1. What did I expect to learn about this topic
before beginning the unit?
I knew we would be talking about technology and its use in
healthcare. I was expecting to learn about how technology has evolved or
affected healthcare in both good and bad ways.
2. What I actually learned:
CRITICAL THINKING
1.
The use of EMR does not guarantee error-free patient care. While using the EMR often helps
catch mistakes or limit the amount of them, there is still room for mistakes
and errors. Nurses and others using the EMR can override the bar code scan. It
is also possible that the order was written down incorrectly and put in the MAR
incorrectly. That is why it is important for nurses to verify the EMR with the
written order from the doctor before verifying it in the EMR.
2.
Nurses who do not pay attention to the alerts
and choose to bypass those just because they are in a hurry jeopardizes patient
safety. Also, nurses may choose not to scan the medication or double check and
just administer it because the patient is in a hurry or the nurse is in a
hurry. That is never an ok thing to do and often results in mistakes. A friend
told me a story about something that happened on her floor. The charge nurse
administered heparin IV to the wrong patient. My first question was how was she
able to scan that in?...she didn’t scan it. She did not verify and take the
extra 15 seconds to do so and that resulted in a huge mistake. I sure hope the
patient is ok. That behavior is never ok.
3.
Excessive system alerts may just get annoying
but honestly I don’t feel that there is a danger to having them. I guess the
danger would be that nurses stop paying attention to or stop reading them. They
may also just get so annoyed and bypass them because of that. I don’t feel that
there are excessive alerts right now in the system I am currently using. I have actually caught myself giving the
entire tablet instead of just giving half like I am supposed to because of the
system alerts.
4.
Nurses cannot become lazy. Nurses need to see
the value and understand the importance of those alerts. Nurses should not have
the annoyed attitude either. If a bypass
is necessary for some reason the nurse should be calling the pharmacist
directly and have them in the room witnessing it. I would hope nurses see the
value in the alerts of the EMR and take the time to check the orders and the
MAR before just assuming a new medication is correct for that patient.
Technology
is an amazing thing and we have made so many advancements with technology in
healthcare. The EMR is incredible and being able to do all computerized
charting is crazy! It is so helpful in so many ways. The critical thinking
exercise this week made me realize though how important it is to always be
checking the MAR and orders especially with medication administration. There
have been many times I am in a patient room or gathering medications and I see
a new order in the computer. Many nurses will just give it. I try very hard to
always check the chart for the order and verify that it has been correctly
entered into the system and it is for the correct patient before I give it. I
also was reminded of the importance of barcode scanning. This has helped so
much with minimizing medication errors. I don’t want to always just rely on the
scanner and I know I need to be checking and doing the 5 patient rights. I also
have promised myself that I will never bypass an alert. If there is an alert,
more times than not, it means I have made an error of some kind whether I
scanned the wrong barcode, the wrong medication, or it is the wrong dose. I
will always immediately call the pharmacist and verify if I am unsure.
CASE STUDY
1.
Diabetic Patient: The nurse should look at the
patient’s history and see what his blood sugars have been and see if there is a
pattern or trend. A blood sugar of 54 is pretty low and does cause some concern
for most patients. I would advise the nurse to contact the patient directly or
contact nursing personnel in his area to visit him and get a set of vital
signs. I think it would be good for the nurse to call him or have someone call him
and can ask him about how he is currently feeling (checking for signs of
hypoglycemia) and tell him to drink some apple juice or have graham crackers
and milk. I would then ask for a repeat glucose after 1 hour.
2.
The first thing is to try and call the patient
and/or family and contact nursing staff in their area. If the nurse didn’t get
an answer I would ask nursing to visit the patient. Best case scenario the patient just forgot to
report or was delayed. Worst case, the patient was taken to the hospital or the
patient is not doing well at home. Calling first can prevent any unnecessary
action but following up will determine the status of the patient.
Because
of technology we are able to do nursing and communicate with patients and
nurses across the country. I liked the case study this week and realized how
difficult it may be to make medical decisions without even seeing the patient.
I know that I will get calls from friends and family desperate for help or for
an answer and I want to be confident and educated enough to be able to make a
decision and help others in those situations. I know I won’t always know what
exactly is going on but I can know enough to decide whether they should go to
the hospital or if it is something I can assist with. Technology also allows
for pictures to be sent and other helpful resources for everyone to use.
The
discussion this week was interesting. It is perfect for what is happening with
IHC with switching to ICENTRA and more recently the new CareFusion pumps. I
know there were staff members that did not want to use the new pumps and would
hide /stash the old pumps to pull out and use when they worked. I think this is
terrible. But it is hard to make a change after years and years of using a
system. Computer charting is very difficult-I am still learning so much and can’t
imagine how difficult it is going to be for those that have used Tandem for 30
years to switch to a new system. But we are in a profession of change and
adaptation. Change is necessary and it is a good thing. I want to be helpful to
all my coworkers and help be the motivation to comply with new policies and
changes. Doctors are very intimidating to me and with this discussion I
realized how hard it would be to approach them. I realized all the resourced I
had and who I can go to for help. But, if patient safety is a concern, I will
go directly to the doctor.
3.
My
feelings/experiences from the individual and team activities:
I enjoyed the discussion this week
with my team and thought we worked well together coming to a consensus. We all
provided information to each other that was helpful and I definitely learned
some new things from my teammates. Focusing on informatics and doing the
critical thinking and case study exercises was helpful and reading the article
from AHRQ reminded me about patient safety and they tied together well.
4. How I will utilize the information learned in
my nursing practice:
Technology is amazing and can be so helpful to me. However, I need to not
allow myself to become completely reliant on the EMR or the scanning or
computer system to ensure patient safety. I always need to be checking all
patient rights with medication administration and always checking the orders
from the physician. I also feel empowered as a new nurse and realize I can be
an influence and speak up. I can approach doctors if necessary and let them
know that what they are doing is possibly jeopardizing patient safety if that
is the case. I am a smart person and I am a smart nurse. There are so many
resources out there for me to use and I need to always embrace the change.
5. My personal feelings about the material
covered:
Informatics in many ways is complicated and hard to understand but the
material this week was presented in a great way and the discussions were
helpful. I liked the case study and critical thinking exercises this week and
felt they were very applicable to my current situations in my nursing practice.
