Clinical Experience
Sunrise Clinical System Version 6.1
The Emergency Room: Hybrid System
Meetings and Collaborative Care Councils
Workflow of the EMR
The KBC ( Knowledge Bas Charting) 3.4 Upgrade 6
The Role of the Nurse Informaticist
Comprehensive Analysis of my Clinical Experience
After completing 100 hours of practicum in informatics, the following will show the time at the site with my preceptor. The practicum took place at Franklin Hospital – North Shore Long Island. North Shore-LIJ which is an award-winning health system that consist of , a nationally well-known children’s hospital, a notorious mental facility and an assortment of community hospitals, in addition to a range of wellness and health programs. System consist of 16 award-winning hospitals and approximately 400 physician practice locations all through New York, as well as Long Island, Manhattan, Queens and Staten Island. North Shore-LIJ Proudly serving an area of seven million people, North Shore-LIJ delivers world-class services designed for every step of your health and wellness journey. North Shore-LIJ Health System also comprises of 14 services and programs including: Bariatric Surgery, Cancer, Cardiovascular Services, Head and Neck, and Home Healthcare. Furthermore, their board-certified bariatric surgeons perform more than 60% of the weight-loss procedures in the region North Shore-LIJ serves — about 1,300 surgeries every year — with one of the finest records for long-term reclamation and operative weight loss ( North Shore-LIJ Health System, 2014).
Sunrise Clinical System Version 6.1
At North Shore-LIJ I was able to get familiar with the Sunrise Clinical System Version 6.1. This is an interesting piece of technology for informatics Sunrise Clinicals is an advanced clinical information solution that assimilates patient, emergency and ambulatory care through a sole, enterprise-wide electronic health record. This is a very powerful tool that I was introduced to and I learned that this method is utilized by many of the leading hospitals and health systems all over the world. After observing and working with this tool, it that aid in driving adoption of clinical choice support that can lead to outcomes that are improved. I learned that the hospital adopted this tool because they heard that it was very promising and that it is very dependable. It was apparent that this technology be used because the lack of useful, obtainable data on emergency department services all over New York State has been significantly challenging physicians’ abilities to develop strategies and plans for meeting the needs of patients who are really depending on the services. From observing it being used over and over, it was easy to understand that there was a strong need for a heightened data collection system for emergency department data.
The Emergency Room: Hybrid System
The ER at the North Shore-LIJ had a hybrid operating system. North Shore-LIJ hybrid operating room is like a surgical theatre that is prepared with radical medical imaging devices for , MRI scanners and CT scanners. After observing for a while, I was able to learn that these imaging devices allow minimally-invasive surgery that is less shocking for the patient. I learned that minimally invasive was just another way of saying that the surgeon does not need to cut the patient open all the way so as to access the body part he wants to perform surgery on, nonetheless can insert endoscopes or catheters through these little holes. (Seidl, 2012)
Meetings and Collaborative Care Councils
Going to all of the meetings were very informative throughout the practicum. I took a lot of notes and some of the material that actually comes to mind is the mention of Informatics / Big Data and how can we generate knowledge from our data and share it to make decision much better. Another point that was talked about was reducing the cost of care and this just talked about how IT investments & Care Coordination can be utilized in order to decrease the cost of care. Another interesting point at the conference was security / risk management and this went into making sure that the data integrity minimize breaches and also provide some kind of a secure access and defend our devices Reimbursement. The way ACA has been affecting the reimbursements and how we move from volume-based to value-based strategies was another interesting point to mention. It was very informative to learn about Data & the Cloud and how we are able to store & structure data to enable information distribution and interoperability. The conference also hit on other topics such as Patient Engagement and how IT can be used in order to better engage the patients. Mobility was also brought up and they discussed how can we use health and TeleMedicine to make sure care is improved. They introduced the ACOs — and explored the role IT plays in the move to ACOs and performance-based pay. The last interesting point that the conference hit on was what they called Population Management. Here they explored how IT can play a much better role in informatics.
Workflow of the EMR
North Shore-LIJ utilizes electronic medical records as an instrument to make their businesses flow much better. I was able to observe how they used this technology to basically make their life so much easier. I thought about the old day when everything was done by human hands but the EMR took care of all of that because I was able to observe how the EMR technology functioned as a system that was really efficient for record-keeping and client management. After observing the EMR for weeks, I was able to understand this was a cost-reducing prospective of a digital record system for North Shore-LIJ. One of the things I liked about this technology was that it could manages messages all by itself and I learned that the EMR was to schedules patients and also checks the patients into their rooms and then check them out. North Shore-LIJ also used the EMR to conducts exams on the patients as well as renews medications.
The KBC ( Knowledge Bas Charting) 3.4 Upgrade
I also observed how to use the KBC which is something that fans out from structured notes into flow sheets and works really well while doing it. The technology was not that hard to learn once I was able to understand that for each observation on a flow sheet, I was able to check if I want it to copy-forward, and identify how far back to look for charting on that observation. When I completed this configuration the copy-forward rapidly, or if I wanted to block any copy-forward, I was able to do that at the structured note/flow sheet level, and at the observation level within the structured note.
I understood that a new feature automatically copies earlier charting on stated observations, for instance earlier anesthesia and preceding functional level. A blue book icon shows near this information to show that documents are being referenced. When I would hover on the book, it showed the actual documents that were pulled into the chart. After a while, I learned that this is set up for the KBC Adult Patient Profile and the KBC Adult Social Work Assessment. I observed and later figured out that it is possible to identify if I want this auto-copy forward to take place at the level of observation. This is part of the new standard configuration within the notes that are structured.
The Role of the Nurse Informaticist
For the duration of the semester long practicum, there were numerous opportunities to learn and put on the role. Even though learning prospects were plenteous, there were as well some challenges. There were four main challenges during the application of the role and were recognized and consist of: (1) keeping fixed ideas about what is comprised in the role at bay, (2) having an mistaken perception of the way NISs work with or affect other restraints, (3) being capable of experiencing all features of the role the preceptor is accountable for, and (4) seeing influences the application of the role produced throughout an shortened era of time.
Challenges
To begin with, the vision of how regulatory compliance and quality improvement was comprised in the role of an NIS was uncertain. The vision comprised of looking at the quality improvement role remaining totally separate from the NIS part. As my present role consists of regulatory compliance and quality improvement, the anticipation was to isolate the NIS role from anything that had to do with quality and bring the focus entirely on the informatics role. Rapidly the understanding of how integral the work of an NIS is to improving quality started setting in. The challenge was obvious after going to Pine Rest’s facility orientation and hearing footings for instance “mental health code” and “recipient rights.” An assumption was made recognizing these positions as related to regulations and rules in behavioral health and led to the study of what the terms meant in addition to their function to the role.
Also, the ANA (2008) standards of professional practice include measuring for, recognizing issues, and being able to know the expected results, but how the standards could be encountered without knowledge about what needed to be measured, what results to expect, and from who came into question. Study regarding what behavioral health particular regulatory agencies anticipated in terms of quality care needed to be directed in order to meet the standards and perform like an NIS. However, the focus inside the practicum could not totally stay with informatics without help, somewhat quality improvement needed to be seen as a vital part of the job.
The second challenge actually involved not really understanding how much NISs need to work together with specialists from other disciplines and how the other disciplines are influenced. Turley and McLane (2011) gave great support when it came down to the need for informaticians to share and understand the data between the disciplines. However, understanding how disciplines are being affected by others’ processes and workflows is vital when making changes, particularly when information technology is complex. How others, even among the same discipline, are being affected was learned very fast through the work done on the clinical project.
After flowcharting, the entire medication resolution procedure from point of admittance to admission reconciliation and reflecting with the preceptor, Ellen, the understanding of how the workflow contained within nursing (from diverse units), physicians, admission clerks, social work, and informatics was obvious. What the social workers and nurses in the admission unit do with data gathering has an effect on the work of the nurses that are in the inpatient units. Also, the information gathered by social workers and nurses, affects the work the physician does to resolve the medications that were in the electronic health record (EHR). When I learned of changes to the medication units of the EHR, I had to interact with all of these disciplines to make sure they all understood what influence the change will make on their workflow.
The concluding noteworthy challenge included not having enough time to observe the influence of the work accomplished all through the practicum. Although achieving the ANA (2012) standard for assessment was not really part of the planning guide when it came to the practicum, the standard would be encountered if there was enough time to be able to measure all of the progress being made when reaching the results that was being sought after. Also, the standard is met when an NIS is ca[able of evaluating and figuring out the impact the project had on caregivers or patients. There was not sufficient time to observe how Ellen was able to end the loop on her numerous projects as they will go on after the practicum experience has come to an end also. Ellen has held her role for two years as clinical transformation manager, so any changes that she classifies as essential needs to be sent to the company for authorization.
Ellen makes the point that the changes are not always approved for so many different reasons, and since the company is so large, the approved changes take place gradually. An example consists of one specific project Ellen and her colleagues worked on toward the end of the practicum. Going to a few of the meetings permitted for detecting how others will be cultured about the material, the discussions surrounding the implementation and impact of the plan, and the updates in regards to the changes. Participation in the multi-pronged project was significant, but because of time restrictions of the practicum, there will be no time to see how the project has been applied and particularly how the changes have obstructed each discipline’s workflow.
Analysis
The general objective for the practicum was to improve the knowledge of the role of a Nurse Informacist Role. Even though other standards for professional practice were met all through the practicum, the intention of meeting the ANA’s Standard 15: Support was purposely performed inside the clinical project work. The ANA (2012) criterion for Advocacy consists of advocating for caregivers and patients through the advancement of accurate and complete information collection and management. Also, the standard was achieved by means of facilitating the facility’s acquiescence with TJC’s (2012) NPSG.03.06.01 for upholding and gathering precise medication data from patients.
To begin with, patient advocacy is of the greatest importance. Methodical reviews all show that multiple sources of support for how precise medication reconciliation, particularly all through changes of care, definitely affects the outcomes of patient (Russell, 2010). Furthermore, the essential data to finish reconciliation consist of an accurate history of medication previous to admittance, any medications expected within another facility, and medications recommended at release. Higher incidences of adverse drug events were experienced by patients predominantly after there was some transition being made in care from one facility to another. Also being able to keeping the effects of possible negative results in mind, advocacy for patients was exercised by making sure have tools that are helpful when it comes to performing the most complete and right data gathering as conceivable. The medication and triage reconciliation implements were changed improving the ability of the caregivers to find more complete information, particularly coming from the hospitals.
A lot of times the CC nurses were not getting any patient medication data and when calling the hospital, the nurse may still get information that is inadequate. The Triage form was reshaped to ready the triage nurse or social worker to request the patients’ reconciled list of medication and not just what was managed all through the hospital stay. Notifying the CC employees that acute care hospitals were as well obligated to act in accordance with TJC’s (2012) NPSG.03.06.01, authorized and permitted them to ask for patients’ resolved list of medication when it is necessary to get in touch with the hospital nurse for more information.
Furthermore, as stated by Smith, K., Tremblay, M.L., Richer, M.C., and Lanctot, S, (2010) imperfect or imprecise communication concerning patient information can be annoying for caregivers, unsuccessful, and fundamentally a disadvantage to patient safety. Having advocacy for patients was likewise revealed in this project through refining information transfer among caregivers. Also, the addition of a segment for caregivers to document more particular evidence in regards to the patient and obstructions come across throughout the info collection aids in making sure the handoff communication to the following caregiver calculated in as much material as probable. Although communication occurs among two associates of the same discipline, the nurses in the CC center will interconnect with nurses looking over various patient populations. Furthermore the updated instrument standardized communication among diverse kinds of caregivers, permitting for more communication effective and better-quality results for patients (Russell, 2010).
Conclusion
The clinical project and practicum was able to provide this formal opportunity to be able to learn and then practice application of the function of an NIS. Also, there were a number of challenges underwent during the course of the practicum, as well as having predetermined thoughts about the role, lack of understanding about the collaboration that goes on among an NIS and others, going through every kind of aspects the role was able to encompasses, and being incapable of observing impacts that were made through the application of the function for the duration of an shortened timeframe. Also, being able to encounter and meeting with and working alongside many different team members, looking out and following through with multiple learning chances, and functioning persistently in order to achieve as much of a clinical project as possible so as to overcome the challenges.
The chance to relate knowledge, research and theory was done within the practicum through being able to meet three ANA standards for professional practice, Outcome, Issue Identification Advocacy, and Identification. A clinical project, made to make parts better that were a part of the medication reconciliation process, gave a particular specific way in order to practice the Advocacy standard and was critical in assisting the development into the function of an NIS. In conclusion, an evaluation, finished by both student and preceptor, provided some feedback concerning how well each standard was being met and then provided a chance to be able to express suggestions for more learning of the role.
Also, being able to facilitate better communication and information collection is not merely supporting for patients, nonetheless could likewise be considered encouraging for caregivers. Support for caregivers was accomplished in the clinical project by observing processes, attending to what matters have been experienced in obtaining the most precise information and reviewing the gears better care for the efforts involved.
Works Cited
North Shore-LIJ Health System. (2014, April 29). Retrieved from North Shore LLJ: http://www.northshorelij.com/hospitals/services-and-programs/bariatric-surgery
Russell, C.L. (2010). A clinical nurse specialist — led intervention to enhance medication adherence using the for continuous self-improvement. Clinical Nurse Specialist, 24(2), 69-75. doi:10.1097/NUR.0b013e3181cf554d
Seidl, K. L. And Newhouse, R.P. (2012). The Intersection of evidence-based practice with 5 quality improvement methodologies. JONA, 42(6), 299-304. doi: 10.1097/NNA.0b013e31824ccdc9
Smith, K., Tremblay, M.L., Richer, M.C., and Lanctot, S. (2010). Exploring nurses perceptions of organizational factors of collaborative relationships. The Health Care Manager, 29(3), 271-278. Doi:10.1097/HCM.0b013e3181e9351a
