“Technological Innovation in the Field of Nursing”

Rosario Naomi Tagimacruz-Fajardo, R.N., PhD

• The future of nursing lies in technological innovations and how they are applied to improve healthcare delivery to patients.

• From the very beginning of nursing as a formal career with standardized education programs in the late 19th century, there have been several points of rapid change thanks to new health-related technologies.

• What has been called the “germ revolution” and the understanding of the sources of infection was one such turning point, the introduction of antibiotics, another.

• Today, as the demand for nursesskyrockets, the field itself is experiencing radical change.

• With the combined forces of medical advancements and information technologies, the field of nursing has experienced yet another substantive transformation, changing nursing careers forever.

• Nursing technology has transformed the way nurses work and continues to evolve, along with the roles that nurses play in today’s health care arena.

• According to various studies and surveys, technology in the nursing world has increased patient satisfaction and overall outcomes, reduced clinical errors and decreased the amount of paperwork that nurses were once required to perform.

Documentation

Documentation is any written or electronically generated information about a client that describes the care orservice provided to that client.

Health records may be paper documents or electronic documents, such as electronic medical records, faxes, e-mails, audio or video tapes and images.

• Through documentation, nurses communicate their observations, decisions, actions and outcomes of these actions for clients.

• Documentation is an accurate account of what occurred and when it occurred.

• Nurses may document information pertaining to individual clients or groups of clients.

Nursing documentation clearly describes:

• an assessment of the client’s health status, nursing interventions carried out, and the impact of these interventions on client outcomes;

• a care plan or health plan reflecting the needs and goals of the client;

• needed changes to the care plan;• information reported to a physician or

other health care provider and, when appropriate, that provider’s response; and advocacy undertaken by the nurse on behalf of the client.

Emergency Department Nursing Admission Record

• The purpose of the Emergency Department Nursing Admission Record is to provide accurate information about a patient’s care, treatment and services, special needs or special precaution and any recent or anticipated changes which ensures patient safety and continuity of care, and is essential in minimizing medical errors, especially in endorsing patients to another unit and staff.

Handoff of Care Communication

• Handoff of care communication is a real-time, interactive process of passing patient specific information from one caregiver or team to another for the purpose of ensuring the continuity and safety of the patient’s care.

• Intrafacility Transfer Form – PCU patient transferred to CCU and vice versa

• Intrafacility Transfer Form + Preop Checklist – PCU patient going to OR and then patient is transferred to a Critical Care Unit

• Dialysis Unit Patient communication Form– for admitted patients undergoing dialysis (temporary transfer of care)

ADMISSION ASSESSMENT & REASSESSMENT

• Registered nurses in the Emergency Department/Patient Care Unit/Critical Care Unit are qualified to perform a complete assessment and reassessment of the patient.

• A complete assessment shall include physical, psychological and social status, as well as educational needs.

PATIENT CARE PLANNING

• A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment.

• The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.

F O C U S C H A R T I N G

• With this method of documentation, the nurse identifies a “focus” based on client concerns or behaviors determined during the assessment. For example, a focus could reflect:

• A current client concern or behavior, such as decreased urinary output.

• A change in a client’s condition or behavior, such as disorientation to time, place and person.

• A significant event in the client’s treatment, such as return from surgery.

• In focus charting, the assessment of client status, the interventions carried out and the impact of the interventions on client outcomes are organized under the headings of data, action and response (DAR):

• Data: Subjective and/or objective information that supports the stated focus or describes the client status at the time of a significant event or intervention.

• Action: Completed or planned nursing interventions based on the nurse’s assessment of the client’s status.

• Response: Description of the impact of the interventions on client outcomes.

Use of Technology

• A client’s electronic health record is a collection of the personal health information of a single individual, entered or accepted by health care providers, and stored electronically, under strict security

E L E C T R O N I CD O C U M E N T A T I O N

• A client’s electronic health record is a collection of the personal health information of a single individual, entered or accepted by health care providers, and stored electronically, under strict security.

Most agencies using electronic documentation have policies to support its use, including policies for:

• correcting documentation errors or making “late entries”;

• preventing the deletion of information;

• identifying changes and updates to the record;

• protecting the confidentiality of client information;

• maintaining the security of the system (passwords, virus protection, encryption, firewalls);

• tracking unauthorized access to client information;

• processes for documenting in agencies using a mix of electronic and paper methods;

• backing-up client information; and

• means of documentation in the event of a system failure.

F A X T R A N S M I S S I O N

• Facsimile (fax) transmission is a convenient and efficient method for communicating information between healthcare providers. Protection of client confidentiality is the most significant risk in fax transmission and special precautions are required when using this form of technology.

• Client information received or sent by fax is a form of client documentation and is stored electronically or printed in hard copy and placed in the client’s health record.

• As the fax is an exact copy of original documentation, additional notations may be made on the faxed copy as long as these meet the agency standards for documentation and are appropriately dated and signed. Faxes are part of the client’s permanent record and, irrelevant, can be subject to disclosure in legal proceedings.

• If a physician’s order is received by fax, nurses use whatever means necessary to confirm the authenticity of the order.

E L E C T R O N I C M A I L

• The use of e-mail by health care organizations and health care professionals is becoming more widespread as a result of its speed, reliability, convenience and low cost. Unfortunately the factors that make the use of e-mail soadvantageous also pose significant

confidentiality, security and legal risks.

• From the nurse’s perspective, it is important to realize that e-mail messages are a form of client documentation and are stored electronically or printed in hard copy and placed in the client’s health record. E-mails are part of the client’s permanent record and, if relevant, can be subject to disclosure in legal proceedings.

• Similar to physicians’ orders received by fax, if physicians’ orders are received by e-mail, nurses use whatever means necessary to confirm the authenticity of the orders.

T E L E N U R S I N G

• Giving telephone advice is not a new role for nurses. What is new is the growing number of people who want access to telephone “help lines” to assist their decision-making about how and when to use health care services.

• Agencies such as health units, hospitals and clinics increasingly use telephone advice as an efficient, responsive and

cost-effective way to help people care for themselves or access health care services.

• Nurses who provide telephone care are required to document the telephone interaction. Documentation may occur in a written form (e.g., log book or client record form) or via computer.

• Telenursing is subject to the same principles of client confidentiality as all other types of nursing care.

Point-of-Care Technology

• Accessing patient records, X-rays, medication information and even obtaining a second opinion from another health care professional, can all be done directly from the bedside thanks to new advances in point-of-care technology. Utilizing a wireless network and computer, nurses in many hospitals can now access and receive a wide array of information right from the patient’s room.

• Computer and software companies are working to further advance point-of-care technology to include wireless and mobile applications that will enable nurses to have the information they need directly at their fingertips

Electronic Lift Systems, Smart Beds and Computerized Staff

Schedules• Many of the health care technologies we

see today have been put in place to make a nurse’s everyday routine safer and more efficient.

• Electronic lift systems operated by remote control and other wireless technologies have greatly reduced injury and stress for both patients and nurses.

• Smart beds and computerized staff scheduling systems have also improved general nursing efficiency.

• Smart beds, such as those developed by Hill-Rom, work in conjunction with other point-of-care technology to obtain and analyze patient information such as weight, temperature and head and neck elevation.

• New staff scheduling systems improve efficiency by enabling nurses to set up coverage and even schedule their shifts remotely.

Medication Safety

• The number of medications has grown an astonishing 500% in the past decade. Today, more than 17,000 trade and generic pharmaceuticals are marketed in North America.

• As a result, the number of medication errors in hospitals and care centers across the country has grown, making it the number one concern of patients who are hospitalized.

Where do medication errors occur most in hospitals across the country?

• 39% in ordering

• 12% in transcribing

• 11% in preparing

• 38% in administering

Why do medication errors occur?

• · Wrong drug• · Wrong Dose• · Similar names• · Similar labeling/packaging• · Transcription error• · Omission error

Ensure correct number of units e.g 3

tablets, 1 vial etc.

must be shown beside transaction ID

number under patient’s name

This opens a list of all patients in the PCU.

Ask ordering physician to complete the

order

Remove physician’s order sheet (POS) and bring to the PC with attached scanner

Yes or

No?

Open the Rx Manager using individual password

Click on the intended patient’s name.

Place POS on scanner face-down and click on “Scan” icon

Click on “Accept” icon

(Scanned sheet should appear on screen)

Check for correctness of patient identifiers Place “Scanning is on-going, please do not

use computer” signage

Do corrective measures

This

eliminates other names on screen

Close all open windows on the PC screen prior to scanning

START

Charge Nurse/ MPN/NIC: check for completeness and correctness of the order prior to scanning

Click on the “Save” icon

Yes or

No?

This transmits scanned sheet to the

Pharmacy.

Verify if POS has been properly transmitted to the Pharmacy

Call Pharmacy Staff to inform of transmitted POS

Remove POS and return to Patient’s Medical Chart

Verify if transmitted order has been transcribed by the Pharmacy Staff

Call Pharmacy to verify if the on-line request has been received

Tick on the box that corresponds to medications to be requested

Click on the “Save” icon

Wait for medications to be sent to the PCU via pneumatic tube or when ready for pick-up by the PCU staff

(MPN/Staff RN/NA)

Close Rx Manager program and remove “Scanning On-going” signage.

END

must be shown

beside transaction ID number under

patient’s name

MEDICATION ORDERS

SCANNING PROCESS FLOWCHART

• Through advanced computerized bar coding – the same technology used for decades on everything from food packaging to concert tickets –physicians and nurses can track drug orders and make the delivery of patient medications even safer.

• Today, every patient wears a wristband with his or her name on it as well as a simple bar code. A computer bar code on each patient’s identification bracelet is used to match and monitor the medication ordered by the doctor. Before administering medications, nurses and other caregivers scan a bar code on the patient’s wristband, on the nurses’ own identification badge, and on the medications using a hand-held device.

• A bedside computer integrates these bar codes with medical databases to provide patient-specific information. Through immediate feedback on the computer screen, the bedside nurse will be alerted to any potential errors and other critical information that could prevent adverse drug effects.

The system is designed to achieve the “five rights”:

• · Right patient

• · Right drug

• · Right dose

• · Right time

• · Right route of administration

The use of barcoding -is now applied to medications prepared by the dose.

The process helps the caregiver apply the right medication in the right dose to the right patient.

Technologies That Changed Nursing Careers Forever

Electronic IV Monitors.

• There was a time when IVs had to be administered with a nurses constant attention to ensure a steady flow.

• Manual IVs were highly sensitive to a patients movement and the flow of the IV could be sped up or slowed to a crawl by a subtle movement.

• To prevent this, nurses had to directly administer an IV from beginning to start.

• With the advent of IV pump infusion and electronic monitoring, nurses are freed up to initiate an IV and allow a machine to monitor and regulate the process. If there is an error, the system tries to correct it, and otherwise contacts the nurse via remote monitoring.

Syringe Pumps:

The SphygmomanometerThe sphygomomanometer is simply a

fancy term for electronic blood pressure cuffs that also measure heart beat rate: automatically.

Gone are the days when a nurse had to measure blood pressure manually. According to one nurse, this is the technological change that makes the biggest daily difference.

The Portable Defibrillator Manual CPR can only do so much and for

the longest time this was the only method available to many nurses for reviving someone’s heart.

Now, even school nurses stand a fighting chance to save the life of a person who’s heart has failed. The few minutes after heart failure are critical, and the portable defibrillator allows for immediate

resuscitative action.

The Sonogram/Ultrasound

Ultrasound devices provide nurses working with pregnant patients the ability to see inside the womb. Ultrasound has been nothing short of revolutionary in the field of Women’s Health and pregnancy, allowing nurses and doctors to noninvasively identify the health of the baby throughout pregnancy.

.

• Now, with the advent of 4-D ultrasound, unprecedented detail is available for diagnosing fetal well-being.

• In addition to pregnancy monitoring, sonogram technology also offers many other new diagnostic advances such as the ability to easily identify cancer tumors in the bladder, and to tell whether the liver is enlarged

Compact and portable medical devices.

• Combined with portable IT and communication equipment, these small, high-tech types of devices allow well-equipped nurses to take their skills on the road. They can travel to patients’ homes and treat conditions that once had to be treated on an in-patient basis.

Videoconferencing

The ability to interact with nursing professionals throughout the world, through such means as video conferencing, offers advantages and opportunities like never before, both in terms of the further development of the nursing profession and the continued improvement in patient care outcomes.

Hamilton Mechanical Ventilator

(Touch screen operated)

Blood Warmer:

Hemodialysis Machine (Touch Screen)

Patient-controlled analgesia (PCA)

ECG machine- uploaded results to PACS

Cardiac Monitor

Critical Care Units Central Monitor

Kangaroo Pump – for continuous tube feeding

Lifescan Surestep Hemoglucotest (touch screen operated) – uploaded to infinit system (computers); using barcode scanning system

Chest Compressor

I-stat machine – measures blood gas, electrolytes, and some blood component

values

Pulse Oximeter

Portable Pulse Oximeter

Intra-aortic Balloon Pump

THERMAL BLANKET

Technological

Innovations in

Different Areas

BYPASS MACHINE

Cardiovascular Operating Room

Catheterization Laboratory

Cardiac Rehab

Non-invasive Cardiology

Laboratory

Nurse Phlebotomist

Emergency Department

Operating Room

Critical Care Units (CCU/ICU)

Coronary Care Unit

Post-Anesthesia Care Unit (PACU)

Pediatric Intensive Care Unit (PICU)

Neonatal Intensive Care Unit (NICU)

Endoscopy Unit

Dialysis Unit

• As technology transforms the profession, nurses adapt and change as well. Many in the field regard the nursing career as a whole as being in transition, especially as new means and methods of patient care are balanced with the core concerns and traditional philosophies of this essential medical profession.

Thank you!