Informatics

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.