Posts Tagged ‘electronic health records’

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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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Nurse Informaticists Address Texas Ebola Case, EHR Design Questions

October 17, 2014

By Susan McBride, PhD, RN-BC, CPHIMS, professor and program director of the Masters in Nursing Informatics Program, Texas Tech University Health Sciences Center, and Mari Tietze, PhD, RN-BC, FHIMSS, associate professor and director, Interprofessional Health IT Program at Texas Woman’s University (TWU). The views expressed are those of the authors and don’t represent those of Texas Tech or TWU.

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EHRs: information ‘siloes’ or interprofessional collaboration?

The recent Ebola case in Dallas—in which a patient was admitted to the hospital three days after he visited the ER exhibiting symptoms associated with Ebola and reporting that he’d recently traveled from West Africa—brought this global public health story close to home for many of us residing in the area. As has been widely reported, the patient died last week after nearly 10 days in the hospital.

An initial focus of media coverage was the suggestion that a failure of nursing communication had contributed to the release of the patient from the hospital on his first visit. Partly reflecting evolving explanations offered by the hospital, the media focus then shifted to a potential flaw in the hospital’s electronic health record (EHR) system, in which information recorded by a nurse about the patient’s travel history might not have been visible to physicians as well. Read the rest of this entry ?

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Health Technology Hazards: ECRI’s Top 10 for 2014

January 15, 2014
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s that time of year again—the ECRI Institute has released its Top 10 Health Technology Hazards for 2014 report, and with it come new (and old) hazards to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the third year running. Other repeat hazards included medication administration errors while using smart pumps (in at number two), inadequate reprocessing of endoscopic devices and surgical instruments (number six), and, at number eight, risks to pediatric patients associated with technologies that may have been designed for use in adults (such as radiology, oxygen concentrators, computerized provider order–entry systems, and electronic medical records). For an overview on these, see our posts from 2012 and 2013.

And here’s a snapshot of new hazards that made the cut, along with some of the report’s suggestions on how to prevent them.

Radiation exposures in pediatric patients (#3)

The risk: Although computed tomography (CT) scans are valuable diagnostic tools, they are not without risk, and children, who are more sensitive to the effects of radiation than adults, are more susceptible to its potential negative effects. According to the report, new empirical studies suggest that “diagnostic imaging at a young age can increase a person’s risk of cancer later in life.”

Some suggestions: The report suggests that health care providers take the following actions: use safer diagnostic options, when possible, such as X-rays, MRIs, or ultrasounds; avoid repeat scanning; and use a dose that is “as low as reasonably achievable.”

Occupational radiation hazards in hybrid ORs (#5)

The risk: Hybrid ORs, which bring advanced imaging capabilities into the surgical environment, are a growing trend. However, with these angiography systems comes exposure to radiation—a risk to both patients and OR staff.

Some suggestions: According to the report, a radiation protection program is a must. The program should include training for staff, who may not have experience with imaging technology; the use of shielding with lead aprons or other lead barriers; and monitoring of radiation levels. Read the rest of this entry ?

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How Perioperative Medication Withholding Affects Patients with Parkinson’s Disease

February 4, 2013

By Sylvia Foley, AJN senior editor

The timing of antiparkinson medications has pro­found implications for motor and cognitive function.… If perioperative surgical staff aren’t sufficiently aware of the importance of minimizing disruptions to patients’ antiparkinson medication regimens, prolonged medi­cation withholding of several hours’ duration can occur. And patients with Parkinson’s disease whose doses are delayed may deteriorate quickly.

In January and again this month, we bring you a pair of CE–Original Research articles that describe the findings of two companion studies on how perioperative medication withholding affects patients with Parkinson’s disease. Here’s a short summary.

The quantitative study—what the EHRs said. The first article, “Perioperative Medication Withholding in Patients with Parkinson’s Disease,” discusses the results of a retrospective review by Kathleen Fagerlund and colleagues. The authors reviewed the electronic health records (EHRs) of 67 surgical patients who had undergone 89 surgeries unrelated to Parkinson’s disease. They looked at the duration of perioperative withholding of carbidopa-levodopa (Sinemet)—the gold standard treatment for Parkinson’s disease, it has a short half-life of just one to two hours—and at symptom exacerbations.

What they found was that medication withholding tended to be prolonged. The median duration of withholding for 32 inpatient and 57 outpatient procedures was more than 16 hours and more than 11 hours, respectively. They also found that for 56% of the inpatient procedures, the patient’s EHR contained a note referencing Parkinson’s disease symptoms or symptom management, which included increased agitation or confusion, increased tremors, and symptom management complicated by pain or pain medications. (Because outpatient EHRs contained minimal nursing notes and patients were discharged quickly, only inpatient EHRs were reviewed.)

figure_captureThe authors offer several recommendations, which include a call for improved nursing education about Parkinson’s disease; they state,

nursing education should stress the importance of patients continuing to take their antiparkinson medications with a sip of water up until shortly before the initiation of anesthesia, and of their resuming these medications as soon as possible after surgery.

The qualitative study—the patients’ take. The second CE, “The Perioperative Experience of Patients with Parkinson’s Disease,” discusses findings from a qualitative study by Lisa Carney Anderson and Kathleen Fagerlund. Read the rest of this entry ?

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Health Technology Hazards: ECRI’s Top 10 for 2013

January 4, 2013
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s a new year and with it comes new health care technology hazards to keep in mind, as listed in the most recent ECRI Institute report, 2013 Top 10 Heath Technology Hazards. While some risks from last year’s list made a repeat appearance, a few new topics made the cut for 2013.

Alarm hazards still posed the greatest risk, topping the list at number one. Other repeat hazards included medication administration errors while using smart pumps, unnecessary radiation exposure, and surgical fires. For an overview on these, see our post from last year.

Several new opportunities for harm seemed to involve new information technology (IT) that is making its way into health care facilities, such as smartphones and mobile devices. Here’s a snapshot of several of these, and some suggestions the report gives on how to prevent them.

Patient/data mismatches in electronic health records (EHRs) and other health IT systems

The risk:
One patient’s records ending up in another patient’s file may not be a new phenomenon—it happened in traditional paper-based systems as well. But newer, more powerful health IT systems have the capability to transmit mistaken data to a variety of devices and systems, multiplying the adverse effects that could result from these errors.

Some suggestions: The report suggests that when purchasing health IT systems, facilities should consider how all the connected technologies facilitate placing the right patient data into the right record. It also states that a “patient-centric” approach is preferable to a “location-centric” one. All patient flow and device movement should be kept in mind, as well as planning for all types of transfers (not just routine ones). And during implementation of any project or software upgrade, appropriate testing should be carried out to avoid surprises.

Interoperability failures with medical devices and health IT systems

The risk:
Establishing interfaces among medical devices and IT systems has the potential to reduce errors associated with manual documentation, but achieving the appropriate exchange of data can be difficult, and can lead to patient harm. (For example, interfaces between medical devices may not work properly, systems can be incompatible, and one device can have unintended effects on another.)

Some suggestions: Although there are challenges to integrating medical devices and systems, the report stresses that health care facilities should be actively engaged in the process—albeit cautiously. An inventory of interfaced devices and systems, including software versions, should be kept. Hospitals should follow best practices as described in the International Electrotechnical Commissioner’s standards (available on the International Organization for Standardization’s Web site). When making changes to interfaced equipment, all stakeholders should be involved (and this includes nurses). Finally, before any broad system modifications are implemented, testing should be carried out to ensure everything works as expected.

Caregiver distractions from smartphones and other mobile devices

The risk: While much has been said about the security considerations associated with the use of smartphones, tablet computers, and other handheld devices, another topic that is starting to get attention is the potential for substandard patient care or even physical harm to patients if caregivers are distracted by their devices. Making mistakes or missing information as a result of distraction isn’t the only problem. Caregivers who are distracted by their devices may miss clues about the patient’s condition or cause patients to question the quality of their care.

Some suggestions: According to the report, staff should be educated about the risks associated with the use of smartphones and mobile devices, especially the potential for digital distractions that affect patient care. Hospitals should come up with a “mobile device management strategy” that includes appropriate use of the devices, including specific measures users must take to ensure safety and security. Hospitals may also want to consider restricting personal use of these devices during patient care activities.

Other hazards that topped the list for 2013 include the following:

  • air embolism hazards
  • inattention to the needs of pediatric patients when using technologies that may have been  designed for use in adults (such as radiology, oxygen concentrators, computerized provider order-entry systems, and electronic medical records)
  • inadequate reprocessing of endoscopic devices and surgical instruments

Click here to request a copy of the full report.—Amy M. Collins, editor

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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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