Informatics Ch. 15 Informatics Tools to Promote Patient Safety and Clinical Outcomes

Smart Room Technology

RFID tag on employee name badge announces to the patient on a monitor exactly who has entered the room and triggers need to know data by caregiver status to be displayed on the monitor in the room clinicians review patient data in real time and chart at the bedside using touch screen technology alert clinicians as they enter the room about procedures that need to be implemented for the patient and can track individual clinical efficiency and effectiveness by aggregating data over time

Key Features of a Safety Culture

acknowledgment of the high risk nature of an organization's activities and the determination to achieve consistently safe operations blame free environment where individuals are able to report errors or near misses without fear of reprimand or punishment encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems organizational commitment of resources to address safety concerns

Strategies to Improve Alarm Response

adding voice over internet protocol phones carried by all nurses that wirelessly receives alarms from technology equipment thus reducing response time to alarms feeding alarm data into reporting database for further analysis encouraging nurses to round with physicians to provide input into alarm parameters

Medication Administration Cycle

assessment of need ordering dispensing distribution administration evaluation human error factors (distractions, unclear thinking, lack of knowledge, short staffing, and fatigue)

Just Culture

blame free environment to encourage error reporting system or process issues that lead to unsafe behaviors and errors are addressed by changing practices or work flows processes clear message is communicated that reckless behaviors are not tolerated

Patient Monitoring Technologies

body area networks or patient area networks provide the ability to wear a small unobtrusive monitor that collects and transmits physiologic data via a cell phone to a server for clinician review wireless chip on a disposable band aid with a 5-7 day battery promises to be able to monitor the patient's heart rate and electrocardiogram, blood glucose, blood pH, and blood pressure, allowing for the collection of important clinical data outside the hospital

eMedonline

collects patient medication compliance data by scanning package barcodes or radio frequency identifier (RFID) medication tags and using personal digital assistant PDA or smart phone technology to send compliance data to the server

Smart Pump Technology

designed for safe administration of high hazard drugs and to reduce adverse drug events during IV medication administration software is programmed to reflect the facility's infusion parameters and includes a drug library that compares normal dosing rates with those programmed into the pump discrepancies generate and alarm alerting the clinician to a safety issue

Human Factors Engineering

discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments this application to system design improves ease of use, system performance and reliability, and user satisfaction, while reducing operational errors, operator stress, training requirements, user fatigue, and product liability

Informatics Nurse Specialist Role

ensure that the technology systems are properly configured and maintained routinely monitor and check these systems while making sure that their human potential, the users, are capable of using the systems accurately to avoid errors must be involved in all stages of the system development life cycle with a focus on safety, safety concerns and remedies need to be analyzed, synthesized, and integrated throughout the SDLC to have a robust tool that provides meaningful information and enhances patient care while preventing errors and promoting patient safety

Clinical Decision Support (CDS)

help a clinician select an appropriate medication will ensure that the order is complete (checks for drug interactions, duplications, or allergy contradictions, the right dose and right route) provides double checks for interactions, allergies and appropriate dose orders during verification and dispensing assists with infusion pump programming issues such as incompatibilities during infusion and proper notation and dispensing when portions of a dose must be wasted assists with patient identification and current assessment parameters that may contraindicate the use of the medication at that point in time checks for interactions with foods or other medications provides patient education guidelines and printable handouts monitoring functions of the CDS provide a structured data reporting system to track side effects and adverse events across the population

Data Collection and Data Management

help to ensure quality approaches to patient health challenges based on research evidence and clinical guidelines also ensure cost effectiveness by alerting clinicians to duplicate testing orders or suggesting the most cost effective diagnostic test based on specific patient data

Just Culture Error Types

human error, risky behaviors, reckless behavior

Informatics Technologies and Safety

improve communication reduce errors and adverse events increase response time to adverse events make knowledge more accessible to clinicians asset with decisions (technology based forcing functions that direct or restrict actions or orders implemented by computer technologies (physician would need to write a full order)) provide feedback on performance

Caps of Pill Bottles

may contain RFID tags that monitor and collect data on when the bottle is opened or containing flashing time reminders when a dose is due

Alarm Fatigue

medical equipment alarms frequently and inappropriately may be related to the sensitivity of alarm parameters

Radio Frequency Identifier (RFID) Uses

patient tracking during procedures and testing or function as part of the EHR communicating pertinent information to clinicians at the bedside track medical supplies and equipment imbedded into surgical supplies to automate supply counting procedures reduce the likelihood of wrong patient, wrong site surgical procedures reducing the potential that a counterfeit medication is inadvertently introduced into the supply and providing for efficient medication recalls specialized tags can detect temperature fluctuations and thus ensure that the blood or blood product was stored at the optimum temperature for safe administration

Computerized Physician Order Entry (CPOE) Benefits

prompts warn against the possibility of drug interaction, allergy, or overdose accurate current information that helps physicians keep up with new drugs as they are introduced into the market drug specific information that eliminates confusion among drug names that sound alike improve communication between physicians and pharmacists reduced healthcare costs due to improved efficiencies

Barcode Medication Administration (BCMA)

provides a system of checks and balances to ensure medication safety nurse scans name badge thus logging in as the person responsible for medication administration patients barcode on the patients ID bracelet is scanned prompting the electronic system to pull up the medication orders bar code on each of the medications to be administered is scanned this technology checks to ensure that the 5 rights of medication administration is there

Technology Integration into Medication Administration Cycle

reduces the potential for human error by performing electronic checks, providing alerts to draw attention to potential errors, tracks performance

5 Rights of Medication Administration

right patient right time right dose right route right drug

Failure Modes and Effects Analysis (FMEA)

systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change

Promoting a Safety Culture

teamwork training, executive walk arounds, and unit based safety teams have improved perceptions but have not demonstrated a significant reduction in error rates IHI strategies include appointing a safety champion for every unit, creating an adverse event response team and reenacting or simulating adverse events to better understand the organizational or procedural processes that failed

Reckless Behavior

total disregard for established policies and procedures enact zero tolerance policy, disciplinary measures

Smart Inhalers

track asthma medication compliance using a microprocessor that records and stores medication compliance

Human Error

unintentional mistakes perform FMEA to understand error

SIMpill Medication Adherence System

uses web based technology to monitor patient compliance and provide reminders about taking medications or to refill prescriptions by sending text messages to the patient or caregivers

Technology in the Pharmacy

verifying function is computer based and the medication order is electronically checked via the knowledge database allergy verification and medication reconciliation with other drugs already in use barcode medication labeling or RFID technology assists with dispensing and administration automated dispensing machines store, dispense, control, and track

Risky Behaviors

work arounds or cutting corners examine workflow, educate

Most Frequent Safety Issues

wrong site surgery hospital acquired infections falls hospital readmissions diagnostic error medication errors many can be prevented or early detected using informatics technologies