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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Module 3: Discussion
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?
Technology and informatics are utilized to support best practice changes. The informatics technology with electronic medical records makes tracking progress and outcomes easier for application to practice changes. The transformation of data collected with research in the patient care setting is analysis. It is crucial to select measurement tools that will provide information for outcome of interest. Informatics allows advanced practice nurses to communicate and treat diseases more effectively. In relation to Chlorhexidine bathing for reduction of hospital acquired infections several pilot studies were conducted and provided to implement intervention or change in practice. A standard bathing protocol with 4% chlorhexidine solution was implemented and produced a 52% reduction in hospital acquired infections (Chapman et al., 2021).
2. Discuss how employing evidence-based practice guidelines improve patient outcomes?
By employing evidence-based practice guidelines patient outcomes can be improved on multiple levels. Often the outcome desired during research leads to secondary unexpected outcomes that can often times be useful for application. Connor et al., (2023) stated from 752 research studies reviewed 89% reported improved patient outcomes with application of evidence-base practice guidelines. A gap that was identified in this study was that nurses did not always implement the EBP guideline across all disciplines. Many organizations provide funding for Quality Improvement (QI) projects and not directly EBP funding. As a result, there are fewer evidence-based practice guidelines put into place. If organizations continue to favor or offer funding for QI advanced practice nurses must be the driving force to ensure any QI implemented is evidence based.
3. What benefits and challenges have you experienced with the integration of information technology in your practice?
In integration of information technology into practice several barriers were faced. The original pilot study for chlorhexidine bathing to reduce hospital acquired infections was implemented on my unit. Several of the nurses did not understand the protocol or need for a change from routine bathing and care. Although data collected supported a reduction in post-operative infections the staff were still reluctant to integrate. The benefits of information technology are assisted with data collection and presentation of graphs/charts for frontline staff to see clearly. The data analyzed from the pilot study showed a reduction in CAUDI, CLABSI, and hospital acquired infections with external devices such as temporary pacemakers and chest tubes. The technology allowed for presentation of improved patient outcome and assisted with clinical decision support.
4 . What strategies did you, or could you, use to overcome these challenges?
I utilized various strategies to overcome these challenges in the pilot study for chlorhexidine solution bathing. The first was providing evidence gathered at other institutions and studies to confirm this change could improve outcomes. I utilized my nursing students to assist with the implementation on the clinical unit. They were excited to be able to participate in research. This assisted with the application of new practice guidelines which became contagious to the senior more resistant staff on the unit. As data was collected it was quicky analyzed to validate the desired outcomes. Education was provided frequently for frontline staff and feedback was collected. The project outcomes were shared with faculty and the results assisted with confirmation to make a practice change to improve post-surgical patients outcomes.
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?
The perfect EHR would be a challenge to develop as I have little informatics technology background. However, I would love all files to be provided in tabs easily located to trend medical history and conditions. I would also like the addition of teaching implemented tabs and evaluation of topics taught to be easily accessible. Patient teaching is a very simple low cost evidence based practice intervention, but at the organization I work with it is not week documented (Sallam et al., 2021). I would like a better way to track this education and what was provided each interaction to patients and families. I know the saying I remember from Nursing school is if you do not chart it you did not do it :) So is teaching being conducted to improve management of post-operative outcomes or not. Some see the paperwork as a tasks and false document it was completed without actually teaching. This may be prevented if the EHR had a section for teaching and the patients response with a time stamp for accuracy.
References
Chapman, L., Hargett, L., Anderson, T., Galluzzo, J., & Zimand, P. (2021). Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients. Critical Care Nurse, 41(5), e1–e8.
Connor, L., Dean, J., McNett, M., Tydings, D. M., Shrout, A., Gorsuch, P. F., Hole, A., Moore, L., Brown, R., Melnyk, B. M., & Gallagher, F. L. (2023). Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review. Worldviews on Evidence-Based Nursing, 20(1), 6–15.
Sallam, G. K. S., Abdalla, K. F., & Mahmoud, S. F. (2021). Effect of an educational program for patients post coronary artery bypass surgery on the compliance with symptoms management strategies. Indian Journal of Forensic Medicine & Toxicology, 15(4), 1194–1203.
Week 3 Discussion – Initial Post
In Family Medicine at my organization, we follow the evidence-based guidelines of the U.S. Preventive Services Task Force. A specific EBP prevention practice that is a staple in Family Medicine practice is screening for depression and suicide risk in children and adolescents. The USPSTF recommends that minors, aged, 12-18, be screened for major depressive disorder (U.S. Preventive Services Task Force, 2022). The Advanced Practice Nurse utilizes various forms of depressions screenings to identify patients who have previously not been diagnosed with a mental health condition or are not exhibiting signs of depression or possible self-harm at that exact moment in time to screen for these potential behaviors. The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders defines signs of depression as having at least two weeks of mild ranging to severe sadness, lack of interest, irritability, fatigue, poor concentration, difficultly sleeping, decreased energy, and appetite changes (American Psychiatric Association, 2013). The DSM5 lists signs of suicide as any type of suicidal behavior or ideation, any behavior that is intended to cause self-injury, any suicide attempts (non-fatal/non-completion), or suicide completion (American Psychiatric Association, 2013).
1. Discuss how technology and informatics are utilized to support the interventions of Advanced Practice Nurses?
Healthcare apps have deployed Psychiatric Services. There is a slew of apps dedicated to helping depression, bipolar, schizophrenia, and anxiety-ridden patients (Ng, Firth, Minen, & Torous, 2019), but there has been a slow increase to service engagement. Electronic Health Record Data merging with clinical decision support systems (CDSS) have created the capability to identify which patients have and have not been screened within a 12-month rolling calendar year for depression and suicide risk (Sutton, et al., 2020). Telehealth services for psychiatry care are now available as well, with or without referrals (Gordon, Landman, Zhang, & Bates, 2020). These virtual and web-based systems can be merged into the patient’s electronic medical record as well.
2. Discuss how employing evidence-based practice guidelines improve patient outcomes?
Children and adolescents are exposed to psychological factors as well as genetic factors, which make them a higher risk for depression and suicide (U.S. Preventive Services Task Force, 2022). These psychological factors can be abuse, bullying, environmental, gender identity, traumatic exposure, neglect, insecure parental relationship, etc. Race and socioeconomical status also play a significant part in predisposition to depression and suicide as Black children have reported a higher rate of suicide attempts in the past few years (U.S. Preventive Services Task Force, 2022). Family Medicine is about taking care of the family unit, and to protect the lives of the children – it is imperative to identify if a child or teen is at risk for depression or suicide as early as we can to intervene and get help for the family and the patient. Improving patient outcomes means to teach better coping mechanisms or creating a better child/parent bond, etc. – whatever is unique to that child/teen’s needs, once we identify what is going on and loop in psychiatry and CPS if needed.
3. What benefits and challenges have you experienced with the integration of information technology in your practice?
Within my practice, I have found that sometimes patients do not want to complete the medical record release forms, which will allow us to integrate their apps or web-based psychiatric provider services into their medical record – I understand this is a patient right, but it is frustrating. I have seen patients refuse to complete the depression screenings for fear of “getting in trouble”. Children and teens sometimes fear to be truthful about how they feel because they feel like they are letting down their parents. These are times that I take the parent/guardian out of the room for a cup of coffee so that the provider to just talk to the child/teen. I have also seen patients become very hesitant to use apps and web-based services – they prefer the in-person method, which usually equates to rather long wait times within my organization. For example: if a patient is referred to mental health in person at my organization, you will be scheduled in 8 months.
The benefits have been that patients who choose to integrate apps and web-based services typically get faster care (Gordon, Landman, Zhang, & Bates, 2020) (Ng, Firth, Minen, & Torous, 2019). When the patient signs the release of medical records, the primary care providers can manage to the best of their abilities the mental health conditions until true psychiatry can take over within the organization.
4. What strategies did you, or could you, use to overcome these challenges?
Our system is working on creating a “collaborative mental health” model that will emulate web-based mental health services. If the primary care team identifies that a child or teen (or adult in other clinics) needs assistance and since our in-person wait time is so long, we will be able to drop a “Collaborative Mental Health Referral”. The patient will get Video Visit and Telephone counselling and the primary care provider will be instructed on what medications to prescribe until the Mental Health Clinic referral can take over for in-person visits. I am very excited for this to roll out. I still have much to learn about it as my clinic will be a pilot clinic for it.
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?
If I could design the perfect Electronic Health Record, I would include data sets that would trigger for the provider to screen at every visit for children and teens 12-18 years of age. I would have the EHR send text messages every so often to monitor patients that are positive for depression for them to answer a mini depression screening – if they do not respond in 48-72 hours, a medical assistant or LPN would need to call them. Finally, I would integrate a CDSS that would notify the provider which patients are acceptable for Collaborative Care Mental Health. Some mental health diagnosis can qualify for telehealth monitoring only – this will reduce the wait time in the in-person mental health clinic.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). doi:10.1176/appi.books.9780890425596.dsm05
Gordon, W., Landman, A., Zhang, H., & Bates, D. (2020). Beyond validation: getting health apps into clinical practice. NPJ Digital Medicine, 3(14). doi:10.1038/s41746-019-0212-z
Ng, M., Firth, J., Minen, M., & Torous, J. (2019). User Engagement in Mental Health Apps: A Review of Measurement, Reporting, and Validity. Psychiatry Online. Retrieved from https://ps-psychiatryonline-org.northernkentuckyuniversity.idm.oclc.org/doi/full/10.1176/appi.ps.201800519
Sutton, R., Pincock, D., Baumgart, D., Sadowski, D., Fedorak, R., & Kroeker, K. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digital Medicine, 3(17), 1-11. doi:10.1038/s41746-020-0221-y
U.S. Preventive Services Task Force. (2022). Recommendation: Depression and Suicide Risk in Children and Adolescents: Screening. USPSTF. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents