Informatics and Quality Improvement

A new employee at the hospital is orientating to technologies used on the floor. The new employee asks the nurse what a clinical decision support system is. What would be the nurse's best response? "It is the weekly committee that together determines solutions to client issues." "It is a computer program designed to guide human decision-making." "It is a database containing of medical knowledge and client information." "It is a special computer that makes client care decisions using algorithms."

"It is a computer program designed to guide human decision-making." A clinical decision support system is a computer program designed to guide human decision-making. It does not make the decision for the provider. It is a support tool. It also is not a database of information, a special computer, or a committee, since it is a program that can be run on multiple computers in a facility. ​

A newly hired nurse is being oriented to the different safety technologies used to provide client care. Which statement by the new nurse should be corrected by the nurse's mentor? "The technologies will prevent all errors." "These technologies will increase quality of care." "The technologies will provide a safer environment." "These technologies will help decrease errors."

"The technologies will prevent all errors." Although technology can decrease errors, provide a safer environment for clients, and increase quality of care, they are not foolproof. There is the human factor. Alerts and safety features can be worked around, ignored, and even turned off. Safety and effectiveness of technologies depends on the users.​

A hospital recently integrated a clinical decision support tool into their electronic health record (EHR). What can the staff expect to see as additions to the EHR? Alerts, reminders, guidelines, order set protocols Nursing-specific documentation forms Access to online journal articles relevant to client care Advanced order sets with nursing specific content

Alerts, reminders, guidelines, order set protocols Clinical decision support tools contain alerts, reminders, guidelines, and order set protocols to guide providers in making decisions. Forms and order sets do not support decisions and are more organizational. Clinical decision support tools are not a resource for education.

One study in an intensive care unit found that they had 187 alarms per bed per day, of which 72%-99% were false alarms (Drew et al., 2014). How could this unit use technology to combat alert fatigue? Increase the decibels on all alarms from 70 dB to 90 dB Install flashing colors that correspond to each of the types of alarms Hire more staff to attend to the alarms Changing the default alarm settings to settings based on each client's condition

Changing the default alarm settings to settings based on each client's condition Since all client's are unique, tailoring alarm signals of devices to each client's needs can reduce the number of false alarms and therefore, reducing the total number of alarms. Increasing the decibels or using flashing colors will cause more sensory overload. Hiring more staff is expensive and does not combat the alert fatigue.

What are key components in error management and prevention in healthcare? Select all that apply. Discuss incident with those involved Collection of data surrounding incidents Analyzing incident data Standardized responses to incidents Reporting of incidents

Collection of data surrounding incidents Analyzing incident data Standardized responses to incidents Reporting of incidents ------------------------- Incident reporting systems should include a standardized reporting template, standardized responses, prompt identification of serious events and details, and automation of data entry and analysis. Discussing the incident with those involved is not needed if the reporting system is thorough. ​

Clinical decision support (CDS) encompasses a variety of technological tools that directly support clinical decisions across settings. Which of the following are an examples of CDS? Select all that apply. Automatic order implementation Condition-specific guidelines, order sets, care plans, and protocols Event-driven alerts and reminders Real-time monitors and dashboards Smart documentation forms and templates

Condition-specific guidelines, order sets, care plans, and protocols Event-driven alerts and reminders Real-time monitors and dashboards Smart documentation forms and templates --------------- CDS encompasses a variety of technological tools that directly support clinical decisions across settings including:​ Immediate warning alerts for clients and providers ​ Event-driven alerts and reminders ​ Parameter guidance for providers ​ Real-time monitors and dashboards ​ Condition-specific guidelines, order sets, care plans, and protocols ​ Smart documentation forms and templates ​ CDS architectures that influence design, implementation, and adoption​ It provides order implementation support for a provider but not the automatic initiation of orders. ​​

The hospital moved from paper incident reporting to electronic. Data was collected and a committee was organized to review the data and produce ideas on how to prevent "never events". Which solutions would reduce medical errors? Use data to track individuals involved in "never events". Report all never events to a national organization. Conduct webinars for providers on safety concerns. Provide strict consequences for violations.

Conduct webinars for providers on safety concerns. Information technology can help providers to use data obtained, apply the knowledge gained, and reduce the rates of medical errors and never events by preventing adverse events and errors through webinars, online meetings, conferences, or classes for healthcare providers. Incident reporting is not to punish or track those involved. Sentinel events are sometimes reported to organizations depending on their nature but the reporting itself does not reduce errors. It is the response to the reports that do. ​

How does color-coding call buttons increase the quality of care for clients? Select all that apply. Creates severity levels Increases specificity of alarms Decreases number of emergencies Decreases false alarms Increases frequency of alarms

Creates severity level Increases specificity of alarms Decreases false alarms -------------------- Adding color to alarms helps distinguish between the types and severity of alarms, so staff are more prepared to answer. Making alarms user friendly also decreases false alerts as clients are more apt to select the correct one. It does not decrease the number of emergencies or increase the frequency of alarms. Color-coding is used to decrease alarm fatigue. ​

The nurse retrieves medication through an automated medication dispensing system. How does an automated medication dispensing system increase the quality of care? Decreases medication errors Reduces intravenous (IV) pump programming errors Eliminates adverse drug reactions Eliminates client misidentification

Decreases medication errors The use of an automated medication dispensing system decreases medication errors. It does not eliminate adverse drug reactions or identification errors, since providers still need to go through the medication administration checks at the bedside. It also does not reduce IV pump programming errors. This alert would be part of a smart pump. ​

A local hospital has high rates of adverse drug reactions. What technologies could be utilized to decrease these rates? Select all that apply. Electronic health records Standardized incident reports Smart pumps Bar code administration Automated medication dispensing

Electronic health records Bar code administration ---------------- Electronic medical records and bar code administration will decrease adverse drug reactions by alerting to drug-drug and drug-allergy reactions. Automated medication dispensing decreases medication errors at the point of dispensing. Smart pumps reduce programming errors. Standardized incident reports help identify quality issues, but the actual reports do not decrease rates.

How does technology promote a culture of safety? Clinical decision support systems determine consequences Databases track who has been involved in unsafe acts Video surveillance catches perpetrators Electronic incident reports improve reporting rates

Electronic incident reports improve reporting rates A culture of safety is where all employees are committed to being safe, whether or not someone is watching. It is not about punishing unsafe acts or catching perpetrators. Technology can be used to improve reporting rates of incidents, allowing organizations to identify issues and respond with solutions to improve quality and safety.

A local clinic had a low rate of reported safety issues. After instituting an electronic incident reporting form, the rates went up. What is the most likely reason for the increase in incident reports? The clinical staff were more careless. It was more difficult to access safety information. It was easier for staff to access and fill out forms. The clinical staff did not understand the reporting process.

It was easier for staff to access and fill out forms. Studies have shown that organizations that moved to an electronic reporting system have an increased rate of reporting frequency. It does not mean the staff were more careless. It means that reporting was easier, so staff were more likely to do it. Information is easier to access and the process is easier to understand.

The nurse scans bar codes of the client's wristband and the medication. An alert comes up on the computer of a potential drug-allergy interaction. This is an example of which type of clinical decision support? Workflow Support Expert Systems Point-of-Care Order Implementation​

Point-of-Care Point-of-Care alerts include drug-condition interaction reminders​​, drug-drug interaction​​, drug-allergy interactions​​, plan-of-care alerts​​, and high-risk state monitoring​. Order implementation assists providers with order sets and protocols. Expert systems offer support for labs, equipment, and tools. Workflow support provides templates and documentation support. ​

The nurse is using a smart pump in the emergency room. How does a smart pump increase the quality of care? Eliminates client misidentification Reduces programming errors Eliminates medication errors Decreases adverse drug reactions

Reduces programming errors The use of smart pumps reduces programming errors. It does not eliminate medication or identification errors, since providers still need to go through the medication administration checks. It also does not decrease adverse drug reactions. This alert would be part of medication administration. ​

Which of these sentinel events, or "never events," could technology prevent? Staff injury associated with a burn Staff death or serious disability associated with an electric shock Surgery or other invasive procedure performed on the wrong client Significant injury of a staff member resulting from a physical assault

Surgery or other invasive procedure performed on the wrong client Identification errors can be prevented using a bar code system or other technology coded system where the procedure or medication is "matched" with the correct client. It is difficult for current technology to prevent spontaneous accidents or situations. ​

What is the main reason staff and providers bypass the safety features of technology? They do not understand the safety features. They do not care. The safety features are annoying. They want to save time.

They want to save time. The main reason safety features are bypassed is the misconception that they save time. Staff are busy in healthcare and alarms sometimes seem like a waste of time. Providers that care and understand why the alarms exist still bypass them. Although some view alerts as annoying, this is not the main reason cited for bypassing them in activity volume-based care to value-based care.