The importance of nursing informatics to upgrade the efficiency and effectiveness of nursing care
Nursing is increasingly becoming as “high tech” as it is a “high touch” profession. Today’s nurses have more technology at their disposal than any nurses ever before, and as one might expect, it’s considerably improving patient care.
One area where nurses are putting technology to use is in informatics. Officially known as the study of information, in the world of health care, health informatics is the management of health information. Using electronic medical records, devices that collect health information electronically, and other electronic information standards, health informatics nurses are responsible for managing, interpreting, and communicating the data that comes in and out of health care facilities, all with one primary purpose: Improving the quality of patient care.
But how does that happen, specifically? How are nurses using informatics as a way to improve the care they — and their colleagues — provide to patients? As it turns out, there are several key ways that informatics is part of that effort.
Documentation has long been considered an important part of the nursing profession, but it’s more vital than ever to the delivery of quality care. While the theory and practice of nursing, the standards of nursing practice, legal and ethical considerations, and other points that are taught in advanced nursing programs all influence the practice of nursing, it’s information, and specifically, electronic documentation, that is having the greatest influence on modern nursing.
Modern nursing care is driven by individual patient needs and history — information that is collected and organized in electronic patient records. By documenting a patient’s condition, and sharing that information electronically, nurses are able to more effectively manage care, and by extension, improve the quality of that care.
A great deal of documentation takes place automatically thanks to connected devices, which collect specific information in real time and transmit it to patient records. By looking at the documentation of a patient’s condition over time, nurses can make better decisions about how to provide care and when changes or adjustments need to be made.
Reduced Medical Errors
Patient safety is a primary concern of any health care provider, and nurses are often on the front lines of ensuring that their patients are kept safe and preventing medication errors, misdiagnoses, falls, and other problems. Health informatics provides important data that can prevent these errors; for example, an electronic record can provide information about a possible dangerous medication interaction or allergy that might not otherwise be immediately apparent. Armed with data, nurses can make quick decisions that keep their patients safe.
In fact, in a study by the Agency for Healthcare Research and Quality (AHRQ), a majority of nurses reported that when they have access to EHRs, they have fewer problems with getting patients ready for discharge, fewer medication errors, and better quality of care. And when it comes to transfers between departments, nearly 15 percent of the nurses surveyed reported that information was more likely to be shared and less likely to “fall between the cracks” when electronic systems are used.
Nursing informaticists can reduce the chance of medical errors in a healthcare organization, together with associated costs. A combination of staff training, process improvement, and best practice will enhance the quality of care and limit patient risks. There are four main areas that drive medical errors:
- Communication doesn’t take place when it should
- Incorrect or incomplete information is communicated
- Information is shared with the wrong recipient or third party
- The message lacks critical facts or is unclear, meaning it isn’t understood correctly
Informaticists can look at how your organization communicates and collaborates around patient information. They can audit individual cases, identify gaps, and provide recommendations for avoiding errors in the future.
Not only does information provide nurses with alerts to avoid errors, it also helps to automate certain tasks, both improving nurse productivity and preventing some of the costs associated with health care.
Information technology systems allow health institutions to more strategically allocate resources and save significant amounts of money, energy, time, and supplies. One example of this is utilizing comprehensive data concerning the specific needs of admitted patients and combining it with information about individual staff skills, availability, and even up-to-the-minute information including fatigue levels when applicable, to more effectively staff and arrange medical personnel to best serve patients. In addition to staffing arrangements, technology systems can allow better management of supplies. Inventory, refrigerator contents, equipment check-outs, and infinitely more can be tracked, viewed, and updated in real time with information systems. The Certification Commission for Health Information Technology reports that an estimated 50 percent of health finances may be wasted each year due to system inefficiencies, and that hospitals could save potentially millions of dollars by utilizing better health information technology.
Improved Coordination of Care
Nurses are often called upon to help coordinate the care of their patients. This often means relaying information from physicians, therapists, pharmacy, billing, and more, both during care and at discharge. Without all of the necessary information, patient care could suffer. Informatics improves the coordination of this information, allowing nurses to give their patients all of the information they need, improving both outcomes and the satisfaction with care.
While there are some who criticize the use of informatics and technology to help manage care, arguing that it makes health care more impersonal, with the provider-patient relationship being replaced with data and algorithms, there is actually overwhelming evidence that informatics actually improves care. Nurses who are trained in this technology and how to best incorporate data into their workflow are often more productive and able to provide better care than ever before.
Faster Lab Results
Electronic health records allow caregivers to retrieve patient information faster than conventional methods, facilitating timely test scheduling and treatment. Furthermore, caregivers can access test results as soon as they become available.
Clinical Decision Support
Clinical decision support creates knowledge and informational support strategically placed at vulnerable decision points, allowing staff to consider safety, options for care, and education prior to proceeding with care decisions. For example, Karla is on the surgical unit, and her patient is being prepared for a procedure; the protocol requires a shower using a soap the patient is allergic to. The chart sends an alert to inform Karla that her patient is allergic, and then Karla informs the physician who orders a different soap. The patient is protected from an allergic reaction.
Improved Administrative Functionality
Leadership is supported by data that can shape the policy for the organization. Understanding what is happening in the facility can assist leadership to determine education needs, improve quality programs, and create a culture of safety and accountability for the managers and staff.
Many unforeseen and counterproductive circumstances may arise during a typical care provider workday, which is compounded when staffing shortages occur. To mitigate this risk, healthcare managers use a technology called resource-demand management that analyzes caseload information and staff availability. A similar technology, workforce-management solutions, performs largely the same tasks, while also helping managers control costs and service quality.
Improved Quality and Safety
Quality of care delivered with access to knowledge and information are two important factors that can reduce errors and improve positive outcomes. Karla has information available to her as links in the orders and other key areas for quick reference. Technology is improving quality and safety in the following key areas:
Clinical workflow can be built into the software that allows a smoother, safer approach to care. For example, Karla has five patients; two of them are more unstable. She has those two on monitors that feed the vital signs to the EHR. Karla can follow their vital signs in the records as she completes her care with the other three patients. This allows her to check on them quickly and intervene if she notes a problem.
Nurses can receive alerts regarding a patient's care to prevent orders from being missed.
Sharing of data can aid in decision-making with the patient. For example, Karla's patient has a low lab result that needs to be reported to the physician. Lab results are readily available for staff.
Increased Patient Safety:
Health information systems can not only store and display but synthesize patient information. This makes it possible to, for example, program security checks that could alert medical personnel of adverse effects the patient might experience on a certain medication before it is prescribed. Being able to store all of a patient’s information, including lab results, medical imaging, and more in one place can also help avoid costly mistakes that arise when not all relevant information is available during decision-making.
Improved Compliance of Accreditation Standards
Many EHR software packages come with the Joint Commission standards embedded into the documentation for providers and staff. Karla's patient is receiving sedation for a procedure. The Joint Commission has standards to address sedation in the documentation that covers all aspects of the care including identification of the correct patient, medication dosage, route, and effect.
Reduced Hospital Stays
According to the Office of the National Coordinator (ONC) for Health Information Technology, electronic record implementation reduces the time needed to assess fall victims by 20-percent, reducing patient stay times in those cases. Likewise, the National Center for Policy Analysis reports that facilities using HIT systems reduce average patient stays from 5.7 days to 5.5 days. This effectiveness has led researchers to explore other benefits to using electronic health records and HIT, such as whether tele-monitoring can delay nursing home admittance among elderly patients
Healthcare technology has many facets of patient and staff education embedded in the patient's record. One of Karla's patients is being discharged to go home and needs information about blood thinners. Karla finds the discharge information sheet for her patient in the EHR and prints off a copy for her patient to review and discuss prior to leaving the facility. In the EHR, education tools regarding procedures, medications, and disease processes are available.
Providing Learning Based on Objective Data
They can use data to identify endemic issues in a healthcare organization and consult on the best way to resolve these problems. These learnings can be integrated with onboarding new staff, ongoing in-house training, or external education and certification. Nursing informaticists can help to create highly-targeted educational programs to deal with specific gaps between ability and provider expectations.
Selecting and Testing New Medical Devices
Connected IoT medical devices can provide vast amounts of health data on patients. Nursing informaticists are ideally positioned to understand the true value of that data and provide recommendations on how it can be recorded, accessed, and used. Involving informaticists in the selection of medical devices will ensure you have additional criteria for understanding how device data can inform diagnostics, treatment plans, and ultimately patient outcomes.
Improved Access to Information
Access to information for patients and providers can increase the quality of decision-making and reduce errors resulting from missing documentation. One of the assignments from the ACA for healthcare is to increase interoperability — an ability to share information between providers caring for the patient, third-party payers, and reporting agencies such as public health.
Enhancing End-to-End Treatment and Continuity of Care
A patient’s care may involve several areas, many teams, and dozens of individuals. Nursing informaticists can create protocols and processes to ensure proper communications and interactions between departments, teams, individuals, and patients. They can help healthcare employees to seek out “one view of the truth” through electronic health records, so everyone has the context and insight they need to ensure excellent continuity of care.
Increased Patient Information Accessibility: Health information technology systems could allow seamless and instant access to patient records for every medical professional working with a particular patient, allowing lab technicians, specialists, physicians, and nurse practitioners to access pertinent information and better inform treatment. But not only do they enable better access for medical professionals, but for patients as well. Digital versions of patient files (including their entire EHR) could potentially be accessed from anywhere at any time, allowing patients to be more involved in their treatment plans and stay better informed about their conditions and care.
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