Nursing Informatics – Transition Module

Jennifer Hardy

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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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The FutureThe FutureThe FutureThe Future Single Health Record On-line

Multiple Health Records Across All Care Settings

Accessible to AuthorisedCare Providers Across the Continuum of Care

Problem

The PresentThe PresentThe PresentThe Present

Specialist Care

•Paediatrics•Orthopaedics•Surgery•General Medicine•Gerontology•Dermatology•Respiratory•Cardiology•Gynaecology•Obstetrics etc.

Primary Health Care

•Education•Drug and Alcohol•Mental Health•Sexual Assault•Home Help•Meals on Wheels•District Nursing•Health Promotion•Child Protection• Baby Health etc.

Hospital System

•Specialist Services•24 hour Nursing Care•Therapists•Pharmacists•Dietitians•Social Workers•Psychologists•Diagnostic Services•Administrators• etc.

•General Practitioner•Allied Health•Medical Centre•Alternative Therapists•Ambulance/Paramedics

Health Care Providers Across the Continuum of CareHealth Care Providers Across the Continuum of Care

Health ServicesCommunity

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DischargeMedications

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Clinical Systems Integrated Framework

Clinical InformationAccess Program

(CIAP)

Electronic Prescribing

Decision Support

Discharge Referral System

Point-of-CareClinical System

Patient Administration and Unique Patient Identifier

Allied Health

SystemsRadiology Pathology DietaryPharmacy

ClinicalSpecialtySystems

Community Health Information System (CHIME)

Electronic Health Record

Hos

pita

l Env

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ent

EmergencyDepartment

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Clinical Systems Integrated Framework

Clinical InformationClinical InformationAccess ProgramAccess Program

(CIAP)(CIAP)

Electronic Electronic Prescribing Prescribing

Decision SupportDecision Support

Discharge Referral Discharge Referral SystemSystem

Point-of-CarePoint-of-CareClinical SystemClinical System

Patient Administration and Unique Patient Identifier

Allied Health

SystemsRadiology Pathology DietaryPharmacy

ClinicalSpecialtySystems

Community Health Information System (CHIME)

Electronic Health Record

Hos

pita

l Env

ironm

ent

EmergencyDepartment

Why Decision Support Systems?

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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)

References1 & 4 Bates et al 19952 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

4%

56%

34%

6%

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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• Patient history and examination• Review past history • Record medical alerts/allergies• Order tests and treatment• Review results reports• Initiate care pathway/plan • Commence discharge planning• Record observations• Record interventions • Evaluate care & manage variances • Educate the patient • Generate reports• Discharge patient

The Care Process

ImplementImplement

AssessAssess

PlanPlanEvaluateEvaluate

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• Clinical Documentation• Clinical Documentation/EHR• Rules - Alerts and Prompts • Order Management • Results Reporting/EHR• Clinical Pathways• Discharge Plan• Charting • Progress Notes• Clinical Reports• CMIs/ Protocols/Guidelines• Clinical Reports• Discharge Referral/ EHR

Information to Support the Care Process

Decision Support (e.g.CIAP, E-PDS, Rules, Alerts, Prompts, Clinical Practice Guidelines)

• Patient history and examination• Review past history • Record medical alerts/allergies• Order tests and treatment• Review results reports• Initiate care pathway/plan • Commence discharge planning• Record observations• Record interventions • Evaluate care & manage variances • Educate the patient • Generate reports• Discharge patient