Implementing an electronic charting system in a healthcare facility, barriers to change, and organizational plan for change. speaker notes are indepth.
Overview of Electronic Medical Records - Sanjoy SanyalSanjoy Sanyal
Gives an overview of Electronic Medical Records (EMR) / Electronic Health records (EHR) / Patient Health records (PHR), with company screenshots and specialty specific EMR examples. Presented at a seminar in Seychelles in 2008.
Very useful for Informatics professional, Medical professionals, Healthcare administrators. This is a constantly evolving issue, and some things mentioned here may have undergone modification since the time of their original publication.
Tags: emr, mapping engine, Electronic Medical Record, EMR, Electronic Health record, HER, Patient Health record, PHR, Sanjoy Sanyal,
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
Emergency Department Quality Improvement Transforming the Delivery of CareHealth Catalyst
Overcrowding in the emergency department has been associated with increased inpatient mortality, increased length of stay, and increased costs for admitted patients. ED wait times and patients who leave without seeing a qualified medical provider are indicators of overcrowding. A data-driven system approach is needed to address these problems and redesign the delivery of emergency care.
This article explores common problems in emergency care and insights into embarking on a successful quality improvement journey to transform care delivery in the ED, including an exploration of the following topics:
A four-step approach to redesigning the delivery of emergency care.
Understanding ED performance.
Revising High-Impact Workflows.
Revising Staffing Patterns.
Setting Leadership Expectations.
Improving the Patient Experience.
Overview of Electronic Medical Records - Sanjoy SanyalSanjoy Sanyal
Gives an overview of Electronic Medical Records (EMR) / Electronic Health records (EHR) / Patient Health records (PHR), with company screenshots and specialty specific EMR examples. Presented at a seminar in Seychelles in 2008.
Very useful for Informatics professional, Medical professionals, Healthcare administrators. This is a constantly evolving issue, and some things mentioned here may have undergone modification since the time of their original publication.
Tags: emr, mapping engine, Electronic Medical Record, EMR, Electronic Health record, HER, Patient Health record, PHR, Sanjoy Sanyal,
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
Emergency Department Quality Improvement Transforming the Delivery of CareHealth Catalyst
Overcrowding in the emergency department has been associated with increased inpatient mortality, increased length of stay, and increased costs for admitted patients. ED wait times and patients who leave without seeing a qualified medical provider are indicators of overcrowding. A data-driven system approach is needed to address these problems and redesign the delivery of emergency care.
This article explores common problems in emergency care and insights into embarking on a successful quality improvement journey to transform care delivery in the ED, including an exploration of the following topics:
A four-step approach to redesigning the delivery of emergency care.
Understanding ED performance.
Revising High-Impact Workflows.
Revising Staffing Patterns.
Setting Leadership Expectations.
Improving the Patient Experience.
Healthcare Transformation: The Journey of High-Value HealthcareHealth Catalyst
To manage population health, one needs to intimately understand the anatomy of healthcare and model how healthcare is delivered, in order to systematically improve healthcare outcomes. In this webinar, Dr. Burton draws on his 26-year executive career at Intermountain, Select Health, and Health Catalyst. He emphasizes the importance of linking administrative data (e.g., billing codes) to processes of clinical care to use the 80/20 principle to prioritize care processes within each venue to focus improvement initiatives on the things that matter most. He will also discuss a Clinical Integration framework to use in driving out waste by reducing variation in the ordering of care, the efficiency with which the care that is ordered is delivered and reducing defects in care delivery to make it safer.
From http://LearnHealthTech.com. What is e-prescribing. Details the workflow and technology aspects of electronic prescribing in Healthcare clinics. Covers, refills, refill requests, eligibility checking, and Surescripts, who is the leading provider of e-prescribing technology.
“Mobile Health(mHealth) is the use of mobile and wireless devices, the technology, to provide Health outcomes, Healthcare services and Health research.”
Electronic Health Record System and Its Key Benefits to Healthcare IndustryCalance
This case study discusses how Electronic Health Record can turn out to be a solution to the problems associated with paper based clinical records. It’s a future-proof solution decreasing chances of error and loss while increasing patient-provider communication. Find out the key challenges faced by US health industry, key benefits of EHRs, and how Calance can help developing an HER solution. For more info about Calance, visit http://www.calanceus.com
Telemedicine presentation delivered at the conference sponsored by HEALTHePRACTICES, ICanNY and Windstream Communications entitled Healthcare Technology and the Networks Which Make it Happen.
EHR Implementation project: Addressing problems with the current EHR system in Star Health and proferring Hypothetic solutions.
Case study of YNHHS EHR implementation strategy.
Data Mining in Healthcare: How Health Systems Can Improve Quality and Reduce...Health Catalyst
This is the complete 4-part series demonstrating real-world examples of the power of data mining in healthcare. Effective data mining requires a three-system approach: the analytics system (including an EDW), the content system (and systematically applying evidence-based best practices to care delivery), and the deployment system (driving change management throughout the organization and implementing a dedicated team structure). Here, we also show organizations with successful data-mining-application in critical areas such as: tracking fee-for-service and value-based payer contracts, population health management initiatives involving primary care reporting, and reducing hospital readmissions. Having the data and tools to use data mining and predict trends is giving these health systems a big advantage.
The Top Seven Healthcare Outcome Measures and Three Measurement EssentialsHealth Catalyst
Healthcare outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this article adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples. The top seven categories of outcome measures are:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these seven outcome measures to calculate overall hospital quality and arrive at its 2018 hospital star ratings. This article also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement.
The Transition from Paper to Electronic RecordsMatthew Kim
A presentation depicting the history, selection criteria, implementation process and market share among various electronic health record (EHR) vendors.
Healthcare Transformation: The Journey of High-Value HealthcareHealth Catalyst
To manage population health, one needs to intimately understand the anatomy of healthcare and model how healthcare is delivered, in order to systematically improve healthcare outcomes. In this webinar, Dr. Burton draws on his 26-year executive career at Intermountain, Select Health, and Health Catalyst. He emphasizes the importance of linking administrative data (e.g., billing codes) to processes of clinical care to use the 80/20 principle to prioritize care processes within each venue to focus improvement initiatives on the things that matter most. He will also discuss a Clinical Integration framework to use in driving out waste by reducing variation in the ordering of care, the efficiency with which the care that is ordered is delivered and reducing defects in care delivery to make it safer.
From http://LearnHealthTech.com. What is e-prescribing. Details the workflow and technology aspects of electronic prescribing in Healthcare clinics. Covers, refills, refill requests, eligibility checking, and Surescripts, who is the leading provider of e-prescribing technology.
“Mobile Health(mHealth) is the use of mobile and wireless devices, the technology, to provide Health outcomes, Healthcare services and Health research.”
Electronic Health Record System and Its Key Benefits to Healthcare IndustryCalance
This case study discusses how Electronic Health Record can turn out to be a solution to the problems associated with paper based clinical records. It’s a future-proof solution decreasing chances of error and loss while increasing patient-provider communication. Find out the key challenges faced by US health industry, key benefits of EHRs, and how Calance can help developing an HER solution. For more info about Calance, visit http://www.calanceus.com
Telemedicine presentation delivered at the conference sponsored by HEALTHePRACTICES, ICanNY and Windstream Communications entitled Healthcare Technology and the Networks Which Make it Happen.
EHR Implementation project: Addressing problems with the current EHR system in Star Health and proferring Hypothetic solutions.
Case study of YNHHS EHR implementation strategy.
Data Mining in Healthcare: How Health Systems Can Improve Quality and Reduce...Health Catalyst
This is the complete 4-part series demonstrating real-world examples of the power of data mining in healthcare. Effective data mining requires a three-system approach: the analytics system (including an EDW), the content system (and systematically applying evidence-based best practices to care delivery), and the deployment system (driving change management throughout the organization and implementing a dedicated team structure). Here, we also show organizations with successful data-mining-application in critical areas such as: tracking fee-for-service and value-based payer contracts, population health management initiatives involving primary care reporting, and reducing hospital readmissions. Having the data and tools to use data mining and predict trends is giving these health systems a big advantage.
The Top Seven Healthcare Outcome Measures and Three Measurement EssentialsHealth Catalyst
Healthcare outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this article adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples. The top seven categories of outcome measures are:
Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging
CMS used these seven outcome measures to calculate overall hospital quality and arrive at its 2018 hospital star ratings. This article also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement.
The Transition from Paper to Electronic RecordsMatthew Kim
A presentation depicting the history, selection criteria, implementation process and market share among various electronic health record (EHR) vendors.
Afro Ant Conversation - Change Management ROI - 3 April 2014Afro Ant
This report documents the information gathered at the Afro Ant Conversation held on the 3rd of April 2014 on the topic of Change Management Return on Investment (ROI). The conversation included 24 professionals who work in the field of Change Management or work closely with Change Managers.
How to Manage Scope Change in Your Next Project | BDO Connections 2016BDO IT Solutions
Ok, you're about to kick-off a project. The scope and budget are set, the teams know what they're delivering, and everyone is ready to begin. How do you a keep a good handle on this project to ensure the work is being completed is within the scope of the project? How do you get a clear understanding of what is in and out of scope? We will review some solid tactics you can employ to progressively manage your project budget, manage change and maintain total visibility from beginning to end.
For those of you who want to get a head start on the chartsmart, these are the applicable slides. Also, Brenda has a sheet of "Descriptive Terms" that you will want for that project. She handed it out to a few people the other day who wanted to get a head start on the charting assignment.
Types of Inventions; Difference between invention and innovation; Types of innovation; Innovation process vs Process innovation; Linear innovation models.. Technology push model, Market pull model; Flexible innovation process models
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
Closed Loop Medication Management - A preferred way to go go forward for Prov...CitiusTech
Closed Loop Medication Management (CLMM) system is a fully electronic medication management process that integrates automated and intelligent systems to completely close the inpatient medication management and administration loop, and seamlessly document all the relevant information.
Railhealth Electronic Medical Record encompasses the information and capabilities required to support healthcare service delivery. This presentation gives you the information regarding the features, objectives and the benefits what doctor gets by using our EMR.
Railhealth EMR encompasses the information and capabilities required to support healthcare service delivery, where the information is captured in a computer-readable form that supports interoperability and clinical decision support.
In this presentation, you will know regarding the features, objectives and benefits by using our Railhealth EMR
Hospital Pharmacy Chapter -7 Applications of computer in Hospital PharmacyNikita Gupta
Here is notes of Hospital Pharmacy Chapter -7 Applications of computer in Hospital Pharmacy - practice electronic health records, softwares used in hospital pharmacy.
Hello my name is Tosin Ola and this presentation will highlight the risk management issue of excessive absenteeism, focus on the methods to curtail absenteeism, steps already in place, the points system, and healthy living programs.
Absenteeism is the term generally used to refer to unscheduled employee absences from the workplace (U.S. Legal, 2008., p. 1). According to the U.S. Department of Labor, companies lose approximately 2.8 million workdays a year because of employee injuries and illnesses (Gale, 2003, p. 40). Of all the expenses related to absence, unscheduled time off has the biggest impact on productivity, profitability and morale (Gale, p. 40).
The inability to plan for such absences forces hospitals to hire last-minute temporary staff (travelers and per diem nurses) at higher rates, pay more overtime to permanent staff, or add a staffing margin to replace anticipated lost labor by utilizing in-house per diem employees (L. Meyer, personal communication, December 8, 2009). All these tactics negatively affect the bottom line of the hospital in every fiscal period.
Care of Sickle Cell Disease Patients: Process Improvement & Change with NursesTosin Ola-Weissmann
Populations with SCD are at risk for disparities primarily because of the lack of knowledge on the part of the healthcare providers regarding the disease; inadequate pain management and prejudice among the staff (Tanabe & Myers, 2007).
On interviewing several nurses in the hospital, many acknowledge that they have never taken care of a patient with SCD and do not know what to assess for. The only nurse with experience of taking care of a SCD patient did not know the complications of the disease and wondered why sickle cell patients “always request pain medication when it’s obvious they are not in pain.”
This presentation is a guide providing essential information to medical professionals on dealing with patients that have sickle cell anemia. In addition, the SCD questionnaire is designed to enhance the assessment of SCD patients by medical professionals in the emergency room and serve as a platform for understanding their vulnerabilities during assessment.
Emphasis of this questionnaire is placed on identifying risk factors for depression, the patient’s socio-economic barriers, lifestyle habits, transportation issues, safe home environment, effective pain management and avenues for possible genetic counseling all of which sickle cell patients have shown vulnerability to (Dorsey & Murdaugh, 2003).
The term cultural competence consists of two words, culture and competence (Jirwe, Gerrish, & Emami, 2006). Culture is defined as the learned, shared and transmitted values, beliefs, norms and life practices of a particular group of people (Leininger & McFarland, 2002). Peoples' culture can be understood through their actions, that is, their behavioral patterns and through understanding why people act in the way they do; their functional patterns (Leininger & McFarland).
Culture can also be understood through an interpretation of one's world, through one's cognitive processes, or through a person's understanding of their world, which is linked to their symbolic interactions (Jirwe, Gerrish, & Emami, 2006). “Since cultural background greatly affects several aspects of people's lives, i.e. their beliefs, language, religion, family structure and body image, this must be considered when caring for people from other cultures” (Jirwe, Gerrish, & Emami, p. 12).
Cultural competence is a way of practicing one’s profession by being sensitive to the differences in cultures of one’s constituents and acting in a way that is respectful of the client’s values and traditions while performing those activities or procedures necessary for the client’s well-being (DeChesnay, 2008). It takes into account the cultural differences between the nurse and the patient, while meeting the needs of the patient.
We have chosen to deliberate on the Amish culture because due to their beliefs, lifestyle and isolation from the modern world, much mystery surrounds their culture and many nurses are unable to relate to their culture, understand it, or practice culturally competent care (Jirwe, Gerrish, & Emami, 2006, ).
Amish families have purposely separated themselves from the advancing modern society that surrounds them and refuse to depend on outside help in order to survive (Baker, 2007). This seems such a rebellious and alternative way of life that is hard for many people to understand (Baker).
The Centers for Disease Control and Prevention (CDC) defines bioterrorism as "the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants” (Centers for Disease Control and Prevention [CDC], 2007, p. 1).
This presentation will cover the initiation, process and roles of agencies in Multnomah County, Oregon and their relationships with international, national and state agencies. The role of the public health department in relation to bioterrorism will also be explored.
Injury is the leading cause of death among children and adults up to age 44 and is the leading cause of potential life lost before age 65 (Healthy States, 2007, p. 3). In 200, more than 120,000 Americans of all ages died from injuries from motor vehicle crashes, suicide, falls, poisoning, drug overdoses, drowning, fires and other causes (Centers for Disease Control and Prevention [CDC], 2006) while more than 20,000 persons in the United States die from drug overdose.
Because of its impact on the health of all Americans--young and old--preventing injury is a serious public health challenge. As recent tragedies shine the spotlight on accidental drug overdoses, it’s becoming increasingly clear that prescription drugs are playing an increasing role in accidental deaths (Kelley, 2009, p. 24).
Healthy Communities: Multnomah county is one of the 36 counties in the state of Oregon, located with Portland as its county seat. Portland is the second largest city in Oregon and the most populous metropolitan area in the state (U.S. Census Bureau [USCB], 2008, p. 1). As of 2007, Multnomah County's population is 681,454 people (Sperling, 2008). For the purpose of this study, the community focus will be primarily on the sector of Multnomah County in the 97212 area code, which will be called the Rose Sector.
Today we will be discussing legal considerations dealing with professional boundaries and sexual misconduct in the workplace. We will examine in depth what sexual misconduct is, and how to prevent this from happening in our nursing practice. This presentation will also review the nurse practice act and its view on sexual misconduct. If you have any questions, please don’t hesitate to ask.
Delegation in healthcare and nursing. Delegating a task does not mean that you have absolved yourself of the responsibility of that task. You are still the principal person in charge of the task and how well the job is done ultimately rests on you. This is why a delegation model is essential in the workplace.
This presentation will identify the key phases of a delegation model, and use that model in a case study based in the healthcare setting.
Today’s presentation focuses on Jean Watson's Theory of Human Caring. During this presentation we will analyze the theoretical framework, review the critical components of the Theory of Caring, and discuss how the theory is utilized in nursing practice. This presentation will also detail application of Watson’s Theory of Caring into the peri-operative environment by instituting a “sacred space” and explain the process of implementing the sacred space. Enjoy!
Healthcare in the United States has become very fragmented, expensive and disjointed. Over the course of a hospitalization, a patient may be transferred from one unit to another, sometimes spending as much as 5 different units in a 3 day stay. This has led to many hand-off reports, and increased the potential for mistakes, improper communication, and patient deaths.
Partnership in this context is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal (The American Heritage Dictionary, 2006). Partnership ensures that each member is equal and brings something important to the table. The Partnership Care Delivery Model (PCDM) ensures that the patient is an integral part of the healthcare team, and their experiences, contributions, advice, and influence is needed and valued.
Self assessment presentation that crafts ones strengths and weaknesses into a perfect position. Hello everyone. I would like to take this opportunity to determine the perfect position for me within the new organization post-expansion. In creating the ideal leadership position, I will identify my leadership style, the strengths, weaknesses and capabilities; as well as contrast different leadership theories and how they apply to my personal style.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. EMAR POLICY IMPLEMENTATION AND CHANGE
Our facility needs to improve patient care and safety by
reducing medication errors. We propose to do this by
changing to a technology based system for administering
medication. We will be implementing the Electronic
Medication Administration Record (eMAR) system hospital
wide.
Our goals:
• improve patient safety
• improve staff satisfaction
• decrease costs associated with medication errors
• increase accreditation by improving patient safety
3. POLICY CHANGES FOR EMAR IMPLEMENTATION
Medication Administration Policy will Change with
the implementation of eMAR.
Initial policy will cover the following:
• All patients will have bar coded wrist bands
• All medications will be ordered electronically
• All medications will have bar codes and must be
scanned before given
• The five rights will be practiced
• Exclusions and Contingencies will be added for system
failure and extenuating circumstances.
4. INTRODUCING: THE ELECTRONIC MEDICATION
ADMINISTRATION RECORD (EMAR)
• A Physician writes the medication order electronically, which
is sent to the Pharmacy. Physicians will no longer hand
write medication orders or phone them into the pharmacy
• A Pharmacist enters the order in eMAR software
• The Pharmacy bar codes the medication and distributes to
patient care floors.
• The nurse views the eMAR screen and reviews the patient's
medication list and verifies with the physician orders.
• eMAR alerts the nurse about the next dose due, overdue
doses, or cautions about medications
• Nurse scans the patient's wristband and then scans the
medications
• Patient’s will be informed about the need for scanning wrist
bands (if applicable)
5. DISCONTINUE EXISTING MEDICATION
ADMINISTRATION PRACTICES
New Implementation requires that the previous medication
system be discontinued. We will enforce the following
with eMAR implementation:
• Physicians will no longer hand write medication orders or
phone them into the pharmacy
• No Medication orders will be written in the patient’s
bedside chart.
• No Medication except in an ACLS emergency will be
given without scanning a patient’s armband.
• Pharmacy will not deliver medications without barcodes
on the package or IV
6. ORGANIZATIONAL BARRIERS TO CHANGE
• The following barriers need to
be overcome:
– Lack of change agent
– Inadequate financial or
physical resources
– Lack of support from
other disciplines
– Poor leadership
– Lack of technology and
logistics
– Failure of previous
change endeavors
– Time restraints
7. INDIVIDUAL BARRIERS TO CHANGE
Individuals may resist change due
to some of the following
barriers:
– Uncertainty
– Unfulfilled needs
– Stress
– Failure to accept need for
change
– Fear of technology
– Takes too much time
8. ADVANTAGES OF EMARS AND
BARCODING
• Reduction of medication errors
• Reduction of human errors
• Enhances patient safety
• Verification of the 5 Rights
1. RIGHT PATIENT
2. RIGHT MEDICATION
3. RIGHT DOSE
4. RIGHT TIME
5. RIGHT ROUTE
• Ability to prevent near misses
• Triggers alerts and warnings
regarding sound-alike or look-
alike drugs
9. FACTORS THAT MAY INFLUENCE
THE USE OF BARCODING
• Generates positive public
relations with the local
community
• Legible orders via computer
from physicians
• Handheld devices offer
documentation at the bedside
• Provides immediate on-line
data for the clinical care
• Provides drug references
information
• Improves nursing staff job
satisfaction
• Improves patient satisfaction
10. FACTORS INFLUENCING EMAR USAGE
• Less reliance on manual data entry and alleviates carpal tunnel
syndrome
• Provides inventory management and tracking as well automated
patient billing
• Accurate billing is accomplished due to real time charting
• Increases the use of pharmacist to perform clinical duties instead of
dispensing tasks
• JCAHO recommends improvement in the accuracy of patient
identification
• Including two or more patient specific identifiers –bar coding will
comply with there recommendation
12. EMAR TECHNOLOGY: A TOOL TO
IMPROVE PRACTICE
• eMAR technology can help
nurses take information and
turn it into insight
• eMAR technology doesn't
replace critical thinking it
enhances it
• eMAR technology used
correctly ensures patient safety
• The Expectancy
theory, Theory ‘Y’ and Hygiene
Motivation theory can be used
to incorporate the eMAR
change in our facility.
13. REFERENCES
Bradydistributor.com (2009). Electronic Medication Administration Record FAQs. Retrieved 9/24/09, from
bradydistributor.com
Carr, D. (2004). A team approach to EHR implementation and maintenance. Nursing Management, 35, 15-24.
Granlien, M., Hertzum, M., & Gudmundsen, J. (2008). The gap between actual and mandated use of an electronic
medication record three years after deployment. Studies in Health Technology and Informatics, 136, 419-424.
(2000). To err is human: building a safer health system. In L. T. Kohn, J. M. Corrigan, & M. S. Donaldson (Eds.), A
report to the Committee on Quality of Health Care in America (Institute of Medicine, p. 1). Washington, DC:
National Academy Press.
INFOHEALTH Management Corp (September 2003). Incorporating Bar Code Technology Into the Health Care Sector.
Retrieved 9/25/09, from www.infohealth.net
14. REFERENCES
Kotter, J. (2008, Spring2008). Developing a change-friendly culture. Leader to Leader, 2008(48), 33-38. Retrieved
September 24, 2009, from Business Source Complete database.
Lionheart Publishing (2007). Patient Safety & Quality Healthcare. Retrieved September 25, 2009, from www.psqh.co
Meadows, M. (2003). Strategies to reduce medication errors, FDA Consumer 37 (3).
Miller, K. (2002). The change agent’s guide to radical improvement. Milwaukee, WI: ASQ Quality Press.
Reducing and Preventing Adverse Drug Events To Decrease Hospital Costs. (2001). Research in Action, 1(1).
Retrieved from ahrq.gov/qual/aderia/aderia.htm
Spector, B. (2009). Implementing organizational change: theory into practice (2nd ed.). New York: Prentice Hall.
Weimar, C. (2009). Going all-digital is easier said than done. Physician Executive, 35(2), 20-22.
Protocare Sciences. (2001). Addressing Medication Errors in Hospitals. 476 Ninth Street Oakland, CA 94607: Protocare
Sciences.
Editor's Notes
Reason for Change: Our hospital had 147 reported medication errors with two resulting in death last year. We want to eliminate future deaths and errors by implementing a technology based medication administration system that has been proven to reduce these errors. We are ready to implement this system after studying it for 6 months. We have interviewed our physicians, nurses, respiratory therapist and pharmacists about how the change would affect them. We have had representatives from all disciplines travel to hospitals where the eMAR is in use so they could experience it first hand. We have trialed the eMAR on a small scale for one month. The change to eMAR will affect all disciplines who prescribe, dispense and administer medication to patients. We are ready to implement eMAR and begin improving patient safety. We can no longer afford to ignore the technology that will improve patient care or stay with practices that don’t ensure patient’s safety. The following paragraph is a strong argument for the implementation of eMAR and discontinuing our current system.“The electronic medication administration record (eMAR) has gained a foothold in inpatient settings to support medication administration safety. With paper records prone to being lost, incomplete, or misread, the bedside nurse needs a fail-safe method to ensure that medications are administered correctly. Medication administration systems that integrate fully with computerized physician order entry (CPOE) and pharmacy systems should provide that fail-safe system, while improving efficiency. Even a standalone medication administration system is a vast improvement over paper medication administration records” ( Meadows, 2003).The eMAR is a computerized system that ensures the patient receives the correct medication, in the correct dose, at the correct time, and alerts staff when the proper parameters are not met. eMAR reduces relying on memory with a system that reminds clinical staff when medications need to be administered or the effectiveness of doses administered should be assessed.
Goals:Improve patient safety. We have studied the efficacy and safety record of similar systems such as the barcode medication administration (BCMA) system and found they have reduced medication errors. Studies at VA hospitals in the 1990s showed that BCMA use reduced medication errors by 86% (Meadows, 2003). This is a significant reduction that will benefit both patients and the hospital.2. Improve staff satisfaction. RNs decrease time administering medications, system is easy to use, it is a safety net to catch med errors alleviating some of the burden on nursing.Cost Savings: “ Patients who experienced adverse drug events (ADEs) were hospitalized an average of 8 to 12 days longer than patients who did not suffer ADEs, and their hospitalizations cost $16,000 to $24,000 more. Anywhere from 28 percent to 95 percent of ADEs can be prevented by reducing medication errors through computerized monitoring systems. Computerized medication order entry has the potential to prevent an estimated 84 percent of dose, frequency, and route errors. Hospitals can save as much as $500,000 annually in direct costs by using computerized systems” ( Agency for Healthcare Services, 2001).4. Accreditation: Program that increases patient safety are part of JCHACO’s safety initiative. Implementation: Implementing an electronic system is a complex endeavor, which involves the training and integration of most hospital disciplines. The cost of initial implementation will be $1, 500,000. We will have eMAR capable computers on all floors. We will have scanning computers in all patient care areas, we will have a bar code medication dispenser in the pharmacy.We plan on implementing the system on the medical/surgical floor in one month and will go live hospital wide in three months.
Similar to other health implementations, barcoding and eMAR technologies require modifications to hospital policies on medication administration and patient identification. We will change our policy for eMAR use.POLICY: A. eMAR software will be used for administration of medications to all inpatients. Exceptions to this include all medications administered in the operating room or during an interventional procedure off the ward. B. With the exception of emergent or immediate need situations, a valid provider order must be present in the prior to the administration of medication or intravenous fluids. An order for emergent medications will be entered as soon as possible. C. Only qualified staff, as defined per policy or scope of practice, will order, dispense or administer medication. D. All employees who are required to utilize eMAR will receive the training necessary to enable them to perform all required duties related to this system. Training will be adjusted to the needs of the individual employee. All staff that use eMAR to chart medication administration must pass a standard proficiency exam prior to use of the system. E. The intent of eMAR software is to provide the nurse with an additional check and balance system that augments, but does not replace, clinical judgment. In order for the eMAR software to effectively provide the necessary check and balance system, the nurse must scan each patient's wristband and scan each medication as it is administered. The five rights must be practiced, circumventing the scanning process will increase the chances for user error.The policy will cover extenuating circumstances when patients can not wear wrist bands such as patients who are in isolation precautions, have infections or can not wear wrist bands for physical reasons such as allergy, swelling or safety issues. In these instances wrist bands can be taped to their doors or computer to be scanned. Extra caution will be used in these instances and the five rights must be confirmed by the RN.We have a contingency plan in the existence of system wide failure such as a power outage or software error There will be paper medication order sheets in all patient care areas. These will be used until the system is working again. All paper ordering will be discontinued when eMAR is working.Policy will be updated after one year use of eMAR.Copy of the new eMAR policy will be made available to all staff.
eMar stands for Electronic Medication Administration Record and it is a point-of-care process utilizing bar code reading technology to monitor the bedside administration of medications. Generally accepted inventory management processes include: Pharmacy to track medication inventory.Inventory management concepts to include item identification Patient Wristbands and medical records. Verification process and decision-making tool at 'point-of-care' at bedsideAt the patient bedside, if any of the scanned information does not match the doctor's orders, a warning message is provided to the clinician. (Bradyid, 2009).The eMAR system will include: Physicians who order medication Pharmacy who verify, prepare and dispense medication Nursing and Respiratory therapy who administer medicationThe following will be implemented with the eMAR system:Patients receive bar coded wrist bands at admit and must have one to before medication is administered.MDs can order medications from any computer in the hospital, all medications must be ordered electronically. Pharmacy will have the software to process and verify dosing medication, Pharmacy will notify physicians when medication is ordered incorrectly.The pharmacy will deliver bar coded medications to patient care areas. All medications including orals, IVs, creams, ointments and suppositories will be bar coded.Patient care areas will have computers with scanners to be used by nursing staff. All nurses will use scanners to scan patient wrist bands before administering any medication. The nurse will verify that the correct patient has been scanned then verify the patient’s medication list in the computer. All medication will be scanned and if alerts appear the nurse will act on them before administering the medication.The nurse will inform the patient about the importance of scanning the patient’s wristband, if a patient is incapacitated this can be deferred.A username and password will be required by all who use the eMAR. We plan on implementing the eMAR system on the medical/surgical floor starting at the beginning of next month and will introduce the system to the rest of patient care areas at the end of the month. We will go live hospital wide in three months. Managers in all departments including nursing, respiratory, pharmacy and MDs will have an in-service introducing the new system and explain the reasons for the change. We have ordered scanning computers and our IT teams are installing software in all hospital computers and in the pharmacy. We have brought in eMAR representatives and technicians to help us with our change. We will train staff in four hour sessions. We will have super users on all floors. We will have on line training and support 24/7. We will not use penalties for those who are not ready to use the system but will provide further training. Our goals for introducing eMAR to the staff will be:Ensure ease of use.Minimize training requirements.Use existing technology.Limit variations and exceptions.Require use.
As part of the eMAR implementation we will discontinue all previous medication administration practices. We will educate all disciplines to the new system with in-services, on hand technicians and computer software courses that are accessible by all 24/7.Physicians are no longer allowed to write medication orders by hand or in patient chartsPhysicians can not phone orders into the pharmacyVerbal medication orders must be entered by the receiver into the computerPharmacy can not deliver medication that is not bar coded to patient care areas.We must discontinue old practices of medication administration once eMAR is in place. Compliance with the new system will ensure optimal results. Staff education and training are paramount for us to be successful. We have found documentation that having two systems can be detrimental to patients and nurses.“ Dual medication systems (i.e., the use of paper MARs in tandem with electronic BCMA documentation) increase the probability of medication error and reduce nursing productivity, as indicated previously in a study by Patterson et al., that examined the human factors issues related to BCMA implementation in a VHA institution. Baseline data collected by our BCMA Collaborative Team in September 2003 indicated that 60 percent of one-time medications and 42 percent of PRN medications for CABG patients were documented in the BCMA system, so the risk of medication error was great. The ICU eliminated paper MARs on November 18, 2003, in favor of the paperless system. Since that time, the documented percentage of these same medications in the BCMA system has risen to more than 95 percent, and several nurses have expressed the opinion that their overall workload has decreased as well” (Meadows,2003).
Identifying or recruiting a change agent should be the first step in any organization interested in implementing an EMAR system. We suggest a change agent that has previous experience with the implementation of an eMAR system. Inadequate financial or physical resources: Since most hospitals are not profit turning companies, it can be difficult to attain the necessary funding to implement the EMAR change. Costs can run from $4 million to upwards of $35 million on implementation alone and this does not include the costs of maintaining the system (Granlien, Hertzum, & Gudmundsen, 2008). We need to analyze the full costs that implementation and maintenance will entail. This includes the costs of bringing the hospital technology up to par. Lack of support from other disciplines: Lack of support from all disciplines like MDs: Physicians are used to ordering meds through the old system and may not adopt this system.An organization might have poor leaders or those that are reluctant or resistant to change at the helm. It is important to identify those leaders, educate, convince and get them committed to the change process. Lack of technology: Before an EMAR system can be implemented, the organization should have a detailed understanding of the existing technology and hardware in the facility. The cost of purchasing and implementing a software system is only 50% of the total cost of the EMAR system (Wiemar, 2009). The actual installation of the entire system; which includes installing or updating computers, adding a barcode medication dispenser in the pharmacy, making sure that all the equipment is ‘talking to each other’, making sure everything is working and having technical support available.Failure: Since people are more resistant to change when there has been a previous failure (Spector, 2010), getting the organization to move away from the defeatist mentality and back into an optimistic , fluid realm of possibilities can be a huge hurdle that many organizations cannot overcome.Time: Implementing an EMAR system can take anywhere from 6 months to several years. Employees can quickly become disinterested or skeptical that the ‘change is never going to come’. To avoid this, it’s essential to have the necessary building blocks already in place so that the employees can see that the change is moving ahead at a measurable pace. We have to set deadlines and goals, communicate them to the whole organization; and give a good overview of what has been accomplished and what still needs to be done (Spector).
Feelings of uncertainty based on the unknown: Employees require an sense of stability in the workplace (Spector, 2010). When change does occur, feelings of insecurity and fear of loss of power, skills or loss of income may increase the resistance. To counteract this, leaders should communicate the stages of the EMAR process, and what the employee’s new requirements will be in a timely manner. Reduction in personal need fulfillment: Some nurses or pharmacists might feel like they are being ‘replaced’ and made redundant (Carr, 2004), or that their autonomy is being taken away. Others might feel like they are going to be unable to perform as well in the new situation since they are not comfortable with the technology. Thus, they feel a reduction in personal and professional fulfillment. To overcome this barrier, we must stress that the EMAR system does not replace jobs; but is important to reduce medication errors, improve patient safety and enhance healthcare delivery. Real or perceived stress: If individuals project that implementing EMAR will be stressful, additional behavioral and emotional blocks need to be overcome. We should advocate stress how easy the system is to use, and how effectively it can be utilized. Highlighting the superb advantages of the EMAR system can help eliminate some of that stress. Failure to accept need for change: Many nurses might be mired in tradition with set ways, and feel like there is no need to convert to an EMAR. To sway this mindset, it is important to stress how EMAR serves as a fail safe in avoiding medication errors. Since the program covers the 5R’s and will notify the nurse of any discrepancy, it protects the nurse and facility from potential hazardous mistakes. Fear of technology on the complexity of the system. Some nurses might not have technical skills and will be intimidated by the computer system, so they might resist it. Some nurses might feel that if the scanner is broken, not scanning, or if they forget how to work the system, it might “make them look stupid in front of the patient” (Granlien, et al, 2008, p. 419). The change agents must impart the idea that if technology breaks down, it is not a reflection on the nurse, but a reflection of the system. Another complaint of nurses is that in emergent situations, the EMAR system can be tedious. To overcome this, it is essential to have emergent protocols in place to circumvent the system as long as appropriate documentation is in place. Takes too much time: Some nurses might feel that scanning will take too much time. To counteract this it is important to stress the benefits of the system in reducing errors and that once one is comfortable with it, it will actually cut down on the time taken to dispense medications.
There is a lot of repetitive reasoning, but it must be stressed to the staff that the goal of bar coding and eMARs is to enhance patient safety. Here are some facts about medication errors in the United States. There are 7,000 deaths per year in U.S. hospitals due to medication errors (Patient Safety & Quality Healthcare [PSQH], 2005). The VA Medical Center in Topeka, Kansas reduced it’s medication errors by 86.2% after the implementation of the eMAR system. Other hospitals have shown a decrease in errors by up to 80% (PSQH).This new change will ensure that the 5 Rights of Medication Administration are followed. They are listed above. We cannot forget that near misses and medication errors can be ultimately prevented with bar scanning and eMARs. The system is already set up to trigger alerts and warnings in regards to sound-alike or look-alike drugs, a National Patient Safety Goal that JCHACO is very particular about. This will ensure our hospital’s compliance with the latest medication standards and protect our patients from potentially hazardous mistakes.
Having a more technologically advanced hospital will generate positive public relations in the community. The eMAR system will ensure that the staff has legible orders, and they will not have to scrutinize and guess at physician’s hand written orders since everything will be computerized. The eMAR System ensures easy bedside documentation in real time. This cuts down on ‘forgetting’ what time a medication was administered. In addition, the new system gives access to immediate data in the clinical setting, accessible from all computers hooked to the system.It improves nursing staff job satisfactionThe eMAR system ensures that nurses will have a reduction in the incidence of medication errors.Patient satisfaction will be increased, due to the fact that patients will realize that prior to giving medication there is an extra effort to confirm they are getting the right medication, the right dose, right time, the right route and of course the right patient.
This slide lists a few more factors that may influence the bar coding system.Repetitive motion has been shown to lead to carpal tunnel. By using the eMAR system, there is less gripping of pens in the workplace, and nurses will have less manual data entry activities with bar scanning.The eMAR system provides an accurate tracking system, inventory management, real time charting and patient billingThe eMAR system allows pharmacists to focus on clinical duties instead of dispensing tasks. This allows pharmacists to be more easily accessible and available to staff, physicians and patients for education and consulting purposes.The final point is that one of the National Patient Safety Goals for 2009 as required by JCACHO is having 2 patient identifiers for medication administration. By using the new system, this supports our organizations’ compliance with the National Patient Safety Goals and also promotes our accreditation process since we have the system already in place.
To achieve outstanding results in the areas of productivity improvement, employee commitment, smoother running processes, resource integration and your management development; Learning Team A offers tips.Douglas McGregor (the author of Theory ‘Y’) believed that people want to learn and that work is their natural activity to the extent that they develop self-discipline and self-development. Employees see their reward not so much in cash payments as in the freedom to do difficult and challenging work by themselves. The job of the manager is to ‘dovetail’ the human wish for self-development into the organization’s need for maximum productive efficiency. Therefore, the basic objectives of both are met and with sincerity and imagination, the enormous potential can be tapped. According to Frederick Herzberg, the author of the Hygiene/Motivation Theory, people work first and foremost in their own self-enlightened interest. Hygiene factors are supervision, interpersonal relations, working conditions and salary. These are the animal needs of people. The human needs (motivators) are recognition, work, responsibility and advancement. Unsatisfactory hygiene factors can act as de-motivators, but if satisfactory, their motivational effect is limited. To meet the human needs more; consider offering shorter work weeks, increased wages, fringe benefits, sensitivity/human relations training and effective communication. Victor Vroom’s Expectancy Theory (VIE Theory) suggests that for any given situation, the level of a person’s motivation with respect to performance is dependent upon his or her desire for an outcome and that the individual’s job performance is perceived to be related to obtaining other desired outcomes; and the perceived probability that his or her effort will lead to the required performance. This theory can be expressed as M=V x I x E .Motivation equals the valence times the instrumentality times the expectancy. This theory is very useful because it helps to understand a worker’s behavior. If employees lack motivation, it may be caused by their indifference toward, or desire to avoid, the existing outcomes. The important question to ask is, “What rewards (outcomes) do your employees value?” Understanding individuals and what motivates them can be a challenge because employees are diverse not only in culture, race and gender, but varying levels of education. It is hoped that these three theories of motivation will assist you in predicting employees’ behavior so that one or more of these theories can be implemented to influence the behavior that is desired. Then and only then, will the organization achieve success through increased job satisfaction.