In the perioperative setting, the collection of data from documentation is critical in making significant changes to prevent wrong site surgeries, wrong procedures, retained items, and other situations that can affect patient outcomes. Nursing informatics is one way that has allowed operating rooms to run safer and improve patient outcomes. “Nursing informatics is a specialty that integrates nursing, science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice” (Sweeney, 2017). Advancements in electronic documentation has us “the ability to track and trend patient outcomes in a more efficient manner and collect data that was previously difficult or impossible to capture” (Cygan, 2015).

With the advancements that have been made in electronic documentation, we can now track data that will give us a clearer picture of communication breakdowns, distractions in the perioperative setting that may be leading to wrong site, wrong procedure surgeries, staffing issues, process failures, and other pertinent data that can lead to poor outcomes.

A nurse leader can use clinical reasoning and judgement to implement new safety measures to reduce or eliminate the opportunities for communication breakdowns and distractors that may lead to poor patient outcomes.  For example, the surgical timeout was introduced in 2003 after data was collected and analyzed to identify the main causes for wrong site, wrong procedure surgeries. “A time-out, which The Joint Commission defines as “an immediate pause by the entire surgical team to confirm the correct patient, procedure, and site,” was introduced in 2003” (Pelligrini, 2017). Although the surgical timeout has not eliminated these sentinel events, it has greatly reduced the number. With the continued use of nursing informatics, hopefully one day, the perioperative environment can be free of sentinel events.

References

Cygan, H. (2015, July 12). Med/surg nurses use informatics to save time, enhance patient safety. Nurse.com Blog. https://www.nurse.com/blog/2015/03/12/medsurg-nurses-use-informatics-to-save-time-enhance-patient-safety/

Pelligrini, C. (2017, May 31). Time-outs and their role in improving safety and quality in surgery. The Bulletin. https://bulletin.facs.org/2017/06/time-outs-and-their-role-in-improving-safety-and-quality-in-surgery/

Sweeney, J. (2017). Healthcare Informatics. Online Journal of Nursing Informatics, 21(1), 4-1.

Susannah, you have highlighted a pertinent issue on turning data from data informatics tools into knowledge that can be applied to support clinical reasoning proficiencies, which, in turn, are fundamental in the clinical judgment process. The latter is central to accurately and successfully analyzing and synthesizing patient’s manifestations, subjective and objective data, and offering evidence-based nursing interventions to enhance clinical decision-making and patient outcomes (Dalton et al., 2015). It is true that nursing informatics plays a central role in informing decision-making in the perioperative setting. For example, the nurse manager can synthesize data from the EHR to identify patterns of surgical-sites infections, identify the possible risk factors, and use the processed data to formulate solutions, including recommending and implementing evidence-based care bundles (Institute for Healthcare Improvement, n.d.).

References

Dalton, D. L., Gee, T., & Levett-Jones, P. T. (2015). Using clinical reasoning and simulation-based education to ‘flip’ the enrolled nurse curriculum. Australian Journal of Advanced Nursing, 33(2), 28–34.

Institute for Healthcare Improvement. (n.d.). Changes to Prevent Surgical Site Infection . Retrieved March 4, 2022, from http://www.ihi.org/resources/Pages/Changes/ChangestoPreventSurgicalSiteInfection.aspx

Susannah,

The only time I was in the O.R was during clinicals in nursing school. I loved it, but only remember one nurse

sitting at the computer. The others were completely hands-on. It’s hard to imagine that one nurse can document

every movement that happens in that room. Do you feel that informatics can decrease the chances of a sentinel event

occurring in this particular setting more than healthcare professionals? ” Currently, there is insufficient evidence to reach

a conclusion on patient safety outcomes for the following health information technologies; electronic sign-out and hand-off

tools, smart pumps, bar-code medication administration, retained surgical items detectors, patient portals, telemedicine and

electronic incident reporting.” (Alotaibi & Federico, 2017.)

There is no doubt that informatics is huge help in preventing such events, however; there is nothing like a

surgeon asking their patient which surgery they are having that day and what side of the body it will be on , etc. There

is nothing like manual counts, though barcodes definitely help I am sure.” When considering these systems and how

they effect the process and flow of the clinical setting, it is important to not only consider the technology at hand but

also the workflow and the data collection process.” (Sweeney, 2017) Technology is only as good as the one using it. It’s

an amazing tool that saves lives but when the wrong data is put into it, it becomes our worst enemy.

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical       

                journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

Sweeney, J. (2017). Healthcare Informatics. Online Journal of Nursing Informatics, 21(1), 4–1.

Susannah,

I really enjoyed reading your post about the operating room and complying data to help prevent future incidents. After working in labor and delivery for over 5 years and participating in cesareans, I could not agree more with the importance of all the different departments taking part of the time out. The Joint Commission established two different National Patient Safety Guidelines (NPSG’s) after compiling data from multiple hospitals on sentinel events in the operating room which would not have been set in place if it was not for informatics or data collection (Hofman & Lobaton, 2016). With “time-outs” in the operating room or even team huddles at the beginning of shifts, we can help prevent patient harm. Wrong-site surgery can have devastating consequences for the patient and a negative impact on the entire surgical team (Kwan, 2006). As nurses working towards our master’s degree and becoming providers, we need to remember one of the important ethics in the standard of care, non-maleficence or do no harm.

Kwan M. S. (2006). Incidence patterns and prevention of wrong-site surgery. Archives of Surgery, 41, 353–358.

Hofman, J., & Lobaton, E. (2016). Case Management Matters. “Time-Out” in the Operating Room. Professional Case Management, 21(4), 209–212. https://doi.org/10.1097/NCM.0000000000000171

Hi Susannah,

You bring up an excellent discussion and scenario on the incorporation of nursing informatics within the perioperative setting. As you stated, documentation is essential and critical in the operating room. Electronic documentation provides an organized log of procedural events involving medication administration, supplies, timestamps, staff, and vital signs. The procedural log can be utilized as a future reference for review for patients undergoing the same procedure or similar procedures later which can enhance safety and preparedness. Additionally, the procedural event log can be used to improve workflow through data tracking and facilitating post procedure debriefing, 

Nursing informatics has optimized the ability of supply tracking of equipment inventory through the use of barcode technology. In the procedural area, it is extremely important to keep an organized record of inventory to ensure availability of necessary supplies for upcoming procedures. Barcode scanning technology can conveniently keep count of supplies and in some cases, can automatically reorder supplies when it recognizes the item falls below a specific par level. “Adding barcode technology can improve accountability, control of the supply chain, and set standards of care at a higher level of reliability” (Lachman & van der Wilden, 2021). Barcode technology can assist the inventory manager in analyzing physician preferences of supplies allowing adjustments to supply par to fit the needs of specific operating rooms. Furthermore, scanning technology for supply control can be used to track expiring items on the shelves, providing a safer and more reliable environment, reducing the risk of human error. Using expired medical supplies can lead to increased probability of infection and negative patient care outcomes. By utilizing this form of informatics technology, members of the procedural team can experience reduced stress which ultimately contributes to quality care and patient safety (Sweeney, 2017). Lachman & van der Wilden (2021) discuss that within high stress and high-risk environments such as the operating room, supply chain system technology benefits clinical process and planning, improves medical device management, increase efficiency, and contribute to patient safety. 

References

Lachman, P., & van der Wilden, E. (2021). Use of barcode technology can make a difference to patient safety in the post-COVID era. IJQHC Communications, 1(1). https://doi.org/10.1093/ijcoms/lyab014

Sweeney, J. (Feb, 2017). Healthcare Informatics. Online Journal of Nursing Informatics (OJNI), 21( 1),

Hello Steven,

Great write up. I do agree with you. Nurses make use of collected data via nursing informatics to coordinate and provide care faster. According to Sweeney 2017, the creation of Electronic Health Records (EHR) facilitates delivery of care in a timely manner. Furthermore, Rady and Anwar 2019, are of the opinion that data mining helps to extract hidden details from large medical and clinical data collected such as labs. This information is very vital as it provides insight to diagnostics and specific plan of care and treatment for the patient. All this safes time which is very vital in-patient care.

Reference

Rady, E. H. A., & Anwar, A. S. (2019). Prediction of kidney disease stages using data mining algorithms. Informatics in Medicine Unlocked, 15, 100178.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Steven, I agree with you that nursing informatics played a critical role in the management of the COVID-19 pandemic. In Taiwan, a national health insurance database was integrated with immigration and customs data to generate real-time alerts during clinic visits to aid in case identification (Wang et al., 2020). Online questionnaires were utilized to risk stratify travelers so that low risk citizens were automatically sent a health declaration border pass while high-risk individuals were quarantined at home and remotely monitored for the development of symptoms with mobile device applications (Wang et al., 2020). Healthcare systems in Houston, Texas, developed remote communication channels between physicians and emergency responders to assist with triaging (Hollander & Carr, 2020) Virtual home visits for high risk individuals and remote ICU monitoring is also being employed to reduce hospital staff contact with patients with suspected or confirmed cases of COVID-19 (Hollander & Carr, 2020). In your view, what are the security concerns with the explosion of informatics tools during the pandemic?

References

Hollander, J. E., & Carr, B. G. (2020). Virtually perfect? Telemedicine for Covid-19. New England Journal of Medicine, 382(18), 1679–1681. https://doi.org/10.1056/NEJMP2003539/SUPPL_FILE/NEJMP2003539_DISCLOSURES.PDF

Wang, C. J., Ng, C. Y., & Brook, R. H. (2020). Response to COVID-19 in Taiwan: Big data analytics, new technology, and proactive testing. JAMA, 323(14), 1341–1342. https://doi.org/10.1001/JAMA.2020.3151

Response #2

Jorge, 

Universal Electronic Health Records (EHR) would be so beneficial especially like you mentioned, for psych patients.  According to Materia Socio Medica Journal, less than 1 in 5 practices accurately use EHR functions to improve patient quality. They also mention the different barriers for universal EHR such as resistance to change, organizations constraints, cost restraints, and standardization limits (Ajami & ArabChadegani, 2013).

My hospital system uses the EHR called Epic. Within Epic is a link called Care Everywhere which is so beneficial to patient care (Organizations on the Care Everywhere Network, 2022). Any health system that uses Epic can go into Care Everywhere and retrieve medical records, imaging, lab results, medications ordered, office visit notes, etc. It helps tremendously with patient care and helps fill in gaps in the patient’s medical history. Hopefully soon we can achieve a universal EHR which will benefit patients and provide easy access to medical records. Thank you for allowing me to contribute to this post.

References

Ajami, S., & ArabChadegani, R. (2013). Barriers to implement electronic health records. Materia Socio Medica, 25(3), 213. https://doi.org/10.5455/msm.2013.25.213-215

. (2022). Epic. https://www.epic.com/careeverywhere/Organizations on the care everywhere network

Hi Jorge,

I related to your response through my real-life experiences at my current job. We recently changed Electronic Health Record systems and started using Epic. I work for a large hospital system and my hospital was part of the first wave to pilot Epic EHR. I have to say, switching electronic healthcare systems is not easy. We are five months in and are still adjusting and discovering kinks within the system while communicating with the Epic system developers to help us improve the system. Barnett et al. (2016) describe the transition to a new EHR as one of the most disruptive events with a hospital, temporarily interrupting employee workflow with one hospital in their sample study reporting a double amount of patient mortality within five months after activating a new EHR system.  Without a doubt, the transition from one electronic health record system to another can threaten patient safety and increase the likelihood of operator error.

Despite the difficulties of rolling out a new EHR, Epic provides many beneficial qualities for healthcare providers as well as the patients. Epic uses a very impressive tool called Care Everywhere, a Health Information Exchange (HIE) tool that contributes positively to delivering quality care. Everson et al. (2016) suggest that HIE can enhance clinician workflow and improve associated patient care outcomes. Through care everywhere, users can obtain medical records from various other healthcare system portals within Epic. In my field, this has saved up so much time and has illuminated patient care aspects that affect the workflow of the cardiac cath lab. For example, in the cardiac cath lab, we use contrast dye for our procedures. I have discovered patient specific patient allergies, to contrast dye in many cases, that have been highlighted in other healthcare systems but not documented within ours. A universal electronic medical record system such as this one allows healthcare providers to be more proactive and is a tremendous benefit when it comes to providing quality healthcare. I can’t even count the number of times that I’ve personally asked patients if they have any allergies and they answer “no”, however I follow up with asking about contrast dye because I noted it from Care Everywhere and the patient then tells me, that they forgot that was one of their allergies. Healthcare providers should recognize the potential risks associated with transitioning electronic health systems and increase efforts to endorse communication and strategies to promote patient safety during the transition period.

References

Barnett, M. L., Mehrotra, A., & Jena, A. B. (2016). Adverse inpatient outcomes during the transition to a new electronic health record system: Observational study. BMJ, i3835. https://doi.org/10.1136/bmj.i3835

Everson, J., Kocher, K. E., & Adler-Milstein, J. (2016). Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations. Journal of the American Medical Informatics Association, 24(e1), e103–e110. https://doi.org/10.1093/jamia/ocw116

Healthcare informatics has grown dramatically over the past thirty years (Sweeney, 2017). The growth has come many different options for electronic medical records (EMR). According to Green (2021), the top three EMRs used in the U.S. include Cerner, Allscripts, and Epic. One great feature about the popularity of the leading EMRs is data sharing and the ability for an entire care team to provide a continuum of care.

Working in home health, communication between providers and us proves to be an issue. Often, clinicians in-home health depend on their patients to relay pertinent information discussed at follow-up appointments with a provider. Unfortunately, naturally poor historians, patients are not reliable sources of this vital information. My hypothetical scenario is an interface program that connects our EMR system, Home Care Home Base, to the top three EMRs. The EMR interface would allow data such as provider visit notes to be accessible to home health clinicians (McGonigle & Mastrian, 2022). In addition, information such as the provider’s plan post-visit is valuable in allowing the clinician to provide comprehensive care and adjust the care plan as a knowledge worker (Department of Health & Human Services USA, n.d.).

A nurse leader, such as a clinical nurse manager, uses clinical reasoning and judgment based on this scenario’s shared information findings. For example, a clinical chart audit performed by the manager can reveal an adjustment needed to the care plan (McGonigle & Mastrian, 2022). In addition, the nursing leader has the clinical knowledge to interpret data within the provider and nursing visit documentation and make connections that the nurse or provider did not previously note (McGonigle & Mastrian, 2022).

Department of Health & Human Services USA. (n.d.). Office rights for civil privacy, security, and electronic health records. Retrieved March 2, 2022, from https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privacy-security-electronic-records.pdf

Green, J. (2021). Who are the largest EHR vendors. Ehrinpractice.com. https://www.ehrinpractice.com/largest-ehr-vendors.html

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Nursing informatics is a foundational pillar in patient care. The collaborative information that can be combined into one system that various members of the health care team can use to improve patient outcomes is a vital resource for nurses. “Healthcare informaticists may uncover findings that serve to prevent the spread of disease in a population, promote treatment adherence, coordinate care among multiple specialists and ensure an organization’s compliance with all relevant privacy regulations and policies” (“Benefits of Informatics in Nursing”, 2020). Decubitis ulcers are a common problem in long-term care. Over the years evidence-based practice has changed how wounds are treated. Some treatments that were once used thirty years ago are now said to cause more harm to a wound than to heal it. Studying contributing factors and physiological changes that can cause the skin to break down can be compiled into data that can be shared among nurses and physicians. Other data that could be collected are the progression of the wound with different wound treatments using uploaded photos. This would provide information on what treatments are most effective for pressure ulcers at different stages. By including patient diagnosis and underlying comorbidities, further data can be collected for detecting which patients are at the highest risk of developing pressure ulcers and prophylactic treatment can be initiated. Over the years there have been developments in creating databases for the treatment and prevention of pressure ulcers. The Office of the National Coordinator for Health Information Technology and the American Nurses Association had a contest for the best creation of an app that would support the assessment of wounds. The winner created an app that included the dimension, skin color, temperature, and moisture of the wound (Murphy, 2013). This is an example of how the data can be collected. The break down of skin could potentially signify that the patient is near the end of life. These particular wounds are called Kennedy wounds (Holland, 2019).  If a patient is identified as having a Kennedy wound, then the data can determine the next phase for the patient, such as hospice care. The nurse leader can use this information for clinical reasoning and judgment when planning the patient’s care. The nurse would be able to determine the proper treatment for the wound and identify contributing factors, as well as, determining whether the wound is showing signs of a terminal stage.

References

Holland, K. (2019). Kennedy Ulcers: Pictures, Symptoms, Causes, Diagnosis, and Treatm.  https://www.healthline.com/health/kennedy-ulcer#causes

Benefits of Informatics in Nursing. (2020). https://online.adelphi.edu/articles/benefits-of-informatics-in-nursing/

Murphy, J. (2013). Using Health IT to Mobilize Data for Pressure Ulcer Prevention – Health IT Buzz. https://www.healthit.gov/buzz-blog/health-innovation/health-mobilize-data-pressure-ulcer-prevention

Hello, Roxanne. I agree with your stance on this topic. Healthcare informatics is a vital part in patient care. The utilization of data in healthcare helps to determine if policies and interventions are improving the quality of care and patient outcomes. Decubitus ulcer prevention was a great example of this. The evolution of the prevention of pressure sores has come a long way with the help of evidence-based practice. According to the Mayo Clinic, there are now steps you can take to prevent and heal pressure sores (Mayo Clinic, 2020). This is all thanks to the data gathered from different forms of treatment to determine which treatment works best. I think the best intervention of pressure sores is risk assessments. Risk assessments are the identification of risk factors and the integrity of the skin ( Bluestein, Javaheri, 2018). I think there should be some data collected on if care providers are doing the necessary interventions for preventing and treating pressure sores. Do you think if there were to be more consequences for improper care for patients at higher risk for pressure sores, there would a decrease in the prevalence of pressure sores? 

Bluestein, D., & Javaheri, A. (2018, November 15). Pressure ulcers: prevention, evaluation, and management. American Family Physician. Retrieved March 4, 2022, from https://www.aafp.org/afp/2008/1115/p1186.html 

Mayo Foundation for Medical Education and Research. (2020, February 29). Bedsores (pressure ulcers). Mayo Clinic. Retrieved March 4, 2022, from https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893 

Hi Lashonda,

Your job as a nurse consultant sounds so interesting. I work with a database like the one you describe. I am a home health clinical supervisor and utilize a system to manage patients. Informatics is very vital to the kind of work I do. Informatics is becoming increasingly present in our profession due to rapidly changing technological advances (Lee, 2014). I am really excited to see what the future holds for nursing informatics and technology. I feel with technological advances, we as practitioners can provide better care for our patients.  Nursing informatics would support the practice of nursing and delivery of nursing care (Graves, 1989).

References

Graves, J. (1989, December 1). The Study of Nursing Informatics. Sigma. Retrieved March 4, 2022, from https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1547-5069.1989.tb00148.x

Lee, A. (2014, July 30). The role of informatics in nursing : Nursing made Incredibly Easy. LWW. Retrieved March 4, 2022, from https://journals.lww.com/nursingmadeincrediblyeasy/FullText/2014/07000/The_role_of_informatics_in_nursing.12.aspx

       According to the Healthcare Information and Management Systems Society (HIMSS) (Schoenbaum & Carroll, 2021), nursing informatics plays a critical role in increasing operational and clinical workflow within healthcare and improving the overall quality of care. Through the collection and analysis of high-quality data and evolving technological resources, nursing informatics specialists can identify and execute advanced workflows contributing to the delivery of proactive, high quality patient care (Schoenbaum & Carroll, 2021). Nursing informatics combines the importance of clinical practice, research, and telemedicine to maximize patient care and transform the rapidly evolving field of healthcare. A wealth of relevant data such as patient care outcomes, adverse patient care events, medical errors, health risk factors, patient history & demographics, can be obtained through health informatics technology and utilized to highlight operational domains in need of remodeling. Collecting appropriate data can accelerate developments of evidence-based practice and provides essential information necessary for developing and updating policy and procedures within healthcare (Maddox et al., 2017).

I work as a nurse in the cardiac catheterization lab have come to realize how significant qualitative data collection is to the process of elective, urgent, and emergent cardiac cath procedures. The American Heart Association (AHA) (n.d.) recommends that revascularization of an occluded coronary artery during a heart attack, should occur within a 90-minute time from the minute the patient engages in medical care, also known as “door to balloon” time (Nathan et al., 2020). “Time is muscle”, is a phrase used quite often within the cath lab signifying the importance of reestablishing blood flow and oxygenation to the heart muscle. While the AHA recommends 90-minute revascularization, the hospital that I work for aims for 60-minute door to balloon time. Nursing informatics plays a key role in developing algorithms based on clinical indicators, EMR data, and the relevance of patient outcomes after undergoing emergent percutaneous coronary intervention. Nursing informatics review of STEMI clinical timestamps with procedural documentation from arrival to the ER, initial EKG, cath lab activation, arrival to cath lab, and revascularization timestamps are essential to continuously improve patient outcomes after a patient experiences myocardial infarction (Yiadom et al., 2018). This information is vital for hospital administrators, policy developers, cath lab/ER staff, and the interventional cardiologists to discuss, debrief, and assure delivery and improvement of life-saving patient care.

References

Maddox, T. M., Albert, N. M., Borden, W. B., Curtis, L. H., Ferguson, T. B., Kao, D. P., Marcus, G. M., Peterson, E. D., Redberg, R., Rumsfeld, J. S., Shah, N. D., & Tcheng, J. E. (2017). The learning healthcare system and cardiovascular care: A scientific statement srom the American Heart Association. Circulation, 135(14). https://doi.org/10.1161/cir.0000000000000480

Nathan, A. S., Raman, S., Yang, N., Painter, I., Khatana, S. A. M., Dayoub, E. J., Herrmann, H. C., Yeh, R. W., Groeneveld, P. W., Doll, J. A., McCabe, J. M., Hira, R. S., Giri, J., & Fanaroff, A. C. (2020). Association between 90-Minute Door-to-Balloon time, selective exclusion of myocardial infarction cases, and access site choice. Circulation: Cardiovascular Interventions, 13(9). https://doi.org/10.1161/circinterventions.120.009179

Schoenbaum, A., & Carroll, W. (2021, June 4). Nursing informatics key role in defining clinical workflow, increasing efficiency and improving quality. HIMSS. https://www.himss.org/resources/nursing-informatics-key-role-defining-clinical-workflow-increasing-efficiency-and

Yiadom, M., Mumma, B. E., Baugh, C. W., Patterson, B. W., Mills, A. M., Salazar, G., Tanski, M., Jenkins, C. A., Vogus, T. J., Miller, K. F., Jackson, B. E., Lehmann, C. U., Dorner, S. C., West, J. L., Wang, T. J., Collins, S. P., Dittus, R. S., Bernard, G. R., Storrow, A. B., & Liu, D. (2018). Measuring outcome differences associated with STEMI screening and diagnostic performance: a multicentred retrospective cohort study protocol. BMJ open, 8(5), e022453. https://doi.org/10.1136/bmjopen-2018-022453

Eshley,

This is a great point you make on how informatics can improve the quality of care, especially when implementing evidence-based practice. Abdekhoda and Khezri found a strong relationship between informatics and evidence-based practice (2021). The example you used for the cardiac catheterization lab directly highlights this and emphasizes the importance of informatics in nursing practice. Not only does it improve the quality of health care, but it also ensures that hospital staff is utilizing the same procedures. Thanks for your great example!

Reference:

Abdekhoda, M. & Khezri, H. (2021). Investigating the impact of health informatics literacy on the evidence-based practice of nursing. Online                    Journal of Nursing Informatics (OJNI), 25(2)

Collection of patient medical data including prior medical history, allergies, home medications, pertinent bloodwork, and diagnostic testing are crucial to patient outcomes before, during, and after coronary angiogram, angioplasty, and emergent coronary reperfusion events, otherwise known as, Acute Myocardial Infarction (AMI). Electronic medical records (EMR) contribute to the efficiency of patient care outcomes when designed with a purposeful workflow and user-friendly operations in mind. The EMR provides essential more than what can be provided by the patient. Everson et al. (2016) suggest that HIE can enhance clinician workflow and improve associated patient care outcomes. The ability to access pertinent patient data in an efficient and timely fashion provides the care team with a greater ability to respond to emergent cases even before the patient arrives to the cardiac cath lab.  An electrocardiogram (ECG) is obtained within 10 minutes of arrival to the emergency department or emergency medical services for patients complaining of chest pain. The results are immediately populated into the EMR. Abnormalities noted ECG such as ST segment elevations indicate the likelihood of coronary artery obstruction and which part of the heart requires immediate intervention and reperfusion. With the collection of this information, the cath lab team can anticipate the possible supplies and equipment to prepare.  Upon Code STEMI activation, all hands-on deck are required to establish timely cardiac reperfusion and prevent further damage of cardiac tissue. While the nurses in the ER prepare the patient for transfer to cath lab, the cath lab team arrives to the hospital, prepares sterile procedure room, and awaits patient arrival. 

Retrospective studies have been conducted to measure the impact of reperfusion time/delays on heart muscle damage, survival rates, and patient outcomes. Current American Heart Association guidelines recommend reperfusion therapy in patients experiencing ST elevation myocardial infarction to occur in 90 minutes or less (AHA, 2021). In addition, studies indicate that the degree of heart muscle damage, heart failure, or mortality is increased significantly for every 60 minutes of delay from start of symptoms to reperfusion with PCI (AHA, 2021). With the assistance of nursing informatics and retrospective data, workflows are designed to establish an organized and efficient clinical response for all care team members involved. The ultimate goal is patient survival and favorable patient outcomes after a heart attack occurs.

A clinical nurse leader must recognize the indications of AMI and activate a Code STEMI response. This includes focusing on methods to shorten delays and transfer time to cardiac cath lab, major effort for communication with care team, medication administration, etc. To improve door to balloon time and deliver high quality patient care for future patients, the nurse leader and care team should have a team briefing to discuss positive feedback as well as any incidents that may have occurred that may have caused a resolvable delay. Ultimately, ensuring patients receive coronary reperfusion in as little time as possible is the main concern, as studies have indicated higher survival rates. 

References

American Heart Association. (2021, January 14). Acting quickly after heart attack symptoms start can be a heart saver. https://newsroom.heart.org/news/acting-quickly-after-heart-attack-symptoms-start-can-be-a-heart-saver

Everson, J., Kocher, K. E., & Adler-Milstein, J. (2016). Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations. Journal of the American Medical Informatics Association, 24(e1), e103–e110. https://doi.org/10.1093/jamia/ocw116

         “Healthcare professionals are known as knowledge workers because they deal with and process information on a

daily basis to make it meaningful and inform their practice.” (McGonigle & Mastrian, 2022. p. 22) It seems as though a

major issue that Chief Nursing Officers are facing, and have faced during the COVID-19 pandemic is that of nursing

retention in the acute care setting. In the case study I chose to base my discussion on, A CNO of a Midwest

hospital used an evidence-based practice method of data collection and problem-solving. More specifically, an

“Evidence-Based Management” model. “…EBM decision-making is the systemic application of the best available scientific

evidence in combination with organizational evidence, leaders’ professional evidence experience, and stakeholder

evidence to decision making.” (Sevy Majers & Warshawsky, 2020. p472)

This means that everything gets factored into the final decision, clinical and non-clinical factors. Data from the

unit managers, patients, families, and other hospital personnel should be gathered for this focus. “Information systems

in the managerial role often consist of interpreting informational modifying data to be utilized in decision-making

processes.” (Sweeney, 2017) CNO’s and other nurse leaders depend on information systems to give them this vital

information that aids guides them in determining their next step.

According to this study, a possible solution is to hire temporary staff or to deploy staff to higher-demand

units. A nurse leader would use clinical reasoning and judgment by always putting the safety of needs of their patients

and staff first.

McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

Sevy Majors, J. & Warchawsky, N. (2020). Evidence-Based Decision Making for Nurse Leaders. Nurse Leader, 18(5),471-475.http://doi.org/10/1016/j.mnl.2020.06.006

Sweeney, J. (2017). Healthcare Informatics. Online Journal of Informatics, 21(1).