Assignment: Integrating Nursing Science

reply to ANDREA JOHNSON
Nursing informatics has expanded over the years, but integrates nursing science, computer science, and information science to manage and store data, information, knowledge, and wisdom in nursing practice (Finkelman & Kenner, 2016). The importance of informatics is that it can lead to safe and quality care measures. This does not mean that the use of informatics is perfected, but a consistent work in progress. Nurses all know how frustrated it can be when technology systems malfunction or fail to work properly. In these times, nurses need to remember that flexibility and versatility is the essence of our profession.

Assignment: Integrating Nursing Science

Nursing informatics has greatly impacted my area of daily nursing practice. First, the electronic medical record (EMR) has definitely been a positive innovative use of informatics in my area. I have been in nursing long enough to remember the horrendous paper charting, so I wholeheartedly embraced the EMR. A typical day in vascular access starts with a review of current orders. This review involves a thorough search of the EMR to determine the patients medical/surgical history, current diagnosis, pertinent laboratory data including renal function, and indication for line placement. The EMR is also reviewed to determine what IV medications and drips are ordered for the patient. This information is readily accessible and allows for easy access of a quick overview of the patient prior to determining line necessity. Some advantages of EMR include quick accessibility, reduction in medication errors, efficiency, coordination and safer care, and reduction in cost (“Advantages of Electronic,” 2014).
Another use of informatics in my daily practice is the 3CG tip location device for PICC placements. This innovative technology is a tracking device that sits on the patients chest during line placement, and actually tracks the PICC as it is being inserted. This technology is beneficial because it serves as tip confirmation, and keeps the patient from having to have a chest x-ray post PICC placement. Instead, the patients external and internal cardiac rhythm are visualized and compared, specifically the P wave. As the PICC gets closer to the desired location, the P wave will peak. When the P wave is peaked to its highest point, without negative deflection, the tip is sitting in the optimal position of the cavo-atrial junction. This technology allows the nurse to be able to use the line immediately after placement, and keeps the patient from having excessive radiation exposure.
Another use of informatics in my daily practice is radiology software, such as Centricity and the PACs system. PACS stands for picture archiving and communication system, and is used to store and distribute medical images such as CTs, MRIs, and X-rays (McGonigle & Mastrian, 2011). This allows for reviewing of any previous chest x-rays prior to line placement, to prepare for accurate measuring and trimming of the PICC. The superior vena cava is assessed on chest films, as well as the identification of pacemakers, AICD placements, axillary lymph node dissection clips, mastectomies, and other vascular access lines such as permcaths and central lines. This is beneficial and makes the vascular nurse aware of any contraindications for specific arms or PICC placement in general. This information is sometimes not readily available or accessible from reviewing the EMR.
There is some room for improvement when it comes to the use of informatics tools and techniques. The current use of the EMR and clinical documentation system used in our facility is Meditech. In my opinion, this system is poorly designed and out dated. There is redundant documentation that has to be completed, as well as additional key strokes for maneuvering. This slows the documentation process, and takes away from patient care. Improvement would focus on a more user friendly documentation system without repetitive steps. Another innovative idea for improvement in my area would be an information software system that integrated current infusion guidelines, standards of practice, contraindications, and precautions for line placements. This information that has to be collected is gathered from multiple sources, and many different places. It would be nice to have all of these guidelines for practice in one accessible location.
REPLY TO ASHLIE BRACKIN Informatics in nursing is so multifaceted. With technology changing daily, it is difficult to stay up to date on the changes that occur so often. The way healthcare is delivered to our patients has been strongly influenced by the changes in the technology and informatics that have become part of our daily lives. Informatics has opened so many doors to many advanced methods of communication between all disciplinarians involved in the patient care.
There are many ways informatics impact the daily practice of nurses. Electronic medical record is one of the biggest ways informatics have impacted nurses. This is a record of the patients history and assessments, orders, laboratory results, description of medical tests and procedures, documentations of the provided care and outcomes. This information can be viewed by all disciplinarians involved in the patients care so that the line of communication between each are open. The second being automated dispensing of medications, most hospitals call these devices Omnicells. These devices allow the nurses to have access to only medications that have been ordered for each individual patient. This has been seen to help reduce the number of medication errors. Thirdly, bar code scanning. Bar code scanning is also used when distributing medications to the patients. The bar code scanner is used to identify the correct patient with the correct medications being administered.
These three examples of informatics are very important to the care of patients because it helps the patient receive the best quality of care and most up to date care possible. It assist in lowering the occurrences of medication errors and helps communication between on disciplinarians involved in the patients care.
There are ways to improve the use of informatics tools and techniques. The electronic medical record (EMR) needs to be user friendly. Education to staff in changes of the EMR are a necessity. Education to staff on where to find certain information that could be beneficially to the patients care is also a necessity. Bar code scanning by nurses are sometimes used inappropriately. Some nurses do place an extra patient arm band under their key pad and scan the arm band on their cart rather than the arm band on the patient. This could potentially cause medication errors.

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