module 1 -first blog post ever.

1)Intro
Hello everyone! This is my very first blog...I guess I am finally catching up with the times.
I am in my third semester of eight to obtain my clinical doctorate as a family nurse practitioner and hope to graduate spring of 2011. Everyone says, "Wow! That’s a long time but it will go really fast!" easy for them to say.
I have two black labs named Sam and Stella and a cat named Rudy. They are like children to me.
I work in the Pediatric Intensive Care Unit (PICU) at Primary Children's and have been there for the past nine years. People I work with have often asked me if I want to work there as nurse practitioner. The truth is… I'm not sure. The kids there are REALLY sick and the intensity is extremely high. The more I think about it the less I am sure.

2)Info management
Technology is rolling out faster than many of us can keep up with. Knowledge is at our fingertips. Any resources that can help me be a more effective, safer practitioner the more I want to know. Technology is a valuable resource that may assist in reducing errors such as medication dosing and administration errors. With so many treatment options and research unfolding it is important to have the ability to access this information to provide the safest best possible cart to patients.

3)IT in my workplace
Very recently the PICU has introduced the EMAR (electronic medication administration record). There have been positives and negatives to this change. Some of the positives have included ensuring that the patient is receiving the right dose at the right time. Reducing medication errors is a national patient safety goal and overrides the associated negatives. The program that we are using was originally created in 1968. The program was not built for an intensive care unit and the creators of the program could never have imagined the medical advances that have occurred in the past 30 years. Needless to say the program is not user friendly or time saving.
Another technology that is utilized in the PICU is the VOCERA, which is a communication device that allows me to immediately locate or speak to my intended audience. Although this technology is not perfect it does allow me to quickly communicate emergent issues to care providers.

4)Structured documentation, standards and terminologies in my practice setting.
For patient documentation at the bedside RN’s use paper charting exclusively. There have been several programming attempts to transition to electronic nursing notes. None of the programs trialed achieved success in the eyes of the LIPs or nursing staff. Although I have never used anything except paper charting I can ascertain the positives of electronic nursing notes. In module 1 power point (Coding and Classification of clinical data) slides 10 and 11 indicate that standards are rules that specify how to overcome obstacles, allows for communication and increases effectiveness. On side one of the nursing note I’s and O’s, vitals, ventilator settings, continuous infusions and some lab values are posted. Side two is where the remainder of lab values, nursing narrative, and physical assessments are charted. Hand written charting and free text nursing narrative presents at least three problems. (1) In an extremely busy and acute intensive care unit it is very easy to have poor handwriting. Poor handwriting may lead to mis-added numbers (inaccurate I’s and O’s) as well as an inability for the care provider to read the charting accurately. (2) Free text (nursing narrative) may not paint an accurate description of patient status changes and how they were addressed by the PICU team. (3) Charting vital signs every hour may not be an accurate reflection of the patient’s condition. In a fast paced intensive care environment patient status may change from minute to minute. Hourly vital sign charting may not be a completely accurate description of patient condition. As mentioned above free text nursing narrative may not be legible due to variability in handwriting or writing skills of the RN.

5) How are structured/coded clinical data useful in promoting quality patient care?
By using standard, structured and coded clinical data, “…medical informatics can contribute solutions that have the potential to decrease unintended variation in practice and health care errors” (Bakken, 201, p. 2001). As care providers (RNs now but future NP’s) it is our duty to promote safety in any way possible. By using standard coding communication and overall patient safety may be improved.

Bakken, S. (2001). An Informatics Infrastructure Is Essential for Evidence-Based Practice. Journal of the American Medical Informatics Association, 8, 199-201.