Question

Evidence-based Practice and Informatics Integration in Nursing Practice

The patient has been in the U.S. for 7 months now for Africa and knows some of the English languages. The patient is postpartum and her husband just sat there on his phone while his wife is bleeding! Her vital signs are 90/50 temp. 99 F, O2 94%. resp. 24. Her risk factors in Fatime Sanogo's case that could have led to postpartum hemorrhage are A large baby, large 2nd-degree laceration, use of Oxytocin, prolonged labor Think through the scenario with Fatime Sanogo and consider the communication gaps in relation to technology, evidence-based practices that were implemented, and the application of technology and information. There is no specific quantity of words or pages for the assignment; be sure to comprehensively address each component. Steps to decrease bleeding, and preventing shock. Bolusing of fluids as well as contacting the physician for additional medications. If there is large blood loss and the patient is showing signs of shock a rapid response should be called and the patient transferred. The physician's order is to check for bleeding every 4 hours and lochia, Give Butorphanol tartrate 2mg IV PRN for pain. Put her in a Trendelenburg position when checking Assess perineum. Administer bolus of 500ml LR over 30min for low blood pressure. Perform a straight cath if the patient having trouble urinating. Palpate the fundus. Assess bladder status. Give oxytocin 60 units in 500 mL. If pain is over 5 give 5 mg of Morphine IV. Give patient non-rebreather mask 10L.

Temp. greater 99, Heart rate below 50 and over 100, Resp. lower then 12 and higher 24, 02 is below 94%. and heavy bleeding in lochia. Call a physician if condition worsens

List the assessment findings and actions that should or should not have been initiated in the care of Fatime, and using evidence-based practice guidelines and describe reliable sources for locating evidence reports and clinical practice guidelines?

Answer 1

INTRODUCTION
Healthcare comprises directing and controlling a group of one or more people or entities for the purpose of coordinating and harmonizing that group towards accomplishing a goal.
Healthcare often encompasses the deployment and manipulation of human resources, financial resources, technological resources, and natural resources. Indian
healthcare Industry is growing at 12% annually, according to a recent report by Springboard Research. The Indian healthcare sector has started to serve customers or patients better to balance the profitable business operation and meeting social objectives. The main area of focus is to improve the service to
the end customer i.e. patients. It is observed that if substantial improvement is to be achieved over the coming decade, then
automation of clinical, financial, and administrative transactions is essential to improve the quality, preventing errors, enhancing consumer confidence and improving efficiency in the health care system.

INFORMATION TECHNOLOGY
Information Technology (IT) has the potential to improve the quality, safety, and efficiency of health care. Delivering quality health care require providers and patients to integrate complex information from many different sources. By increasing the ability of physicians, nurses, clinical technicians, and others to
readily access and use the right information about their patients should improve care. The ability for patients to obtain information to better manage their condition and to
communicate with the health system can also improve the efficiency and quality of care. IT allows healthcare providers to collect, store, retrieve, and transfer informationelectronically.
To capture the role of informal interactions in the process of knowledge diffusion, physicians relies on the recommendations of colleagues with whom they interact on a day-to-day basis.
Colleague recommendations are helpful because they can link specific treatments to the clinical needs of particular patients
under a physician’s care, but these recommendations are not sufficient to resolve the problem of information overload. After
all, physicians making recommendations have limits on their own cognitive abilities and these limits will generally make it hard for them to keep abreast of all the newest procedures. For
this reason, physicians will also have to devote time to independent reading in medical journals. Reading journal
articles may expose the physician to the newest innovations, but journal articles do not identify for physician the specific patients for which the innovation applies. The influence of IT enabled decision support follows naturally in this set-up. In comparison to traditional learning modalities (colleagues’
recommendations and independent reading of medical journals), the computer based decision support tools are more likely to
suggest treatments that are both new and relevant to the care of a specific patient. As a result, the new information technology
will have greater influence on physicians and under plausible conditions, enhance the rate of diffusion of new knowledge.
IT enable doctors, paramedics, patients, insurers and regulators everywhere to become aware of new information quickly. A
remarkable feature of IT is its capacity to establish and disseminate publicly accessible global databases of prices of healthcare commodities and services. The core role of IT in healthcare may be understood from the way designs of healthcare development and delivery enabled and supported by
IT include or exclude people and encourage or discourage their participation in influencing decisions about allocation of
healthcare resources. Participation is a vital aspect of healthcare because health consumption requires participation in
its production at every level starting from individual persons (diet, hygiene, lifestyle, belief and trust in one or more medical
systems) to communities (safety, pollution control, sanitation, public hygiene), and nations (healthcare standards, budgetary
allocations, medical education).
Need for IT in Healthcare
Following points discuss the need of IT in healthcare :

i. The challenge in the 21st century is a surplus of patient
information. The human brain, even a physician's brain, cannot
keep up with the exponential growth in medical knowledge that
will occur in forthcoming years.
ii. The ability of human to memorize things has remained flat,
but the medical knowledge that needs to be assimilated is
increasing geometrically. It is difficult for the human brain to
memorize all the information at a given period of time. With
the help of computer we can store massive amount of data and
can retrieve it when required. Rapid technology advancements
and continuous increase in performance/price indexes have
made information technology (IT) applicable at all levels in
health care organizations and patient management.
iii. It is difficult for physicians to keep up with the rapidly
changing state of medical knowledge and to understand what
these changes mean for the treatment of specific patients. In
such situation IT based decision support system could help doctors to learn about new treatments. iv. Health Information Technology (Health IT) allows
comprehensive management of medical information and its
secure exchange between healthcare consumers and
providers.[4]
IT TOOLS IN HEALTHCARE
Today number of tools exist and are being developed to help
health information technology (IT) stakeholders to plan for and
to evaluate health IT. Health IT programs serve to bring it to
individual stakeholders such as providers, patients, hospitals,
pharmacists, and others in this industry. These Health IT tools
support in specific areas and promote better, more efficient
healthcare through the use of today's technologies. Commonly
used health IT tools are discussed below :
I. Electronic Medical Records (EMR) : The EMR provides a
clinician with real-time access to patient information, such as
patients medical condition, visits to health providers, images
and reports of diagnostic procedures, schedule of services ,allergies and contact information to caregivers and a complete
longitudinal record of care evidence based on decision support
tools that can be used to aid clinicians in decision making. A
fully integrated EMR enables a physician to update clinical and
other information about a patient on a continuous basis. The
EMR can automate and streamline a clinician's workflow,
ensuring that all clinical information is communicated .The
EMR can support the collection of data for uses such as billing,
quality management, outcome reporting, public health disease
surveillance and reporting. Electronic document has
tremendous advantages over the paper document such as it
does not require a warehouse for storage and is readily
accessible from anywhere.
II. Clinical Decision Support (CDS) :
CDS encompasses computerized alerts and reminders to care
providers and patients, clinical guidelines, condition-focused
order sets, patient data reports and summaries, diagnostic
support, and other tools that enhance decision making in
clinical workflow. CDS provide clinicians, staff and patients
with knowledge and person-specific information, presented at
appropriate times to enhance health and health care. CDS has
the potential to increase adherence to clinical guidelines,
protocols and best practices which helps to avoid medication
errors, and to prevent complications. CDS requires
computable biomedical knowledge, person-specific data, and a
reasoning or inferencing mechanism that combines knowledge
and data to generate “advice” to clinicians.
III. Computerized Physician Order Entry (CPOE) : CPOE
is used by physicians for ordering medications, orders for xrays and other diagnostic procedures, referrals, discharges, and
transfers. One important higher-level application in CPOE is
that providers write orders including prescriptions using
computers. Computerization of ordering is important because
most actions in health care follows an order.
IV. Electronic Prescribing (E-prescribing ): E-prescribing is
the transmission, using electronic media of prescription
between a prescriber, dispenser, pharmacy manager, either
directly or through an intermediary, including an e-prescribing
network. E-prescribing includes, two-way transmissions
between the point of care and the dispenser. It is
recommended that electronic prescription applications should
be robust enough to include safety checks for allergies, drugdrug interaction warning, dose appropriateness, drug-clinical
condition warning, and drug-laboratory alerts.
V. Health Information Exchange : It is the electronic
connectivity via internet and other networks that enables health
care providers to exchange patient health information. It is
necessary that the networks that permit electronic
communication among providers must be secure in order to
safeguard the information from unauthorized access, use and
disclosure. It requires to develop data and messaging standards
to establish the critical goal of interoperability to communicate
with one another.
VI. Personal Health Record (PHR) : PHR is an electronic
application through which individuals can maintain and
manage their health information in a private, secure, and
confidential environment. The most salient feature of PHR,
and the one that distinguishes it from the EMR and EHR, is
that information it contains is under the control of individual.
The individual is distinctively the guardian of information
stored who can decide what volume of information to include,
how it is maintained and ordered, and who to read them or
“check them out.” It is necessary to decide standards and policy
to determine how individuals can delete or modify information
in a PHR that originated from an EHR and how these
modifications are communicated to other providers with whom
the data in the PHR are shared. Significant sources may include
health care providers, medical devices, individuals, health
insurers, research institutes etc.
VII. Remote Monitoring : Remote monitoring is the
electronic transmission of health care data either entered
directly by a patient (or his/her caregiver) or through a medical
device to a clinician’s Electronic Health Record (EHR) or a Patient’s Personal Health Record (PHR). The ability for a
clinician to monitor patient information about diagnostic,
medication tracking, and activities of daily living (ADL)
measurements, captured remotely is a key enabler for the
management of chronic health problems and management of
new conditions. Remote monitoring could include physiologic
measurements (e.g., weight, blood pressure, heart rate and
rhythm, pulse oximetry, glucose), diagnostic measurements,
medication tracking ,device information (e.g., medication
pumps, infusion devices, electronic pillboxes), and activities of
daily living measurements (e.g., ADL biosensors, pedometers,
sleep actigraphy etc). [10]
VIII. Telehealth/Telemedicine : Telehealth is the use of
telecommunication technologies to deliver health-related
services and information that support patient care,
administrative activities, health education, health services and
information over distances. It is a new method of delivering
health care by sharing/exchanging the patient related data and
medical opinion between medical specialist and a doctor in a
remote location through telecommunication networks. The
technology is a means to improve access to care, while
reducing cost of transportation and increasing convenience to
patients care. Tele-homecare, video-conferencing and
electronic health records are all components of telehealth and
use information technology in delivering their service. It can
source expertise within seconds any where and effectively
mediates the diagnostic shortages and surplus.
IX. Home monitoring of Patients : Due to the institutional
healthcare costs escalating worldwide, IT can be applied to
home monitoring of patients particularly the chronic sick aged
patients. In one project, a system which is linked to the home
telephone can measure ,collect and record information about
ECG, blood pressure and body temperature of the patient with
cardiovascular problems at home. The telephone is modified to
hold an IC memory card and multifunction such as simple
character and picture processing functions. The collected
information is sent from the patient’s home to the medical
facilities by using online facility to the physician..

X. Clinical Data Processing (CDP) : Clinical data processing
is used for patient monitoring. Often patients have to be
monitored continuously (for ECG monitoring) or
periodically(monitoring of vital signs) . These monitoring
processes may be done for diagnostic purposes in emergency
room, for therapeutic purposes in the operating theatre or for
surveillance purposes in the ICU. By automating the
monitoring process , manpower cost can be saved as more
nursing time can be freed from recording observations for
patient care activities.
4.0 PRIVACY AND SECURITY IN HEALTHCARE
INFORMATION TECHNOLOGY
In health care, accurate and complete information about
individuals is critical to provide high quality and coordinated
care. When physician adopt new health IT to enhance the
quality and efficiency of care in his practice, it is necessary to
reassess health information security policies. Information
security is achieved by ensuring the confidentiality, integrity,
and availability of information.
When physician assess health IT environment, then there may
be situations that may lead to unauthorized access, use,
disclosure, disruption, modification or destruction of electronic
health information To mitigate each risk , physician should implement the
important steps in his practice such as : [5]
i)Review existing health information security policies and
develop new policy statements to address new risks to
electronic health information. These new policy statements
could require the use of certain technology i.e. encryption of
data on mobile computing equipment such as laptops .
ii)Refine who is authorized to view and administer electronic
health information, or clarify and improve how and when
electronic health information is provided to patients or other
health care entities.
iii)Apply updated health information security policies into the
practice to mitigate new risks to electronic health information.
iv)Follow administrative, physical and technical safeguards in
the practice.[9]
5.0 QUALITY AND HEALTH INFORMATION
TECHNOLOGY
A New Health Care System for the 21st Century, emphasized
the need for improvement in six key areas: safety,
effectiveness, responsiveness to patients, timeliness, efficiency,
and equity. A growing number of published studies suggest that
IT can play a key role in improving the quality of care in each
of these areas. In the area of safety, CPOE systems with
decision support functions can reduce errors in drug
prescription and doses. Clinical decision support
systems(CDSS) have been shown to improve efficiency by reducing redundant lab tests. IT can also improve the
effectiveness of care by promoting compliance with clinical
practice guidelines. Real-time access to specialty information,
including consultations between rural physicians and leading
specialists at academic medical centers, help to promote an
equitable health care system by reducing the geographic
variability in access to the best quality care. The secure
transmission of patient information among physicians will
significantly improve the coordination of care. Quality
healthcare relies on physicians, nurses, patients and their
families, and others having the right information at the right
time and using it to make the right decisions. [6]
6.0 CURRENT STATUS OF IT IN HEALTHCARE
The degree of use of IT in healthcare varies by health care
setting. IT and the internet had a significant impact on
consumers. Numerous websites have made health information
available to patients, thereby strengthening their role in care
decisions. Now a days some technologies are emerging in
healthcare such as Clinical Data Warehouse, Clinical Decision
Support Systems (CDS), Data-mining Techniques, Online
Analytical Processing (OLAP) and Online Transactional
Processing (OLTP). These technologies are used to maintain
and utilize patient data intelligently , based on the user’s
requirements. Information systems are used to educate patients
about the latest developments in medical science through the
internet and specially configured kiosks in hospitals and
clinics [9] .
7.0 CONCLUSION
With the help of IT, it is possible to transform health care and
improve patient safety by better leveraging information
technology to improve the efficiency, accuracy, and
effectiveness of health care system.. Implementing and
supporting IT applications require skills, hence physicians must
make significant changes to both office and physician
workflow and take time away to learn how to use IT. Health
care administrators and planners should take a long term view
because the benefits will not be immediately tangible. In India
today healthcare is inefficient, error-prone, and of variable
quality. Hospitals are slowly moving towards clinical
information systems, which helps them to lower their cost, to
raise the quality and to improve their cash flow. [8]
8.0 FUTURE SCOPE
Information technology has the potential to substantially
improve healthcare by bringing decision support to the point of
care, by providing vital links and by allowing routine quality
measurement to become reality. Healthcare IT market is fastest
growing where the hospitals across the country are leveraging
the power of IT to provide the best of healthcare services.
Health IT may be especially beneficial for inner-city and rural
populations and other medically underserved areas. It is
necessary that latest IT technologies in healthcare centre that
are available in urban population to be made available to rural
areas of India. Rural users can access information by
connecting block headquarters to fiber optic network, using
wireless technology to achieve last mile connectivity.
Achieving this potential will be challenging task, but it is
possible.