ATENEO DE NAGA UNIVERSITY

College of Nursing
Nursing Informatics
S/Y 2019-2020

CHAPTER SUMMARY

Submitted by:

JENNY ROSE T. ANIETE

RR22

Submitted to:

DENNIS A. LOCSIN, RN, MN, MAN

Clinical Instructor

Chapter 23:
Nursing Informatics
Chapter Summary

Structuring Advanced Practice Knowledge: An Internet Resource for Education and

Practice

Improving Health and Healthcare Through Nursing

● Advanced practice nurses manage information.
● Information comes in many shapes. One form revolves about initiatives aimed at improving
health and healthcare through nursing.
● Much of informatics involves reflection.
● While informatics may begin with reflection, it doesn't end with reflection.
● Structuring also occurs when we recognize or name clusters within actual or mathematically
imposed space.
● Finally, we structure knowledge when we look at its various dimensions

➔ Input - refers to structural, financial, human, or technical resources.

➔ Activities - tasks or processes employed to produce output.
➔ Output - the end products of the activities, whether on or off target.
➔ Outcomes - the intermediate effects of the activities.
➔ Sustained Impact - refers to macro numbers e.g, institutional, healthcare system, state or
national effects in terms of decline in sepsis-related mortality rates and costs.

The DNP student is introduced to, is immersed in, and progresses through an advanced
practice program of learning.
Nursing Informatics
Chapter Summary

Knowledge Structures Facilitate the Creation of Advanced Practice Internet Database

● Healthcare Technology Domain

- Informatics
- Health technology, research, development and entrepreneurship

● Organizational Science Domain

- Epidemiology and Biostatistics
- Healthcare Policy
- Leadership
- Ethics and Care Delivery Systems
- Organizational Climate

● Advanced Nursing Science and Practice Domain

- The content of this domain is central to advanced practice and to DNP programs
nationwide.

Chapter 26:
Foundation of a Nursing Plan of Care Standard

Background
Nursing Informatics
Chapter Summary

A Nursing Special Interest Group (SIG) was initiated in 2006 within the Integrating the Healthcare
Enterprise (IHE), an International Standards Development Organization, to reflect the importance of
communication integrity and continuum of care during patient/client transfers.

Introduction:
Federal Initiatives
● The federal government began to focus on computer-based healthcare technology with the
Institute of Medicine (IOM) report on the Computer-based Patient Record.
● The ONC mandated the American National Standards Institute (ANSI) establish a strategy for
reviewing and recommending healthcare technology standards.
● Nurses noted most terminology standards in hospitals were used for the reimbursement of
medical services and terminology used for the documentation of the patient care processes
performed by the nurses was overlooked and a missing "gap" from the national dialog.

Development of a Nursing Plan of Care

● The Nursing Plan of Care (PoC), under the name of the Coded Nursing Documentation Plan of
Care, was proposed and accepted by IHE as a New Work Item Proposal (NWIP).
● The CCC System was used repeatedly as an exemplar of structured, coded, nursing terminology.
● The Nursing PoC identified a missing and essential professional component for the electronic
documentation of nursing practice.
Meaningful Use
● Responsible for the diagnosis and treatment of patients prescribing medications, laboratory tests,
radiology procedures, other care modalities, activities and services.
1. Provide individualized patient care
2. Coordinate care with other providers
3. Provide caring practices
4. Use the nursing process
5. Provide quality healthcare and achieve optimal outcomes.
Meaningful Use Stages 1 and 2
● Stage 1 MU objectives omitted and excluded the eligible providers of patient care and/or the
caring process.
● Stage 2 MU focused on quality indicators.

How a Nursing Plan of Care Could Impact Meaningful Use

Nursing Informatics
Chapter Summary

● The Nursing PoC offered a readily available standard to summarize the quality care as part of
each Clinical Quality Measure's Description for the transition of care along the continuum of
care.

Meaningful Use Stage 3

● It is poised to identify the requirements for care coordination and sharing of information across
multiple provider groups - from long-term care and post-acute care to behavioral health and other
allied services.
● The identification and harmonization of standards for the longitudinal coordination of care will
improve efficiencies and promote collaboration by:
➔ Improving provider's workflow by enabling secure, single-point data entry for the
Transfer of Care (ToC) and Care Plan exchange including a Nursing PoC.
➔ Eliminating the large amount of time wasted in phone communication and the frustrations
and dissatisfaction of the receiving provider in not always obtaining care transition and
care planning information in a timely manner.
➔ Reducing paper and fax transmissions, and corresponding labor intensive, manual
processes during a ToC or Care Plan exchange including a Nursing PoC.
➔ Supporting the timely transition of relevant clinical information at the start of home
healthcare and as the patient's condition changes.
➔ Enabling sending and receiving provider groups to initiate and/or recommend changes to
patient interventions more promptly.

Nursing Plan of Care Framework and Nursing Process

● The nurse is required to apply nursing knowledge systematically and logically to interpret,
analyze, and use data to determine the appropriate plan of care based on knowledge of the
physical, biological, and behavioral sciences.
● The Nursing PoC using the nursing process provides a clinical decision support tool to enhance
patient care outcomes.
● The Nursing Process is the standard of practice and includes the following six phases:
assessment, diagnosis, expected outcomes, planning, implementation and evaluation.
● Other characteristics of the Nursing PoC and Nursing Process framework include:
➢ Universally Applicable
➢ Goal Oriented
➢ Cognitive Process
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Chapter Summary

Descriptions of "Other Plans of Care"

● A Nursing PoC is an information standard "blueprint" for nursing and serves nurses and allied
health professionals.
Care Planning Proponents
Health Level Seven International
● "Care planning is a conceptual framework with many interrelated dependencies and antecedents"
● "The benefit of care planning is enabling a multiprofessional care plan used by teams across
organization boundaries.
Standards and Interoperability Framework
● Another initiative to create better care, better health, and cost reduction by care delivery
improvements.
Healthcare Informatics Standard Groups
● Focused on coordinating the adoption, implementation, and use of health information technology,
including the electronic exchange of health information to achieve the Triple Aims Framework.
1. Better Care
2. Healthy People/Health Communities
3. Affordable Care
Standards and Interoperability Framework
● It was formed to enable healthcare stakeholders to improve the quality of healthcare through
greater health information exchange.
Longitudinal Coordination of Care Initiative
● It provides an infrastructure to standardize transition of care and care plan exchange across the
continuum of care.

Transitions of Care Initiative

● It improves the exchange of core clinical information among providers, patients and other
authorized entities electronically in support of meaningful use and IOM-identified needs for
improvement in the quality of care.
Chapter 29:
Health Information Technology: Striving to Improve Patient Safety

Introduction
● The first Electronic Health Record (EHR) with Computerized Provider Order Entry (CPOE) was
introduced in 1971, over 40 years ago.
● Since then, adoption of these systems in both acute and ambulatory settings has been relatively
slow until the signing of the American Reinvestment and Recovery Act (ARRA).
● The Institute of Medicine's To Err Is Human has been a driving force for improvements in patient
safety across the nation since it was published in 1999.
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Chapter Summary

National Health IT Safety Initiatives

Institute of Medicine - Health IT and Patient Safety Report
● The Office of the National Coordinator for Health Information Technology (ONC) requested that
the Institute of Medicine (IOM) form a team of experts to assess the current state of EHRs and
their ability to improve patient safety.
● The IOM panel of experts found a little published evidence to quantify the magnitude of the risk,
but believe that if designed and implemented inappropriately, EHRs could lead to unintended
adverse consequences.
● The need is to develop strategies that will standardize the reporting of health IT-related errors.

Office of the National Coordinator for Health Information Technology -Safety Plan
● ONC published their response to the IOM report in the form of the Health Information
Technology Patient Safety and Action and Surveillance Plan.
● The plan revolves around three key areas: Learning, Improving, and Leading.
● ONC plans to focus on improvement efforts which the goal is to develop resources and evidence-
based corrective actions to improve health IT safety and patient safety.
● Driving safety improvements requires leadership and the ONC spells out a number of strategies
to address the direction that needs to be supported.
● Encouraging state governments to get involved and incorporate health IT into their patient safety
oversight program is included in this plan with an emphasis on statewide adverse event reporting.

Agency for Healthcare Research and Quality-Common Formats

● AHRQ have taken a significant interest in the area of health IT over the last several years in
partnership with the ONC.
● In using the Common Formats for reporting, it is hoped that standardized aggregate data will
provide valuable analysis and trending that can lead to more focused efforts and significant
improvements in patient safety.

Food and Drug Administration

● The FDA has received several hundred thousand medical reports (MDRs) of suspected device-
associated deaths, injuries or system malfunctioning.
● The Congress enacted the Food and Drug Administration Safety and Innovation Act (FDASIA).
Nursing Informatics
Chapter Summary

● The intent is for the framework to promote innovation, protect patient safety, and avoid
regulatory duplication.

The Institute for Safe Medication Practices

● The ISMP is devoted entirely to medication error prevention and safe medication use.
● Their mission is to lead efforts to improve the medication use process.
ECRI Institute
● It is a non-profit organization, has focused on scientific research to discover the effectiveness of
medical procedures, devices, drugs, and processes, all to improve patient care.

Leapfrog Group
● It represents a coalition of healthcare purchases that has been a driving force in the improvement
of healthcare quality.
● They are strong advocates for the use of CPOE systems.

Health IT Safety Tools and Resources

● Resources for organizations to turn to for help in not only developing health IT safety strategic
plans but for assessing their current situation have been emerging over the last several years.

AHRQ's Guide to Reducing Unintended Consequences of Electronic Health Records

● It is an online resource designed to help organizations anticipate, avoid, and address problems
that can occur when implementing and using an electronic health record (EHR).
● It is to provide practical knowledge, troubleshooting tools and resources.

SAFER guides
● This consists of nine guides organized into three categories which enable healthcare organizations
to conduct self-assessment of their EHR safety in a variety of areas.
● These guides identify recommended practices to optimize the safety and safe use of EHRs.

CPOE design Checklist

Nursing Informatics
Chapter Summary

● This tool includes checklists for configuring a CPOE system and creating Pick-List, or drop-
down lists that are based on published health IT safety evidence.

Pick-List Checklist
● This can be used by all levels of informatics specialists to assess current configuration based on
the best evidence available.
● It represents a starting point for informatics specialists to evaluate and improve the systems that
care providers rely on to deliver safe patient care.

Chapter 31:
The Magnet Model

Introduction
● The nursing practice environment is being challenged to rapidly respond to internal and external
demands.
● New models of care are emerging that require empirical, evidence-based accountable care.
● The Magnet Model defines five components that when fully disseminated and enculturated
throughout an organization create professional practice environments that yield positive patient,
nurse, and organizational outcomes that yield positive patient, nurse, and organizational
outcomes.
● The five components are: transformational leadership, structured empowerment, exemplary
professional practice, new knowledge and innovation, and empirical outcomes.
Transformational Leadership
Nursing Informatics
Chapter Summary

● This is the one who develops a strong vision for the practice and creates an environment where
nurses at every level have a voice to advocate for resources, fiscal, and technology, to support
their practice.
● A strategic vision for practice that is supported by informatics promotes the development of
innovative approaches to care by improving the work of the nurse through improved access to
information and opportunities and new ways for the nurses to communicate and interact with
other providers and the patient.
● One of the sources of evidence organizations must be able to demonstrate is the work of the
nursing leader and department in strategic planning.
● For organizations to achieve successful implementation of health information technology there
must be leadership buy-in and sponsorship and engaged nurse executives.
● The role of Chief Nursing Informatics Officer (CNIO) has emerged to support and help translate
the science of informatics for all nursing roles.
● Leveraging technology to support the alignment of practice and operations will lead to more
creative and successful solutions to improve workflow, and process changes that improve
communication and care coordination to improve outcomes.

Structural Empowerment and Exemplary Professional Practice

● The voice, autonomy, and decision-making authority of direct care nurses are at the core of the
structural empowerment and exemplary professional practice components of the ANCC magnet
model.
● Magnet organizations are required to demonstrate improvements in practice settings across the
continuum that have occurred as a result of the use of data and information.
● Exemplary professional nursing practice within the magnet framework is supposed through a
professional practice model and care delivery system.
● At the core of achieving exemplary professional nursing practice is the ability to monitor care for
effectiveness by having access to data to analyze and evaluate against national benchmarks and
respond to improve.
● With the new models of care evolving to support the shift toward accountable care technology
will be a tool that can help providers coordinate care across settings with the increasing utilization
of health information exchanges.
New Knowledge, Innovation and Empirical Quality Outcomes
Nursing Informatics
Chapter Summary

● The demand for exceptional performance and continuous improvement requires Magnet
organization to integrate the current evidence into practice.
● Organizations must demonstrate activities to support research and innovation and that nurses are
involved with the design and implementation of technology to enhance the patient experience and
nursing practice.
➢ Pathway to Excellence
- The ANCC Pathway to Excellence program is a program which recognizes a
positive nurse practice environment.
➢ Exemplars in Practice
- This both highlight nursing excellence in the delivery of quality patient care.
➔ An organization established the goal of having their nurses provide
evidence-based practice more consistently.
➔ An organization developed intra-professional councils to drive IT and
changes to IT.