2. Nursing Informatics – Transition Module Jennifer Hardy

3. Transition Module 2006 Hardy2 Overview Definition NSW Health IT Strategy

4. Transition Module 2006 Hardy3 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)

5. Transition Module 2006 Hardy4 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.

6. Transition Module 2006 Hardy5 Information Technology used in the Health Care Industry Current status of Informatics in NSW

7. Transition Module 2006 Hardy6 Clinical Information Systems The NSW Health Strategy Dianne Ayres MInfoCommTech, BAdmin(Nurs), RN, RM Assistant Director, Clinical Systems Strategy Unit

8. Transition Module 2006 Hardy7 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

9. Transition Module 2006 Hardy8 The Future Single Health Record On-line Multiple Health Records Across All Care Settings Accessible to Authorised Care Providers Across the Continuum of Care Problem The 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 Care Health Care Providers Across the Continuum of Care Health Services Community

10. Transition Module 2006 Hardy9 Discharge Medications

11. Transition Module 2006 Hardy10 Clinical Systems Integrated Framework Clinical Information Access Program (CIAP) Electronic Prescribing Decision Support Discharge Referral System Point-of-Care Clinical System Patient Administration and Unique Patient Identifier Allied Health Systems RadiologyPathologyDietaryPharmacy Clinical Specialty Systems Community Health Information System (CHIME) Electronic Health Record Hospital Environment Emergency Department

12. Transition Module 2006 Hardy11 Clinical Systems Integrated Framework Clinical Information Access Program (CIAP) ElectronicPrescribing Decision Support Discharge Referral System Point-of-Care Clinical System Patient Administration and Unique Patient Identifier Allied Health Systems RadiologyPathologyDietaryPharmacy Clinical Specialty Systems Community Health Information System (CHIME) Electronic Health Record Hospital Environment Emergency Department

13. Why Decision Support Systems?

14. Transition Module 2006 Hardy13 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.”

15. Transition Module 2006 Hardy14 In the USA Numerous studies have shown that –180,000 deaths a year were attributable to ADEs 1 –Cost of ADEs is $76.6 billion a year 2 –The number of deaths is equivalent to a jumbo jet crashing every day 3 –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) References 1 & 4 Bates et al 1995 2 Institute for Safe Medication Practice (ISMP) (2000) 3 Leape et al (1998) 4 Low and Belcher 2002

16. Transition Module 2006 Hardy15 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

17. Transition Module 2006 Hardy16 Where Medication Error Occurs

18. Transition Module 2006 Hardy17 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)

19. Transition Module 2006 Hardy18 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

20. Transition Module 2006 Hardy19 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

21. Transition Module 2006 Hardy20 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.

22. Transition Module 2006 Hardy21 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 Implement Assess Plan Evaluate

23. Transition Module 2006 Hardy22 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