Week 1 Assignment
RE: Discussion – Week 1
Dr M thanks for your question.
I used to be the chairman of the safety committee when i worked with the Presbyterian Hospital Dallas, TX. a magnet facility that puts a premium on patient and staff safety. Avoiding hospital-acquired infections, medications errors, bedsores, fall and wrong-side surgery were priorities of Presby hospital, all aimed at improving the patient experience and maintaining the position of the hospital of choice in the area. So that patient will return for continued patronage.
But for the sake of your question, I will limit my answer to falls only.
Here is how a nurse leader will use data to improve safety.
As the person responsible for collecting, collating data and writing monthly reports, which the committee presents to the board. After each incidence of a reported complete fall, an assisted fall, or a near miss, i will carry out a Root-Cause-Analysis. (RCA).
A root cause analysis is an investigative study to research the immediate and remote cause of the fall or factors leading to the fall. RCA will find out if the fall was due to a new medication, was the dose appropriate? was it due to poor lighting? or was the patient vision failing?
Furthermore, was it due to trips by objects obstructing the passage? or was the fall due to slips on slippery floor from un mopped water of fluids? or was the fall to the fact the patient was wearing over-sized shoes? or was the garment too big? Was the patient alert and oriented? or was there dizziness involved?
We bring all these factors into account. And put out the data as to the cause of each fall and address the causative factor or reasons and remove them. So that the same factor will not lead to another incidence of a fall in he hospital in the future.
By using the data gleaned from RCA the hospital will better mitigate and prevent future falls from the origin.
According to a study by Rudduck, Hannah, Schade et, al, (2008). Falls account for 40% of all hospital accidents causing injury and death among older adults. Regrettably, resulting in annual cost of $27.3 billion in 1994 and estimated to reach $43.8 billion by the year 2020. (Ruddick, Hannah, Schade, et al 2008)
Ruddick P, Hannah K, Schade CP, et al. Using Root Cause Analysis to Reduce Falls in Rural Health Care Facilities. In Henriksen K JB Keys MA, et al. Advances in Patient Safety: New Direction and Alternative Approaches (Vol. 1: Assessment) Rockville (MD): Agency for healthcare Research and Quality:2008) Aug. Available from: https://www.ncbi.nlm.nih.gov/books/NBK43646
Discussion – Week 1 Application of Data to Problem-solving
Week 1 Discussion Post: The Application of Data to problem-Solving
Informatics and Information technology have greatly enhanced the utilization and delivery of health care in the united states and globally in developed countries. Developing countries are still grappling with harnessing this vital tool.
Informatics is the blending of technology and information to create something new for people, organizations, and individuals to utilize. This is achieved by combining computer principles and information science to turn data into knowledge to a variety of professions including health care. (Laureate media, 2018).
The data mined from informatics will help to enhance better health care, by assisting providers to make health decisions and diagnoses in real-time benefiting both patients and hospitals.
According to Moen & Maeland, (2013). Application and use of informatics in healthcare help clinicians improve decision-making at the point of care.
Through the development of informatics and technology, various tools and avenues of care have become available. Examples, Tele-medicine or a broader more encompassing term “Tele-health” has evolved. Including Electronic health records, (EHR), Personal health record (PHR) and smart assistive tools including stand-alone applications or portals for personal self-care. (Moen & Maeland, 2013).
In the Veteran health administration (VA) where I work, there are at least two areas where the impact of this technology is being utilized with tremendous benefits.
1. Tele-Nursing. (Chronic Disease management CDM) Where nurses can monitor the progress of patients either improvement in health or deterioration of patients who are the sickest of the panel. Through computer terminals/monitor in the patient’s home hooked up to the clinic. These patients often have co-morbidities. (Cancers, Heart failure, Diabetes, High blood pressure, High cholesterol, Strokes, HIV/AIDS). The older the patient, the more co-morbidity the patient has, the computer assigns a higher level/number of risks.
The data provides predictability: From the data, we can tell which veteran is likely going to have a sentinel event, hospitalized or fall sick and those at the top of the list are called/visited or taken to the hospital to see the doctor even before their next scheduled appointment.
2. My HealtheVet: This is a portal where veterans can log in to access their health information, reorder their medication, check their upcoming appointments, review their health records and progress notes and lab results. And the ability to send end to end secure messages/encrypted emails to the Ambulatory pact team. Only accessible by the assigned pact team and expectation of reply within 72 hours.
3. Tele-psychiatry and telemedicine. The VA presently utilize video visits. The provider is at a remote location and the patient is being seen as a regularly scheduled patient in the clinic.
Finally, there was an interesting case when I was care manager in ambulatory care in the VA, through an APP downloaded to the patient phone or computer, I invite the patient to a video chat after I have established a video connection, I call the doctor to come and see the patient this has prevented the hassle of traveling long distances to the clinic. One particular patient that was diagnosed as having scabies after he showed the particular type of rashes through the camera he had medications ordered and sent in the mail to him.
Availability of patient records. All VAs nationwide can share information and records can be pulled from one location to another. This comes handy for the continuity of care and the veteran is always able to continue his or her care in a different location.
Drawback: Unfortunately, due to the accessibility of their records by logging into the “My Healthevet” portal, Veteran are able to read, contest or challenge and petition unsavory notes to be removed even though the record was correct, the veterans are usually obliged and the said item edited out. This technology often is expensive and requires computers, monitors, video cameras, training, power/electricity, and internet connectivity availability to work.
Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of nursing informatics in promoting the quality of health care and the need for appropriate education. Global journal of health science, 6(6), 11–18. doi:10.5539/gjhs.v6n6p11
Holden, R. J., Rivera-Rodriguez, A. J., Faye, H., Scanlon, M. C., & Karsh, B. T. (2013). Automation and adaptation: Nurses’ problem-solving behavior following the implementation of bar-coded medication administration technology. Cognition, technology & work (Online), 15(3), 283–296. doi:10.1007/s10111-012-0229-4
Laureate Education (Producer). (2018). Health Informatics and Population Health: Trends in Population Health [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). What is Informatics? [Video file]. Baltimore, MD: Author.
Moen, A., & Mæland Knudsen, L. M. (2013). Nursing informatics: decades of contribution to health informatics. Healthcare informatics research, 19(2), 86–92. doi:10.4258/hir.2013.19.2.86
Veteran Health Administration, VA My HealtheVet. https://www.myhealth.va.gov/mhv-portal-web/home
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