MHI-815-INFORMATICS FOR ADVANCED PRACTICE
Module 3: Discussion
Assignment Description:
Technical Support to Healthcare: Electronic Health Records and Applications
Choose a specific evidence-based practice (examples: CLABSI prevention, Sepsis risk assessment, Vaccination schedules, etc.).
1. Discuss how technology and informatics are utilized to support the interventions of Advanced Practice Nurses?
2. Discuss how employing evidence-based practice guidelines improve patient outcomes?
3. What benefits and challenges have you experienced with the integration of information technology in your practice?
4. What strategies did you, or could you, use to overcome these challenges?
5. If you could design the “perfect” EHR to enhance and support evidence-based practice, what would you include? How would this new technology improve patient care?
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Research has shown a direct correlation between inappropriate antibiotic prescribing and the increase in antibiotic-resistant microbes (Jefferson & Fitzgerald, 2020). Evidence-based practice (EBP) dictates that antibiotics be prescribed for bacterial infections only, meaning 90% of upper respiratory infections will be treated symptomatically related to the viral cause (Jefferson & Fitzgerald, 2020). A new update to the electronic health record (EHR) system used at my clinic includes links to the most commonly prescribed medications for the patient diagnosis when the prescribing tool is accessed. This link is helpful because it provides a quick link to the most appropriate medications and visually represents your prescribing habits. The medications prescribed most for the diagnosis are at the top of the list, revealing any pattern of over-prescribing antibiotics. For instance, Azithromycin being at the top of the list of medications for an upper respiratory infection would indicate that it was the most commonly prescribed medication for that diagnosis. If this were the case, the provider would have a visual reminder of non-compliance with the EBP of antibiotic stewardship to decrease microbe resistance.
Current Centers for Disease Control and Prevention (CDC) estimations have more than 2 million antibiotic-resistant infections annually, with approximately 23,000 deaths (Jefferson & Fitzgerald, 2020). This large number of antibiotic-resistant infection-related deaths is expected to grow to 10 million by 2050 due to the unnecessary prescribing of antibiotics (Jefferson & Fitzgerald, 2020). The average length of a cough associated with a viral upper respiratory infection is 18 days (Jefferson & Fitzgerald, 2020). The EBP of antibiotic stewardship includes symptom management and delayed antibiotic use for at least ten days (Jefferson & Fitzgerald, 2020). Antibiotic stewardship will not necessarily improve patient outcomes immediately but will not worsen patient outcomes, and it will improve patient outcomes by preserving antibiotic therapy's future effectiveness (Jefferson & Fitzgerald, 2020).
Integrating information technology into practice has many benefits and challenges. One of the most notable benefits is the ease of prescribing medications without having to write or print every order and send it with the patient to the pharmacy. The prescriptions are sent electronically and filled while I get the patient's school or work note and distribute their discharge education. I also appreciate the convenience of saving standard discharge instructions for common diagnoses for quick access and printing. The biggest challenge related to integrating information technology into practice has been increased charting. Getting patients out of an urgent office promptly and closing their charts is challenging, making it necessary to return to their charts to complete their assessment documentation. I have begun documenting the assessment while speaking to the patient and educating them on treatment options and medications. This change speeds up the process but does not make the patient feel less important because I am sitting and talking to them, making them feel like they are getting more time and attention from their provider.
Most of the available EHRs are adequate. If a "perfect" EHR existed, it would have more carry-over from one area of charting to the next and less duplication. EHR users lose a lot of time charting the same information in the same chart. Another aspect that would make an EHR "perfect" would be for the system to alert the provider when a result, whether vital signs or laboratory values, is out of range and provide relevant information to possible causes and additional testing to assist with diagnosis and treatments. This aspect of the EHR would increase patient safety and improve patient outcomes by expanding the provider's focus. It would be similar to having a team of providers looking at every patient's health data. A program that includes these resources would benefit new providers by putting information at their fingertips, increasing the quality of care they deliver, and decreasing the time spent researching patient conditions. This program would also catch more obscure diagnoses.
References
Jefferson, N., & Fitzgerald, K. (2020, September). Antibiotic stewardship for treatment of acute bronchitis in retail health. Journal for Nurse Practitioners, 16(8), 608-611. doi:10.1016/j.nurpra.2020.05.005
Discuss how technology and informatics are utilized to support the interventions of Advanced Practice Nurses.
Technology and informatics are essential in today's healthcare to assist APNs in providing top-notch treatment. Electronic health records (EHRs) give APNs access to detailed patient data, allow them to record care procedures, and let them keep track of results. To ensure adherence to evidence-based recommendations for preventing Central Line-Associated Bloodstream Infections (CLABSIs), electronic health records (EHRs) give real-time data on central line insertions, maintenance, and care practices (Kleib et al., 2021). By providing warnings, reminders, and evidence-based suggestions based on the most recent research, clinical decision support systems (CDSS) further improve APNs' decision-making (Kleib et al., 2021). These tools provide APNs with current knowledge and make providing patient-centered, evidence-based treatment easier.
Discuss how employing evidence-based practice guidelines improve patient outcomes.
The results for patients are greatly improved when evidence-based practice recommendations are used. By adhering to these rules, APNs can guarantee that care is delivered based on the most significant available evidence. Standardized practices improve care quality and patient safety by eliminating variances (Melnyk & Fineout-Overholt, 2019). Following evidence-based recommendations assists APNs in lowering the prevalence of infections, which improves patient outcomes in the context of CLABSI prevention. Evidence-based recommendations consider aspects like patient preferences and the clinical knowledge of APNs, resulting in tailored care plans that meet the needs of each patient (Melnyk & Fineout-Overholt, 2019). This strategy enhances therapeutic outcomes, boosts patient happiness, and maximizes resource use.
What benefits and challenges have you experienced with integrating information technology into your practice?
The use of information technology in APN practice has many advantages. APNs are better equipped to make knowledgeable judgments and deliver prompt care because of improved access to patient data through EHRs. Secure messaging systems and other communication tools let healthcare providers collaborate, fostering coordinated and patient-centered treatment. Electronic documentation lowers the possibility of mistakes and gives a thorough overview of patients' medical histories. Technology also improves productivity and streamlines processes, giving APNs more time to focus on direct patient care (McGonigle & Mastrian, 2017). However, integrating information technology has its challenges. Some APNs could have a learning curve when adjusting to new technology, necessitating support and training. Workflow disruptions and system outages can compromise patient care. Information overload and alert fatigue may impact APNs' decision-making and cognitive load, which could result in mistakes and reduced effectiveness.
What strategies did you, or could you, use to overcome these challenges?
APNs can use several tactics to overcome the obstacles to information technology integration. To guarantee that APNs are adept at using technological systems, adequate training and instruction are crucial. Working with information technology experts can assist in solving technical problems quickly and effectively. System dependability can be increased, and downtime can be reduced with regular system updates and maintenance. APNs can concentrate on important patient information by customizing alerts and notifications inside EHRs to lessen information overload and alert fatigue.
What would you include if you could design the "perfect" EHR to enhance and support evidence-based practice? How would this new technology improve patient care?
A "perfect" EHR to enhance and promote evidence-based practice would have several essential components. The first benefit is that it would allow seamless integration with evidence-based recommendations, giving prompts and reminders based on the most recent studies. Second, it would include user-friendly interfaces that simplify navigation and documentation. The EHR would promote interoperability to facilitate seamless information transmission among healthcare professionals and care settings. It would consist of decision-support tools made specifically for the practice areas of APNs, including advice based on research at the point of care. Thanks to the system's robust data analytics capabilities, APNs could continually track and evaluate results, spot trends, and make data-driven decisions to enhance patient care.
References
Klein, M., Chauvette, A., Furlong, K., Nagle, L., Slater, L., & McCloskey, R. (2021). Approaches for defining and assessing nursing informatics competencies: A scoping review. JBI Evidence Synthesis, 19(4), 794–841.
McGonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge. Jones & Bartlett Learning.
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice. LWW.
