NURSING INFOMATICS

HOSPITAL/CRITICAL
CARE APPLICATIONS
 CRITICAL CARE NURSING
▪ Is an area of expertise
within nursing that focus
specifically with human
responses to life-
threatening problems.
 WHAT IS CRITICAL CARE?
▪ CRITICAL CARE
multidisciplinary health
care specialty that cares
for patients with acute,
life threatening illness or
injury. Data must be
accessible at the point of
care.
 CRITICAL CARE NURSE
▪ Is responsible to ensure that critically ill
patients are seriously conditioned
individuals.
▪ Ensure that families of the medically ill
patients should receive optimal care.
▪ Rely upon dedicated knowledge, skills
and experience and automated system
of support and intelligent system to
provide care to patient and families and
create environments that are healing,
compassionate and caring
CRITICAL CARE APPLICATIONS
▪ Areas where patients require complex
assessment, high-intensity medication,
continuous therapy and interventions, and
unrelenting nursing attention and continuous
watchfulness.
WHAT ARE THE TECHNOLOGY USED?

▪ Physiologic monitors including: arrhythmia

and hemodynamic monitors
▪ Mechanical ventilators
▪ CCIS (Critical Care Information System)
DEVICE CONNECTIVITY INFRASTRACTURE

▪ Aside from monitoring, devices are capable of

sending information to software applications.
▪ Medical Information Bus (MIB) is used to classify
the backbone of information exchange allowing
data to be moved from one point to another.
▪ Most Medical Devices have small
communication ports.
PHYSIOLOGICAL MONITORING SYSTEMS

▪ Physiological monitors were developed to

oversee the vital signs of the astronauts. By the
1970's these monitors found their way into the
hospital setting.
 5 BASIC PARTS OF PHYSIOLOGIC MONITORING
EQUIPMENT

▪ Sensors
▪ Signal conditioners to amplify or filter display device
(amplifier, paper recorder, oscilloscope)
▪ File to rank and order information
▪ Computer processor to analyze data and direct reports
(storage for graphic files, paper and summary reports)
▪ Evaluation or controlling component to regulate
equipment or alert the nurse (notice on display screen,
alarm signal)
 MICROPROCESSORS

▪ Physiologic signals are typically of very small amplitude and

must be amplified, conditioned and digitized by the device in in
preparation for processing by its embedded microprocessors.
▪ Analyzes information store pertinent information in specific
places, and controls the direction in reporting.
▪ Alerts nursing personnel through a report, an alarm or a visual
notice.
 PHYSIOLOGIC MONITORING
▪ Monitoring systems also store various data elements with a time stamp
derived from the monitoring system's internal clock.
▪ Physiologic monitoring systems typically have modern platform allowing
the selection of various monitoring capabilities to match the needs of a
variety of clinical settings.
▪ More specialized monitoring capabilities such as intracranial pressure or
bispectral index monitoring are also in modular format.
▪ Physiologic monitors are usually built to incorporate both arrhythmia and
hemodynamic monitoring capabilities.
 HEMODYNAMIC MONITORS
Can be used to:
▪ Measure hemodynamic parameters
▪ Closely examine cardiovascular function
▪ Evaluate cardiac pump output and volume status
▪ Recognize patterns (arrhythmia analysis) and extract features
▪ Assess vascular system integrity
▪ Evaluate the patient's physiologic response to stimuli
▪ Continuously assess respiratory gases (capnography)
▪ Continuously evaluate glucose levels Store waveforms
▪ Automatically transmit selected data to a computerized patient database
 THERMODILUTION TECHNIQUE
▪ The bolus must be injected within 4 seconds.
▪ Amount of solution must be accurate.
▪ Temperature of the solution must be measured and accurately
maintained.
▪ Catheter must be properly placed.
▪ Computer must have the appropriate computation constant.
▪ Bolus must be injected at the appropriate time in the
respiratory cycle.
WHAT DOES IT LOOK LIKE?
 HOW DOES IT WORK?
▪ The influence of these user-related issues is negated by using heat of a
thermal filament embedded in the catheter to replace the injectate.
▪ An alternative means of measuring cardiac output noninvasively if
provided by thoracic electrical bioimpedance.
▪ Four sensor are positioned on the sides of the neck and thorax.
▪ Monitoring these changes permits measurement of stroke volume:
indices of contractility such as velocity and acceleration of blood flow,
supraventricular rhythm and index.
▪ Using bioimpedance as a factor integrated with analysis of the finger
blood pressure waveform has also been demonstrated as a method of
cardiac output measurement.
 PULSE OXIMETRY
▪ A critical piece of hemodynamic information involves the
availability of oxygen to bodily tissues. the standard for
measurement of blood's oxygen saturation is coximetry.
▪ Pulse oximetry is a noninvasive method of measuring oxygen
saturation that also uses spectrophotometry.
▪ Light is emitted through a pulsatile arteriolar bed and then
detected by photosensor.
 PROBLEMS?
▪ Largest contributor to alarms in the ICU
▪ Caused by: blood pressure cuff
▪ Tourniquet
▪ Air splint that may cause venous pulsations
▪ Limits the sensors ability to distinguish between arterial or
venous blood pressure
-While pulse oximetry provides a measure of oxygen delivered
to the tissue, mixed venous oxygen saturation provides a
measure of the amount of oxygen used by the patient.
 WHAT IS TELEMETRY?
▪ Hemodynamic monitoring can take place at the bedside of can
be conducted from a remote location via telemetry.
▪ Telemetry allows for the continuous monitoring of patients
usually outside of the ICU.
▪ Telemetry monitoring is susceptible to signal loss.
▪ Computer-based hemodynamic monitoring offers the critical
care nurse a wealth of information.
▪ Does not replace clinical judgment.
 ARRYTHMIA MONITORS
▪ Computerized monitoring and analysis of cardiac rhythm have
proved reliable and effective in detecting potentially lethal heart
rhythms.
▪ A key functional element is the system's ability to detect
ventricular fibrillation and respond with an alarm.

SYSTEM TYPES
▪ Detection Surveillance
▪ Diagnostic or Interpretive.
 WHAT IS THE DIFFERENCE?
▪ In a detection system, Interpretive systems search the ECG
the criteria for a normal complex for five parameters:
ECG are programmed ▪ Location of QRS complex
into the computer. ▪ Time from the beginning to the end
of the QRS
▪ Comparison of amplitude, duration,
and rate of QRS complex with all
limb leads
▪ P and T waves
▪ Comparison of P and T waves with all
limb leads
 BASIC COMPONENTS
▪ Sensor
▪ Signal conditioner
▪ Cardiograph
▪ Pattern recognition
▪ Rhythm analysis
▪ Diagnosis
▪ Written report
ARRYTHMIA MONITORS
WHERE DO YOU PUT THEM?
 INFORMATION TECHNOLOGY AND CAPABILITIES
AND APPLICATIONS IN CRITICAL CARE SETTINGS

▪ Process store and integrate physiological and diagnostic

information from various sources.
▪ Present deviations from preset ranges by an alarm or an
alert.
▪ Accept and store patient care documentation in a
lifetime’s clinical repository.
▪ Trend data in a graphical presentation.
 INFORMATION TECHNOLOGY AND CAPABILITIES
AND APPLICATIONS IN CRITICAL CARE SETTINGS

▪ Provide clinical decision support through alerts alarms and

protocols.
▪ Provide access to vital patient information from any
location both inside and outside of the critical care setting.
▪ Comparatively evaluate patients for outcomes analysis.
▪ Present clinical data based on concept-oriented views.
CRITICAL CARE INFORMATION SYSTEM
(CCIS)
 CRITICAL CARE INFORMATION SYSTEMS
▪ A CCIS is a system designed to collect store, organize, retrieve, and
manipulate all data related to care of the critically ill patient. CCIS is the
organization of a patient's current and historical data.
▪ CCIS allows the free flow of data between the critical care unit and other
departments. Provides a rich repository of patient information that can be
integrated for use of outcomes management.
▪ Each patient's data can be accessed from any terminal or workstation. This
capability can extend across units and departments or be restricted to a
single unit.
CRITICAL CARE INFORMATION SYSTEM
▪ Provide real-time resource utilization data and management of
information and access critical care areas through the integration of
the medical facilities in the critical care or intensive care unit to an
intelligent computer system which is capable of processing all data.
▪ Enables the electronic collection of hospital and patient-specific
critical care data of the entire patient in the critical care areas
which can be processed to create a patient profile which generate
real time and historical report on indicators including bed
occupancy, delayed discharges, readmission rates, and outcomes.
▪ Automated collection and management of medical information will
become the important task of the critical care information system.
MEDICAL INFORMATION BUS (MIB)
▪ Provides a generalized method of attaching patient monitoring devices to
a common interface.
▪ This interface converts the unique manufacturer data communications
protocol into a standardized hardware and software system.
▪ It eliminates the need for custom connector and software presently
needed to interface such device.
▪ Has the ability to filter, store and select information sent for inclusion into
the clinical medical record on the clinical computer system. Infusion
pumps, ventilators, pulse, and other patient equipment are now
transmitting clinical information for use in clinical data reporting and
decision making.
COMPONENTS OF
CCIS (Critical Care
Information
System)
 VITAL SIGNS MONITORING
▪ Vital signs and other physiologic data can be
automatically acquired from bedside instruments and
incorporated into the clinical database.
▪ Data can be incorporated into flow sheets with other data
elements such as: laboratory results, body system,
assessment findings and problem lists.
 Diagnostic Testing Result
▪ Results can be displayed in flow sheets such as:
Laboratory, Radiology and Cardiology results.
▪ Clinicians can also access picture archival information.
 Clinical Documentation to support the
process of Physical assessment findings
▪ As the critical care environment requires frequent
assessments, these flow sheets may be configured to
ease this extensive data collection.
▪ Flow sheets may also be organized by body system.
▪ All disciplines can document patient assessment findings
into the CCIS.
▪ Automatic calculation of physiologic indices can be
performed.
 DECISION SUPPORT
▪ The CCIS can provide alerts and reminders to guide care in
accordance with evidence-based guidelines.
▪ Point of care access to knowledge bases that contain
information on evidence-based guide-lines of care, drug
information, procedures and policies. Data can be
integrated with patient information.
 MEDICATION MANAGEMENT
▪ Can facilitate the medication administration process.
▪ Medication administration of flow sheets incorporate the
use of bar code technology.
 INTERDISCIPLINARY PLANS OF CARE
▪ Special flow sheets incorporating required
treatments and interventions may be provided.
▪ Work flow management solutions that help
orchestrate all of the numerous, simultaneous
processes.
 PROVIDER ORDER ENTRY
▪ Electronic entry and communication of patient
orders can help clinicians improve communication,
streamline processes, facilitate care, and can help
clinicians and all providers in managing quality.
 COORDINATION AND SCHEDULING OF
PATIENT CARE ACTIVITIES
▪ Critical care flow sheet is a predominant display format for
CCIS.
▪ The goal of CCIS is to have as much information
integrated into the system as possible to obtain a
comprehensive picture of the patients.
ADVANTAGES OF CRITICAL CARE
INFORMATION SYSTEM
▪ Intelligently integrates and process physiologic and diagnostic
information and store it to secured clinical repository.
▪ Creates trends analysis with graphical representation of
results.
▪ Offline stimulation can be performed to test the condition of
the patients.
▪ Provide clinical decision support system
▪ Provide access to vital patient information
▪ Providing feedback and quick evaluation of the patient
condition and provides alert.
ADVANCEMENTS
▪ Advantages of monitoring systems resemble the
advantages of electronic nursing documentation.
▪ These systems focus heavily on collecting storing
and displaying physiological data.
SOURCES
▪ Daisy Jane Antipuesto RN MN - Currently a Nursing Local Board
Examination Reviewer. Subjects handled are Pediatric, Obstetric
and Psychiatric Nursing. Previous work experiences include:
Clinical instructor/lecturer, clinical coordinator (Level II),
caregiver instructor/lecturer, NC2 examination reviewer and
staff/clinic nurse. Areas of specialization: Emergency room,
Orthopedic Ward and Delivery Room. Also an IELTS passer.
▪ SITE: Nursing Crib (nursingcrib.com)
▪ Date Published: May 2011
SOURCES
▪ BRIGITTE MARIE GALAURA NURSING
INFORMATICS
▪ SITE: slideplayer.com