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Informatics in Large Health Systems: Organization, Transformation and Nursing Informatics Leadership Perspectives
Published in Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber, Deborah Trautman, Kedar Mate, Howard Catton, Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition, Book 1, 2022
Sheila Ochylski, Rebecca Freeman
Within VA, nurse informaticists have a long legacy of innovation to define and use data to build knowledge within the nursing domain (Deckro et al., 2021). The legacy began in the 1970s with the innovative efforts to create the Computerized Patient Record System (CPRS) and again in the 1990s with the development of the Bar Code Medication Administration (BCMA) application. This program has become the hallmark for current medication administration records (Brown et al., 2003). In the 1990s, CPRS was released, and clinical application coordinator (CAC) roles emerged within nursing informatics to support it as client-server programming within a graphical user interface (GUI). Nursing informaticists in the Veterans Health Administration (VHA), the healthcare division within VA, have been instrumental in improving, supporting and informing both CPRS, clinical information systems and BCMA across the VHA system development life cycle. Nursing informaticists within VHA continue to evolve and build upon these foundational nursing informatics strategies to seek opportunities to provide excellence in patient care to our nation's Veterans and their families. Today in VHA, there are over 500 nurses with an informatics specialty who have graduated from university-based training programs are certified in the specialty of nursing informatics.
Leveraging a Unique Nurse Identifier to Improve Outcomes
Published in Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber, Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition, Book 4, 2022
Whende M. Carroll, Joyce Sensmeier
For several decades, nurse leaders have recognized the need for the use of a unique nurse identifier, without which the aggregation and use of data to improve nursing practice is not possible (Werley & Lang, 1988). Ingesting and manipulating the data points in technology systems associated with a unique nurse identifier enable the transparency of time, cost and the human resources needed to provide patient care. Different unique identifiers track and classify nursing services for billing, staffing and resource planning purposes. Robust nursing data analysis makes visible to health leaders and decision-makers the direct value of nurses' contributions in all care settings. The challenge of measuring nursing value is that intangible assets are generally unquantifiable. With the now-common use of EHRs, point-of-care documentation data make it possible to quantify clinical and administrative services. Also, other complementary technology systems used in patient care can capture the nurse's ID and feed it into their systems to measure nursing value. These systems may include intelligent IV pumps, single sign-in logins with the use of badges, bar code medication administration and point-of-care test devices that require unique user codes.
Nursing Education and Digital Health Strategies
Published in Connie White Delaney, Charlotte A. Weaver, Joyce Sensmeier, Lisiane Pruinelli, Patrick Weber, Deborah Trautman, Kedar Mate, Howard Catton, Nursing and Informatics for the 21st Century – Embracing a Digital World, 3rd Edition, Book 2, 2022
Nurses are key to this digital health evolution as nurses comprise approximately 30% of the healthcare professional workforce. Nurses are engaged across the spectrum of care from the home to the acute care system, to long-term care, to the community and out to the population. Nurses work in all segments of the healthcare sector and in roles as varied as direct care, advanced practice, education, research and policymaking (Schur, 2020). All nurses who provide care, expertise and compassion to patients, communities or populations do their work using a variety of technologies to (1) enter data collected during assessment, (2) develop information from which to make decisions, and (3) to form knowledge from information and experiences. Most often this is accomplished not with paper and pencil but while using some type of information technology as a matter of routine business. All nurses engage with digital health tools daily. They need to be competent and confident to use these tools to change the system. Nurses use informatics processes and a variety of information technologies during every shift of every workday without considering the complexity of these processes or the ubiquitous nature of the information systems and digital health tools all around them. Nurses use information systems and data to formulate actions based on critical thinking using formed information and a distinct body of evidence. Nurses are often the last point of interaction between a patient and a treatment, and this decisive action often is supported and guided by technology, such as Bar Code Medication Administration systems. Some of the information systems are interacted with in an active way and some passively. The trackers that patients, clinicians and staff wear gather data on location, date and time using radiofrequency readers. Decisions are made from this passively collected data. Some of those decisions are helpful and a few can be harmful or unsafe. During this current COVID-19 pandemic, nurses use an information and communication technology tool, the tablet, to facilitate the last communications between a dying patient and their loved ones. This informatics process was developed to meet a tragic human need to connect and out of a deep concern for safety. All this is to say that nurses use information technology, the data and information contained within their related databases as a matter of course and as part of their routine work often without considering that this is informatics and that they should have a keen role in guiding the development, implementation and use of these systems and processes as we all move toward digital health.
Economic impact and chronic obstructive pulmonary disease outcomes of a comprehensive inhaler to nebulization therapy protocol implementation in a large multi-state healthcare system
Published in Current Medical Research and Opinion, 2019
Nebulized arformoterol and budesonide expenditures are shown in Table 4 and make up the majority of the post-implementation spend. Of particular interest is the fact that budesonide nebs alone accounted for approximately 50% of total overall drug expenses in both years post-implementation. Further analysis showed that at only three of the 27 campuses did budesonide nebs account for 30% or less of their total expenditures. At all the rest, budesonide made up 42% to 62% of total campus drug expenditures and this occurrence was consistent in both PY1 and PY2 and transcended small, large, urban, rural and academic hospitals in all six states. One important consideration that needs to be addressed regarding the budesonide expenditure is that 99% of this is from the unit dosed (UD) Nephron Pharmaceuticals product. This is more expensive than alternative generic manufacturers; however, this UD product is individually wrapped and barcoded which greatly maximizes shelf-life vs. non-UD products. It also avoids the need for technicians to manually barcode, so it functions with bar-code medication administration (BCMA) scanners. Having noted our high budesonide expenditures, our system has now been able to re-negotiate contracting with Nephron in 2019 to reduce the price of this product by approximately 44%. Based on annual budesonide expenditures of $1.2 million, this should further reduce annual drug costs by another $500,000 going forward vs. what is being reported for PY1 and PY2 savings.
Maximizing New Technologies to Treat Depression
Published in Issues in Mental Health Nursing, 2019
Veronica Decker, Michael Valenti, Vicki Montoya, Alla Sikorskii, Charles W. Given, Barbara A. Given
Nurses are highly aware of the use of barcode technology in the daily care of patients receiving medications. This is the electronic health record (EHR) bar code medication administration (BCMA) used in health systems to aid in mitigating medication errors (Gann, 2015). Recent studies have been conducted using a smartphone application to scan labels on prescription containers. This use of informatic technology is hoped to reduce medication errors that often occur at home, not a hospital. The application uses an optical character recognition (OCR) software program, which can send prescription information to providers, all in real time (Sarzynski et al., 2017). This is especially pertinent in fully understanding the prescribing practices of antidepressants by providers (Sanjida et al., 2016) and the efficacy and acceptability of these medications for depressed patients (Ostuzz, Benda, Costa, & Barbui, 2015).
Impact of nurse’s worked hours on medication administration near-miss error alerts
Published in Chronobiology International, 2020
Jlynn A. Westley, Jessica Peterson, Daniel Fort, Jeffrey Burton, Robert List
Capturing medication errors through self-report has limitations. Self-report relies on participants’ memory and willingness to disclose errors. Using bar-code medication administration (BCMA) information from the electronic health record (EHR) provides an opportunity to collect data that is more reliable and objective. The EHR captures the time that a patient medication is due, the time it is dispensed, and the time it is administered, allowing researchers to examine time-referenced medication errors such as dose delays (Welton et al. 2018). The purpose of the current study was to investigate the impact of nurses’ work hours on near-miss medication error alerts as captured through the BCMA system.