Module 1 Questions

1. Introduction: My name is Shirleen Gamonal. I am currently in the Clinical Nurse Leader (CNL) program of study. The CNL role is heavily focused on Quality Improvement. In order to adequately identify trends, and opportunities for improvement the CNL must to be able to utilize information such as data warehouse. Being able to measure data points and access information systems can better equip the CNL in measuring the success of process improvement projects. In addition, the ability to access systems will help the CNL to be able to benchmark and compare thier organization with others which are similar throughout the nation.

Currently, as a nurse manager, I am buried with e-mails, and data from all levels (financial reports, incident reports, committee meetings, etc.) I need to know what is available and how to access information when needed. For example, when facilitating a process improvement team, it is best to have some key indicators to measure for success or failure. Previously, when faced with a concern, I would personally collect stacks of medical records for review. With the final phase of electronic medical records, there are greater opportunities for gathering quantifiable data. I need to not only know how to access information regarding evidence based practice, but be able to guide the nurses to strive for best practice.

2. What is happening related to IT in my clinical setting? Our hospital is entering the final phase of implementing computerized medical records. This last phase involves provider order entry (CPOE). Given the fact medical errors and patient safety are a national safety goal it is encouraging to read electronic medical records and CPOE for inpatient medication orders can reduce errors by 50% (Zytkowski, 2003). Without CPOE, my unit alone has experienced a dramatic increase in medication errors. Our nurses and pharmacists are excited to finally have this last piece (CPOE) fall into place. My unit has been selected to be one of three pilot inpatient units prior to the "go-live" date for the entire institution on May 2nd, 2009.

Currently we are using a combination of paper and electronic documentation. the confusion is high as the outpatient clinics are completely paperless, while the inpatient areas are electronic for nursing documentation and printed for physician orders. We are eager for the conversion to CPOE. We had readied ourselves last Spring. Unfortunately, there were several periods of electronic "downtimes" which identified a problem with the hardware and lack of sufficnet backup. The delay was necessary to assure patient safety.

Structured documentation, standards, and/or coded terminologies do you see within our practice setting? How are structured/coded clinical data useful in promoting quality patient care? Our electronic electronic medical record is from Cerner; commonly called "PowerChart". Within the system, there are many "PowerForms" which give the user choices for documenting. The system is set up such that the healthcare provider (RN, HCA, etc.) can chart readilly while also allowing the system to capture qualtifiable data. The data is accessible to measure patient outcomes, trends, etc. Another similar system is our electronic system for reporting incidents, "Patient Safety Net"(PSN_ from the University Healthcare Consortium. The data warehouse is accessible to managers to better identify areas of concern while promoting networking with peers across the nation. Until recently, I have never asked the nurse to comoplete an incident report (PSN) for anyone who transfers to a higher level of care. We have recognized the need to reoirt any unplanned event (transfer, line infection, etc.) to assist the identification of trends through the institution. For example, a recent increase in resonse times to a brain attack or a cardiac arrest sparked the creation of a task force to determine solutions.