The Challenge of Adoption: A Nurse's View of EMR and the Road Ahead
- A Nurse's View of the EMR -- Kathy English, Kris Hanke
- Closed Loop Pharmacy Safety Demo -- Kris Hanke
- Clinical Coordinator -- Carol Blair, Midland Memorial
- Questions and Discussion
- Medsphere.org: Tip of the Month
The December call will center on a Nurse's perspective of the EMR and will feature a demonstration of the closed loop medication capabilities of OpenVista. This would be an excellent call for any clinical application coordinators, specialists and nurses to join. Please feel free invite any colleagues that might find this topic relevant.
When: December 18, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
Details and Recording available here: http://medsphere.org/blogs/events/2008/12/18/community-call-december-2008
The Institute of Medicine’s 1999 report, To Err is Human, set
a goal to help remedy a healthcare system compromised
by preventable patient errors. One of their major
recommendations to reduce medical error frequency
encouraged the use of medical informatics and electronic
record systems (Kohn LT, 2000). Bates and Gawande stated,
“If medicine is to achieve major gains in quality, it must be
transformed, and information technology will play a key part,
especially with respect to safety” (Bates, 2003). The American
College of Obstetricians and Gynecologists’ continuing
commitment to patient safety led them to classify seven
objectives in 2003 (updated in 2009), two of which focused
on improving communication between medical staff and
patients including incorporation of technological solutions
(American College of, 2003; American College of, 2009).
The Institute of Medicine’s 1999 report, To Err is Human, set
a goal to help remedy a healthcare system compromised
by preventable patient errors. One of their major
recommendations to reduce medical error frequency
encouraged the use of medical informatics and electronic
record systems (Kohn LT, 2000). Bates and Gawande stated,
“If medicine is to achieve major gains in quality, it must be
transformed, and information technology will play a key part,
especially with respect to safety” (Bates, 2003). The American
College of Obstetricians and Gynecologists’ continuing
commitment to patient safety led them to classify seven
objectives in 2003 (updated in 2009), two of which focused
on improving communication between medical staff and
patients including incorporation of technological solutions
(American College of, 2003; American College of, 2009).
“The phrase ‘Never Events’ now evokes strong feelings in both medical and consumer circles. The Picker Institute has seized the concept and stood it on its head to come up with the notion of ‘Always Events.’ Picker is looking to identify those elements of the health care experience that should always happen from a humanistic perspective.”
Dr. James is medical director of Humana’s National Network Operations and practices Pediatrics/Internal Medicine at Normton Community Medical Associates-Audubon West.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
Apply Patient Safety Solutions to Clinical Practice: why is it so hard by S. ...ALIAS Network
If you are interested in the topic please register to the ALIAS network:
http://network.aliasnetwork.eu/
to download other materials and get information about the ALIAS project (www.aliasnetwork.eu).
Lessons Learned in the National Patient Safety Agency in UK. Helen Glenister. III International Conference on Patient Safety: "Patients for Patient Safety" (Madrid, Ministry of Health and Consumer Affairs, 2007)
StackOps creates the most reliable OpenStack Distro and a suite of products built for the enterprise. In this presentation, Arturo Suarez, Founder and COO, explains why the Adoption of Cloud Computing in Europe is 2 years behind, what are the reasons, the players and how OpenStack is the platform that, due to its great flexibility, can help Europe close the gap.
Presentation done in Paris, November 29, 2012
“The phrase ‘Never Events’ now evokes strong feelings in both medical and consumer circles. The Picker Institute has seized the concept and stood it on its head to come up with the notion of ‘Always Events.’ Picker is looking to identify those elements of the health care experience that should always happen from a humanistic perspective.”
Dr. James is medical director of Humana’s National Network Operations and practices Pediatrics/Internal Medicine at Normton Community Medical Associates-Audubon West.
Presentation to class at University of Notre Dame who are creating website and materials in honor of Amanda Abbiehl. Amanda died of a PCA-related incident and would have been attending college if she was alive.
Apply Patient Safety Solutions to Clinical Practice: why is it so hard by S. ...ALIAS Network
If you are interested in the topic please register to the ALIAS network:
http://network.aliasnetwork.eu/
to download other materials and get information about the ALIAS project (www.aliasnetwork.eu).
Lessons Learned in the National Patient Safety Agency in UK. Helen Glenister. III International Conference on Patient Safety: "Patients for Patient Safety" (Madrid, Ministry of Health and Consumer Affairs, 2007)
StackOps creates the most reliable OpenStack Distro and a suite of products built for the enterprise. In this presentation, Arturo Suarez, Founder and COO, explains why the Adoption of Cloud Computing in Europe is 2 years behind, what are the reasons, the players and how OpenStack is the platform that, due to its great flexibility, can help Europe close the gap.
Presentation done in Paris, November 29, 2012
How OpenStack is paralleling Linux adoption (and how it isn't)Gordon Haff
OpenStack is paralleling and will likely continue to parallel the adoption of another open source project that has become enormously popular and successful—namely Linux. The parallels are educational and useful in that they lend insight into the rate at which adoption takes place and what we might expect successful adoption to look like. At the same time, this session will provide appropriate caveats about assuming that OpenStack can be viewed as just a latter-day Linux. By applying this sort of historical perspective, we can better understand what might be the most effective approaches to collaboration, community-building, and cooperation moving forward.
Rudi Schubert (IEEE Standards Association) Challenges for Smartglasses AdoptionAugmentedWorldExpo
A discussion on the role of smart glasses in the Industry 4.0 context firstly requires a classification on the different types of smart glasses. A taxonomy for smart eyewear allows to map use cases and business requirements of the industry with the strengths and weaknesses of each class. The gap between business reality and hardware aspiration is the basis to discuss future trends and the expected evolution. Smart glasses are a key component to provide human-centered support and to connect the desk-less operator with the IoT and other elements of the cyber-physical factory of the future.
Software Defined Networks (SDN) is an evolutionary paradigm that will not only change how the vendors will built their products and technologies, but also change how the organizations are going to consume these capabilities. That said, adoption of these SDN capabilities is very low. Some of them is shaped by the myths and expectations around what SDN can versus cannot do. It is therefore important to understand these adoption challenges and correspondingly use some of the consultative services frameworks to overcome these challenges.
Medical errors are ubiquitous and the costs (human and financial) are substantial. The top priority must be to redesign systems geared to prevent, detect and minimise effects of undesirable combinations of design, performance, and circumstance.
This is Dr. Peter Madras' presentation that was given at the Health Innovators meeting on July 21st.
For more information on Health Innovators, please visit us at http://www.healthinno.org
This presentation has the measures to be taken for the safety of patients. It covers the 6 goals
Goal 1: Identify patients correctly
Goal 2: Improve effective communication
Goal 3: Improve the safety of high-alert medications
Goal 4: Ensure safe surgery
Goal 5: Reduce the risk of health care-associated infections
Goal 6: Reduce the risk of patient harm resulting from falls
Health care consumers benefit from understanding some of the issues involved in providing them with the best care, and some things they can do themselves to prepare for and learn about these issues. Doctors, nurses, and other health professionals dedicate their lives to caring for their patients. But providing health care can be complicated.
Risk Management and Patient Safety Evolution and Progress. Charles Vincent. Match Safety critical component of quality (Madrid, Ministry of Health and Consumer Affairs, 2005)
More people die annually from medication errors than from workplace injuries. An error in the prescribing, dispensing, administration of a drug irrespective of whether such errors lead to adverse consequences or not. In India, Medication Error is just a TERM and its significance is undervalued and remains unreported. Reported incidence of this iatrogenic disease related to medication error- tip of the iceberg. medication error can be visualized with the SWISS CHEESE MODEL OF SYSTEM accidents
Medication errors are described under prescription errors, transcription errors, administration errors. Based on the causes of errors the NCC MERP Index is formulated to categorize medication errors from Category A- I. Appropriate monitoring, good team communication, knowledgeable staff, RCA and policy on check of medication errors can reduce its incidence and make patient more safe.
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
Today we hosted a small group of community members to discuss progress on the .org site and chart future directions.
At a high level we discussed:
* Review progress on site
* Contributors agreement
* Statistics on users
* Community member spotlight (Hartsel Bryant)
* Product demonstration (Pharmacy Pricing Engine)
* Future of the Community call
Challenges of Automating Radiology with an Open Source SolutionMedsphere
The presentation included some discussion of the VistA Imaging product, need within the community for a PACS solution, Radiology automation/worklist queuing, Autofaxing system (including technical details on integrating with Hylafax), and closed with a tip on customizing the Medsphere.org interface to be more useful to individual needs.
When: November 20, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
What: Challenges of Automating Radiology with an Open Source Solution
- Introduction
Solutions:
- Integrating PACS to RIS
- Radiology Worklist and Flow Monitoring
- Autofax
- Autofax Under the Hood
- Open Discussion
- Medsphere.org Tip of the Month
Details and Recording available from here: http://medsphere.org/blogs/events/2008/11/20/community-call-november-2008
The January call will focus on introducing the concepts of open development, software lifecycle and upcoming open projects. We have a number of projects on the roadmap and would like to give the community an opportunity to help prioritize the list.
We'll discuss the upcoming GT.M Integration project to more tightly couple OpenVista and GT.M. You can read the proposals and discuss this project at Medsphere.org, see the project homepage here: http://medsphere.org/community/roadmap/gtm
Please feel free to invite any colleagues that might find this topic relevant or interesting.
When: January 15, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
What: Open Development
- Ecosystems at work
- Open Development Introduction
- Community Project Overview
- GT.M Project Introduction
- Project Review
- Medsphere.org: Tip of the Month
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/01/15/community-call-january-2009
April 2009 Community Call
When integrated medication processes and automated cabinets are in place, pharmacists are enabled to practice more “clinical pharmacy”. Often this means getting pharmacists out of the basement and onto the floors where they are available to patients and their caregivers. One of pharmacy’s services is to promote a safe, effective, and economical list of preferred drugs. With well-designed EHR technology as a tool, pharmacists can proactively influence physicians to choose the “right” drug. They can also measure and report on compliance to formulary preferences. The goal of this session is to explore the options available and present experience with a program currently in place at one of our ecosystem sites.
This topic is both clinical and administrative in nature and will likely be useful to all pharmacy staff, clinical specialists involved in building/maintaining CPOE systems, physicians, nurses and others interested in pharmacy management, both from a clinical and fiscal perspective.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Pharmacy-driven Clinical Transformation
- Strategic Drug Selection
- What is it?
- Why do it?
- How can it be done?
- How is it measured?
- Who has done it?
- Transformation Working Group Update
- Review of status
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: April 23, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording here: http://medsphere.org/blogs/events/2009/04/23/community-call-april-2009
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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.
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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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. The Challenge of Adoption:
A Nurse's View of EMR and the Road Ahead
December 2008 Community Call
3. Presenters
• Kathy English
• Kris Hanke
• Larry Washington
• Carol Bair
• Jon Tai
• Ben Mehling
4. Agenda
• The Challenge of Adoption
• Closed Loop Medication
• Guest Speaker: BCMA from the frontlines
• Community Discussion
• Medsphere.org: Tip of the Month
5. The Challenge of Adoption: A Nurse’s
View of EMR & the Road Ahead
December, 2008
6. Introduction
• Kathy English
– Vice President Product Management, Medsphere
• Kris Hanke
– Director Clinical Operations, Medsphere
7. Objectives
• Review of “what makes it difficult to deliver great nursing
care”
• Show how Open Source technology and principles can
address challenges in nursing care delivery and result in
adoption of information technology
9. Nursing Executives are challenged to:
• Drive delivery of safe patient care
• Meet the demands of regulation
• Keep up with the demands of new technology
• Adhere to staffing requirements & prevention of attrition
• Increase staff satisfaction
• Support improvements in patient satisfaction
• …and, do it all with a constrained budget
10. Let’s talk about disruption…
quot;In 1834 The Times said, regarding a significant
piece of medical technology, that, 'it will never
come into general use notwithstanding its
value. It is extremely doubtful because its
beneficial application requires much time and
gives a good bit of trouble to both the patient
and the practitioner; and because its hue and
character are foreign and opposed to all our
habits and associations. It is just not going to
get used.”
11. Patient safety
There is an ever
increasing focus on
patient safety and the
prevention of medical
errors
The human error rate is
11%
Greater than 60% of
error events1
It is estimated that on
average every ICU
patient suffers 1.7
medical errors per day2
1 Romney B Duffey, John W. Saull; The Probability and management of Human Error.2004
Donchin et al. Crit Care Med 1995; 23:294-300
2
12. More than medication errors
•5000 errors per year
Nursing Errors •On a Sample of 393 RN’s
Procedural,
•58% Medication Errors
18.4%
•18.4% Procedural
•11.9 % Charting
Charting, 11.9%
Medication,
58%
(1.) Balas MC, Scott LD, Rogers AE. The prevalence and nature of errors reported by hospital staff nurses. Appl Nurs Res 2004;
13. Errors
40% of Nursing errors that impact patients are not caused
from medications or administering medications.
Other errors identified from a recent study
– Procedural
– Charting
Related causes
Fatigue
Overtime
Burnout
Human nature
(1.) Balas MC, Scott LD, Rogers AE. The prevalence and nature of errors reported by hospital staff nurses. Appl Nurs Res 2004;
14. Information technology the Answer!
“When people become patients, they place their trust in their health
care providers. As providers assume responsibility for their diagnosis
and treatment, patients have a right to expect that this will include
responsibility for their safety during all aspects of care. However,
increasing epidemiological data make it clear that patient safety is a
global problem. Improved nursing care may prevent many adverse
events, and nursing must take a stronger leadership role in this area.
Although errors are almost inevitable, safety can be improved, and
health care institutions are increasingly making safety a top priority.
Information technology provides safety benefits by enhancing
communication and delivering decision-support; its use will likely be a
cornerstone for improving safety. “
Source : PMID: 15246041 [PubMed - indexed for MEDLINE]
15. The use of systems that
prompt bedside
providers to institute and
maintain best practices
for routine care, have
been shown to improve
clinical outcomes and
decrease the cost of
care*
* Holcomb et al. Curr Opin Crit Care 2001; 7:304-11
19. Manual records are subject to interpretation
A Typical Critical Care Flowsheet……..
9
20.
21.
22. Real time accurate communication is critical
“A significant number of
dangerous human
errors occur when
transcribing
information. Many of
these errors could be
attributed to problems
of communication
between the physicians
and nurses.” *
* Donchin et al. Crit Care Med 1995; 23:294-300
27. Nursing climate
• There is a shortage of experienced nurses
• Nurses are right out of school or from agencies needing
further education
• Staffing ratios are dictated & difficult to achieve
• Other countries are providing Nurses
– Communication barriers
– Care responsibilities are different
– Advanced technology options are different
• Installation and use of information technology takes
nurses away from primary responsibilities
*Health Management Academy CNE Forum; Scottsdale, Arizona, Fall 2006
28. Open Source initiatives to help
• Academic Universities are collaborating
– Oklahoma University
– University of Arizona
– University of Washington
– University of Hawaii
– Georgetown
• Collaboration efforts
– Best practice protocols
– Training programs
– Lutheran Medical Center – ED Charting Templates & Tracking
board
– Midland Memorial Hospital – Documentation Templates
30. Factory build & advanced training programs
CIS MODULE FOR CPOE
I. Objectives
A. Place Orders in the Electronic Medical Record (EMR)
B. Sign and update order by changing, renewing, and discontinuing orders in the EMR
C. Place Delayed Orders in the EMR
D. Creating personal quick order templates.
II. Review of Patient Selection Screen
A. Patient Selection
1. Ward/Unit
2. Clinic Name
3. Provider
4. Last,First name
5. Saving default patient selection
B. Notifications (Two types – information only and action)
1. Unsigned notes and orders
2. Critical lab/imagining results
3. Consult updates
4. Flagged orders
5. Completing action notifications
6. Viewing notice only notifications
31. CIS MODULE FOR CPOE
I. Objectives
A. Place Orders in the Electronic Medical Record (EMR)
B. Sign and update order by changing, renewing, and discontinuing orders in the EMR
C. Place Delayed Orders in the EMR
D. Creating personal quick order templates.
II. Review of Patient Selection Screen
A. Patient Selection
1. Ward/Unit
2. Clinic Name
3. Provider
4. Last,First name
5. Saving default patient selection
B. Notifications (Two types – information only and action)
1. Unsigned notes and orders
2. Critical lab/imagining results
3. Consult updates
4. Flagged orders
5. Completing action notifications
6. Viewing notice only notifications
32. CIS MODULE FOR CPOE
I. Objectives
A. Place Orders in the Electronic Medical Record (EMR)
B. Sign and update order by changing, renewing, and discontinuing orders in the
EMR
C. Place Delayed Orders in the EMR
D. Creating personal quick order templates.
II. Review of Patient Selection Screen
A. Patient Selection
1. Ward/Unit
2. Clinic Name
3. Provider
4. Last,First name
5. Saving default patient selection
B. Notifications (Two types – information only and action)
1. Unsigned notes and orders
2. Critical lab/imagining results
3. Consult updates
4. Flagged orders
5. Completing action notifications
6. Viewing notice only notifications
33. Clinician satisfaction in a challenging climate
• Recruitment is challenging
• Nurse to patient ratios are mandated
• Overtime due to hours spent documenting
• Fatigue & burnout
34. Improving Nurse satisfaction
• Recruitment
– Attracting good Clinicians to your organization
• Nurse to patient ratios
– Maintaining Good Nurse/Patient ratios
– Tools to manage your Patients better
• Overtime
– Eliminating Redundant documentation
– Streamlining workflow and process
– Deploying tools to improve Process
35. Streamline Process
• Organizational
• Departmental
• Role
• User
Most often Clinicians will be focused on their own
responsibilities and not the bigger picture of care
36.
37.
38. Regulatory Requirements
• HIPAA
• Core Measures
• Never Events
• Mandatory reporting, Registries
• Decrease variance
• Adherence to care protocols
39.
40.
41.
42.
43. In summary
“given the moral importance of patient safety and quality care in
nursing and related health care domains, the inseparable link
between nursing practice and patient safety, and the central role
that research has to play in driving safety improvements in these
domains, it is morally imperative that the nursing profession gives
sustained and focused public attention to patient safety and
quality care as a national research priority. “
PMID: 16541827 [PubMed - indexed for MEDLINE]
45. Nurses will adopt IT that solves problems
• Promotes safe patient care delivery
• Meets the demands of regulation without extra work
• Keeps up with the demands of new technology through ease of
use, easy to learn & provides information in real time at the point
of care
• Does not negatively impact staffing requirements
• Prevents attrition by permitting a streamlining processes
• Increases staff satisfaction with their job
• Support improvements in patient satisfaction through safe and
efficient care delivery
• …and, do it all with reduced cost and time to efficiency
46. The Ecosystem and Community: Together
Who is better positioned to solve the challenges to nursing in
healthcare?
…a community of nursing care providers who collaborate to bring
complete and best practice solutions to healthcare
68. Guest Speaker
Carol Bair, LVN, Educator/Trainer HIS
Carol presents lessons learned at Midland
Memorial Hospital from the frontlines of an EMR
and BCMA rollout.
69. BCMA from the frontlines
Carol Bair
LVN, Educator/Trainer HIS
Midland Memorial Hospital
70. Workflow: Pharmacy
• If starting with CPOE learn how to finish orders off as if you have
BCMA.
• Insure ordered items are pre packed with barcodes.
• Maintain barcodes.
• Trouble shooting users.
• Flagging data/comments in order to show.
71. Workflow: Nursing
• Important: BCMA is for patient safety and not for the
convenience of the nurse.
• Time management will change.
• Nursing will need to wait until pharmacy verifies orders and
should verify orders in Vista before giving in BCMA.
72. Example
• Be aware that when a medication is ordered that the dosage they
have in their hand needs to match with what is supplied by
pharmacy.
• For example: Lasix 20mg IVP is ordered, the nurse has a Lasix
40mg vial on hand, but pharmacy finishes the order as a Lasix
20mg vial. When the nurse scans the vial she will receive an error
message that says invalid medication look up.
73. Team Effort
• Pharmacy and nursing need to work closely together.
• During training, nursing and pharmacy need to see what
they other department sees. E.g., Nursing will say to
pharmacy when they call “it is the third medication order
down (in CPRS/CIS)”, yet pharmacy’s view is via a different
(Terminal-based) application.
74. The BCMA Committee
Committee should consist of BCMA analyst, Pharmacy
Coordinator, BCMA educator, pharmacist, nursing
administration, cardiopulmonary, staff nurses (valuable).
75. BCMA Committee:
Policies and Procedures:
• What to do when BCMA goes down (Downtime Contingency Plan)
• What happens if safety using BCMA is not followed
• How often to run reports (e.g., missing med and prn effectiveness)
• Range orders (such as Lortab 7.5 1-2 tabs q 4 – 6 hrs): Order will need to
be finished either q 4 hours or q 6 hours.
• Decide on reasons for held, refused, prn’s, and IV sites.
• Who will be able to access BCMA? Nurses, students, physicians?
76. BCMA Committee
Technical Details:
• Decide if BCMA will be loaded onto desktops or only
Computers on Wheels (COWs).
• Decide what scanners and carts to use.
• Verify barcodes scan on armbands, medications, and IV
bags. (e.g., Light colored barcodes are hard to scan.)
77. BCMA Committee
Responsibilities:
• How much training and who will be trained?
• How will implementation be conducted?
• Competencies -- who is responsible for filling out?
• General support coverage (24-7). (Also, make sure you
have adequate (additional) staffing during go live.)
78. Going Live!
• Decide when to go live with BCMA
• Consider a “soft go live” (i.e., select only one or two
patients)
• Make certain that adequate support staff are
available/scheduled during go live
• During the go live, meet daily to document, discuss, and
solve any issues
• Decide who will print armbands. Extra armbands available if
all units can print
79. Questions?
Discussion, questions and comments?
Authors:
Carol Bair -- carol.bair@midland-memorial.com
Randy Adams -- randy.adams@midland-memorial.com
81. Searching on Medsphere.org
• Accessing the Search feature
– Persistent User Bar on Medsphere.org
– Getting Started widget on Medsphere.org home page
– Adding Medsphere.org to your browser’s built-in search box
• Default search is an AND search
– Content containing all of the words in your query will be
returned
82. More Options
• You can limit your search by
– Content type
– Last modification date
– Community
– Author
83. Advanced Searching
• You can limit your search to the
– Subject, e.g., subject:FAQ
– Body, e.g., body:HIPAA
– Attachments, e.g., attachmentsText:autofax
– Tags, e.g., tags:linux
• Use quotes for phrases
– e.g., “medical record” or “OpenVista CIS”
• Use OR and AND keywords
– e.g., (laboratory OR radiology) AND autofax
• Use NOT to exclude keywords
– e.g., (laboratory OR radiology) NOT autofax
• Use ^ to boost a keyword’s importance
– e.g., “medical record”^5 VA
84. Additional Reading
• More search resources
– Jive blog post on improved searching in Clearspace 2.x
• http://www.jivesoftware.com/jivespace/blogs/jivespace/2008/06/16/search-
improvements-in-20x-and-21
– Medsphere.org search tips page
• http://medsphere.org/search-tips.jspa