DNR Status: Can We Do Better?

March 16, 2015

In the Viewpoint column in the March issue of AJN, a staff nurse at an oncology center argues that we can improve our use of color-coded wristbands to communicate patient DNR status. There’s also a short podcast interview with the author below, in which she explains that her motivation for writing this article was “a near-miss” on her unit several years ago.

A lot of attention has been paid lately to the reasons why clinicians don’t follow end-of-life preferences in advance directives. Overaggressive care by some physicians is one reason, as is the vagueness of the language used in advance directives to express treatment preferences.

BlimaMarcus_ViewpointAuthor

Author Blima Marcus

Another major reason advance directives are ignored is lack of immediate access to a patient’s end-of-life preferences at critical moments, such as during a code. This month’s Viewpoint column, “Communicating Patient DNR Status Using Color-Coded Wristbands,” is by Blima Marcus, a doctoral student at the Hunter-Bellevue School of Nursing in New York City as well as an RN at the NYU Langone–Perlmutter Cancer Center. Marcus points out that a “patient’s choice of do-not-resuscitate (DNR) status is a major one, and communicating this status in the hospital is often the responsibility of nurses.”

However, she argues, paper and/or electronic chart documentation of patient end-of-life preferences isn’t always adequate, given clinical realities, and can leave “communication gaps that can lead to wrongful resuscitations and mistaken fatalities.” Read the rest of this entry ?

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