IT in Nursing Practice

• The unit is a discussion of the information technology applicable in nursing practice.
• Such IT aspects are hospital and critical care applications using monitoring devices.
• Community health applications are centered on the health information system of the community.
• Key emphases include disease prevention, medical intervention, and public awareness.

Purpose & Objectives

• Ability to describe the information technology applicable in nursing practice by the conclusion of the unit.
• Comprehension of the application of nursing informatics in community health practice is also an objective.

Hospital and Critical Care Applications

• A lot of information technology is applicable in the hospital.
• Information technology applications can be branched out based on the major functional hospital departments of Administration, Clinical, and Nursing.
• In the administration department, patient admission and retrieval of records uses computer applications for efficiency.
• The focus is on critical care and how the nursing division benefits from information technology.

Applications of Information Technology

• Applications are focused on patient care:
• Process, store and integrate physiological and diagnostic information from various sources.
• Provide clinical decision support through alerts, alarms and protocols.
• Present deviations from pre-set ranges by an alarm or an alert.
• Provide access to vital patient information from any location inside and outside of critical care settings.
• Accept and store patient care documentation in a lifetime’s clinical repository.
• Comparatively evaluate patients from outcomes analysis while presenting clinical data based on a concept-oriented view.
• Trend data in a graphical presentation.

Physiologic Monitoring Systems

• Original physiological monitors oversaw the vital signs of astronauts.
• By the 1970's, monitors were in the hospital setting.
• Physiological systems have sensors
• Systems also include signal conditioners
• Additional parts include file to rank and order information
• Furthermore there is a computer processor to analyze and direct reports
• The evaluation or controlling component regulates the equipment or alerts the nurse.

Microprocessors

• Physiologic signals are typically of very small amplitude.
• Signals must be amplified, conditioned, and digitized by the device.
• The information is prepared for processing by its embedded microprocessors.
• The reporting direction is controlled.
• Nursing personnel are alerted through a report, alarm, or visual notice.
• Monitoring systems store various data elements with a time stamp from the monitoring system's internal clock.
• Physiologic monitoring systems typically have a modern platform.
• Modern platforms allow selection of various monitoring capabilities to match needs in a variety of clinical settings.
• Specialized monitoring capabilities like intracranial pressure or bispectral index are in modular format.
• Physiologic monitors usually incorporate both arrhythmia and hemodynamic monitoring capabilities.

Hemodynamic Monitors

• Hemodynamic monitors measure hemodynamic parameters to closely examine cardiovascular function.
• Cardiac pump output and volume status are evaluated.
• Patterns (arrhythmia analysis) are recognized, and features extracted.
• Vascular system integrity is assessed; the patient’s physiologic response to stimuli are evaluated.
• Respiratory gases (capnography) are continuously assessed.
• Glucose levels are continuously evaluated.
• Waveforms are stored.
• Selected data is automatically transmitted to a computerized patient database.

Thermodilution Technique

• The bolus must be injected within 4 seconds.
• The amount of solution must be at an accurate temperature.
• The catheter must be properly placed
• The computer must compute it appropriately.
• A constant bolus must be injected at the appropriate time in the respiratory cycle.

The Process of Thermodilution

• User-related issues are negated by using heat from a thermal filament embedded in the catheter to replace the injectate.
• An alternative for measuring cardiac output noninvasively is thoracic electrical bioimpedance.
• Four sensors are positioned on the sides of the neck and thorax.
• Monitoring these changes permits measurement of stroke volume.
• Monitoring changes also measures indices of contractility, such as velocity and acceleration of blood flow, supraventricular rhythm, and index.
• Bioimpedance is a factor integrated with analysis of the finger blood pressure waveform.
• Using bioimpedance has been demonstrated as a method of cardiac output measurement.

Pulse Oximetry

• Availability of oxygen to bodily tissues is a critical piece of hemodynamic information.
• The standard for measurement of blood’s oxygen saturation is co-oximetry.
• Pulse oximetry is a noninvasive method of measuring oxygen saturation.
• Spectrophotometry is also used.
• Light is emitted through a pulsatile arteriolar bed and detected by a photosensor.

Anticipated Problems

• Blood pressure cuffs will cause alarms in the ICU.
• So will Tourniquets
• Air splints may cause venous pulsations.
• Sensor's ability to distinguish between arterial or venous blood pressure may be limited.
• Pulse oximetry provides a measure of oxygen delivered to the tissue.
• Mixed venous oxygen saturation provides a measure of the amount of oxygen used by the patient.
• Nurses spend more time in troubleshooting.
• Troubleshooting can lead to less bedside care
• It is important for nurses to become familiar with the user guide.
• Machine familiarity includes knowing the trouble shooting aspect.
• Some pulse oximeters are more sensitive and need specific charging times.
• Some pulse oximeters are more durable than others.

Telemetry

• Hemodynamic monitoring can take place at the bedside or be conducted from a remote location via telemetry.
• Telemetry facilitates continuous patient monitoring usually outside of the ICU.
• Telemetry monitoring is susceptible to signal loss.
• Computer-based hemodynamic monitoring offers a wealth of information to the critical nurse, but does not replace clinical judgment.

Arrhythmia Monitor

• Computerized monitoring and analysis of cardiac rhythm is reliable and effective.
• Arrhythmia monitoring is effective in detecting potentially lethal heart rhythms.
• A key functional element is the system’s ability to detect ventricular fibrillation and respond with an alarm.
• System types include: Detection, Surveillance, Diagnostic, and Interpretive.
• Basic components of arrythmia monitors: Sensor, signal conditioner, and cardiographer.
• Further listed components: Pattern recognition, rhythm analysis, and diagnosis written report.

Differences in Arrythmia Monitoring Systems

• In a detection system, the criteria for a normal ECG are programmed into the computer.
• Interpretive systems search the ECG complex for five parameters.
• Monitored parameters include: location for QRS complex, time from the beginning to the end of the QRS, comparison of amplitude, duration, and rate of QRS complex with all limb leads P and T waves, and comparison of P and T waves with all limb leads.

Critical Care Information System (CCIS)

• A system designed to collect, store, organize, retrieve, and manipulate all data related to care of the critically ill patient.
• CCIS is the organization of a patient’s current and historical data.
• CCIS allows the free flow of data between the critical care unit and other departments.
• Each patient’s data can be accessed from any terminal or workstation.
• CCIS components include: Patient management service, length of stay, mortality, and readmission rates.

Vital Signs Monitoring (CCIS)

• Vital signs and other physiologic data are automatically acquired from bedside instruments.
• Vital signs are incorporated into the clinical database.
• Data is incorporated into flow sheets with other data elements.
• Other data elements include: laboratory results, body system assessment findings, and problem lists.

Clinical Documentation (CCIS)

• Supports the process of physical assessment findings.
• Flowsheets may be configured to ease data collection, since the critical care environment requires frequent assessments.
• Flowsheets may also be organized by body system.
• Information system benefits all medical professionals
• All medical staff document patient assessment findings into the CCIS
• Automatic calculation of physiologic indices performed.

Decision Support (CCIS)

• CCIS provides alerts and reminders to guide care in accordance with evidence-based guidelines.
• It provides point of care access to knowledge bases.
• Included knowledge includes: evidence-based guidelines of care, drug information, procedures, and policies.
• Data can be integrated with patient information.

Medication Management (CCIS)

• CCIS can facilitate the medication administration process.
• Medication administration flowsheets incorporate the use of bar code technology.

Interdisciplinary Plans of Care (CCIS)

• Incorporates Special flowsheets, required treatments, and interventions.
• Workflow management solutions help orchestrate all the numerous, simultaneous processes.

Provider Order Entry (CCIS)

• Electronic entry and communication of patient orders can help clinicians improve communication.
• Using systems in the CCIS streamlines processes, facilitates care, and helps clinicians manage quality.
• The system benefits all providers.

Community Health Applications

• Focuses on the health information system of the community.
• Centered on the majority part of the public.
• Emphasizes disease prevention, medical intervention, and public awareness.
• Fulfills a unique community role promoting and protecting health.
• Maintains sustainability and integrity of health data and information.

Goal of Community Health Informatics

• To have effective, timely assessment.
• This involves health monitoring and tracking of populations.
• Includes disease outbreak and epidemic identification and control.

Community Health Application System

• Encourages the application of computer system, programs and communication for the benefit of the majority of individuals.
• Includes family and community.

Primary Focus of Community Health Information System

• Preventing, identifying, investigating, and eliminating communicable health problems.
• Providing Accessibility of data and information, through communication.
• Educating and empowering individuals to adopt a healthy lifestyle.
• Facilitating data retrieval and its effective transformation into information.
• Integrating information with other disciplines to create better concretized knowledge and understanding.
• Creating computerized patient records.
• Creating a medical information system with central repositions of all data, such as a data warehouse.
• Creating a Simple Graphical User Interface (GUI) for nurses, other healthcare providers, patients, and consumers.

Computer Based Survey System/Health Statistical Surveys

• Surveys include health statistical surveys:
• Survey use includes information collection, about items in a population
• Survey use includes: establishing certain information from the obtained data.
• Focused on opinions and factual information.
• Many administer questions to individuals.

Health Statistical Surveys Advantages

• Consistent exchange of response
• Disease tracking
• Data and information sharing, also building strategies.
• Early detection and monitoring of disease and sickness and control of spread of disease.
• National alertness and preparedness, while building strong communication.
• Maintaining strong relations between nurses and other healthcare providers.
• Continuous coordination of synchronization of decisions by healthcare professionals as a team.
• Improving Streamlining the process.
• Providing Effective management of data and information along with optimal operation of hospital and clinics.

Philippine Integrated Disease Surveillance and Response (PIDSR)

• The system is a multi-faceted public health disease surveillance.
• The goal of PIDSR is Providing public health officials the capabilities to monitor the occurrence and spread of diseases.
• The Vision is to Improve availability and use of surveillance and laboratory data, so that public health managers and decision makers can plan response to leading causes of death.
• Goal of the system is to Strengthen surveillance and response capabilities at each level of the health system through local capacities or leveraging strengths through coordination.
• Facilitate collecting, managing, analyzing, interpreting, and disseminating health-related data diseases (nationally notifiable)
• Develop and maintain national standards and Develop consistent case definitions.
• PIDSR maintains official national statistics and Provides detailed data to control programs while working with cities and provinces to implement prevention and control programs.

Ambulatory Care Systems

• Ambulatory care nurses focus on quality and safety.
• Focus includes appropriate interventions, such as identifying patient needs, performing procedures, promoting advocacy, and coordinating services.
• The healthcare system also involves assisting the patient to navigate the system and evaluating patient outcomes.
• The wide ranged services are offered to medical patients
• Integrating the ambulatory care information system facilitates data processing, and billing.

Ambulatory Care Info System Advantages

• Access of medical records of patients to health care providers
• Nurses provide quality care, improve workflows and reduce medical errors.
• Quality care monitoring, prescriptions and medication billing is easily managed.
• Make sure that the patient receives the care that needed;
• Improve the quality of care.

Emergency Preparedness and Response

• Over-all objective is public health when it comes to informatics in community health.
• The difference is focus and level of prevention.
• Community Health-focus of informatics is promotive and preventive aspects.
• Emergency Preparedness-focuses on the mitigation and control of emergencies.
• Mitigation and control includes rapid transfer of information with clear communications.
• Bio surveillance is a key capability.
• Requires Early recognition and under departures from animal/human/plants/environment.
• Baseline Informatics give early warnings and save lives.
• Some say the U.S. plays a key role as part of surveillance network.

Informatics Movement

• Rapidly modernizing
• New data tracking capabilities available to health care organizations
• All populations benefit from information expansion
• Disaster communities reap these rewards too
• Radiofrequency Identification (RFID) is one technology for tagging potential disaster victims.

Mass Software

• Better available for disaster and file sharing
• Collaboration in business and reduction of work
• Emergency operation centres distribute support
• Centers are now less centralized.

Telehealth

• According to Mayo Clinic (2020), telehealth is the use of digital information and communication technologies.
• Use assists in providing access to care remotely, while helping to manage one's health.
• Telehealth includes technologies one uses from home.
• Mobile phone health logging is an option for food, medication, and levels.

Diabetes Care

• Carbo counting videos and downloads are available through smart phones.
• There are apps to control how much medication to distribute too.
• Patients are able to reach doctors to check results fast and efficiently.

Telehealth Goals

• The following are the "reach" goals:
• Those whom live in rural areas and have no contact to the surrounding area.
• Telehealth may improve access to medical specialists.
• Care improves communication.
• Easy self-management support is available.

Telehealth in the Philippines

• Emergence of pandemic and quarantine necessity
• Widely adopted here
• UP national center and use available tech to improve distance
• Telehealth is implemented
• Cost effective and maximum available tools are implemented for delivery

Informatics during Covid

• Global society was majorly impacted by the COVID-19 pandemic.
• Informatics teams are a critical part of these efforts
• Informatics can support while new methods of delivering care.
• Informatics also aids in tracking the relating impact data.

IT and informatics Specialist

• Integral to actions taken by facilities
• Partner shortage solutions are solved though informatics
• PPE technology is advanced though Informatics

IS and IT Mass Covid Notifications

• Mass notifications
• Updated rapidly
• Communication system must allow information to those
• Equipment disinfection may be achieved as well.

Interoperability

• Processes are supported by rapid testing.
• Lab tests may rapidly be done given the proper technology, decision systems and EHR’s
• Important to protect data in pandemic.

Digital Health Canada

• Collection to health specialists • Support frontline workers • Also support connections in Canada through links

Wegree Robots

• Robots use is to contact clients and staff alike that may be used for check in.

Virtual Covid

• IT assist those whom may be isolated in hospitals or home care. • Paramedics rely in this type of tool. • Technology helps protect all data.

Tracking and Forecasting

• Covid tracked on interactive dashboards to get Canadians data • IAHSI emphasized informatics with informatics so they can see data available.

Pandemic tracking.

• Track and check consent to protect privacy • Get any independent analysis