NURS 372: Final Exam Review (Old Content)

NURS 372: Final Exam Review (Old Content) The triple aim was created by what organization? Institute for Healthcare Improvement (IHI) The three deminsions of triple aim and its focus - quality - safety - innovation What is a population? collection of people who share one or more personal or environmental characteristics -registry tracking a defined group of people over time Dimension 1: Improving population health the health outcomes of a group of individuals including the distribution of such outcomes within the group Dimension 2: Improve the patient care experience - The perspective of the individual as he or she interacts with the healthcare system - The perspective of the healthcare system focused on designing a high quality experience for patients. Dimension 3: Reducing Per Capita Healthcare Costs by saving money that's wasted in healthcare every day we could: improve health care quality and improve health of populations There are multiple types of aims we can use but we use which one? Triple aim- because we can barely get these 3 things right...why add more add more if you can but focus on the 3 dimensions first! Why do we care? US healthcare is expensive There are new demands on medical and social services related to: Aging population Increased longevity Chronic conditions How do we make this happen? o "Upstream Approach" o There are more factors in play with our patients than just seeking and getting the healthcare they need o Making smarter decisions based on long term thinking o Fixing the heart of problems, not just putting a band-aid on it Social determinants of health Non-medical factors which influence health outcomes. These factors include the conditions in which people are born, grow, work, live, and age (CDC, 2022). Health equity The state in which everyone has the opportunity to attain their full health potential and is not disadvantaged because of social position or other socially determined circumstances (CDC, 2020). Health literacy The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves (CDC, 2023). Health disparity Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations (CDC, 2023). Aspects of the Social Determinants of Health (SDOH) People with more money the less likely they will have any... stress, health problems, etc. Examples of SDOH Quadruple Aim in healthcare adds care team well being Quintuple Aim in Healthcare Health equity affects: • Length of life • Quality of life • Rates of disease, disability, and death • Severity of disease • Access to treatment -Racial and ethnic minority groups are often disproportionately affected by health inequities. What are a few reasons why a person might not go to the doctor? can't afford- NO INSURANCE! don't trust/like doctor scheduling conflicts afraid of outcome language barriers transportation Health literacy definition the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Clinical Decision Support System - intended to improve healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient info, and other health info - comprised of software designed to be a direct aid to clinical decision-making, in which the characteristics of an individual pt are matched to a computerized clinical knowledge base and pt-specific assessments or recommendations are then presented to the clinical for a decision Where CDSSs are Used - primarily used at the point-of-care, for the clinician to combine their knowledge with information or suggestions provided by the CDSS Administration of CDSSs - often make use of web-applications or integration with EHRs and computerized provider order entry systems - can be administered through desktop, tablet, smartphone, biometric monitoring, wearable health technology Classification of CDSSs - knowledge-based or non-knowledge based Knowledge Based CDSSs - rules (if-then statements) are created - system retrieves data to evaluate the rule and produces an action/output - rules can be made using literature-based, practice-based or patient-directed evidence Non Knowledge Based CDSSs - still require a data source, but the decision leverages AI, machine learning, or statistical pattern recognition rather than being programmed to follow expert medical knowledge Difference Between Knowledge and Non Knowledge Based CDSSs - knowledge based uses an interface engine and bases its findings on expert medical knowledge whereas non knowledge based uses an AI powered interface engine to produce an algorithm/pattern rather than expert knowledge Rules in Knowledge Based CDSSs - based on literature, practice, or patient-directed evidence Scope of Functions in CDS - diagnostics, alarm systems, disease management, prescription drug control, etc. - can manifest as computerized alerts and reminders, computerized guidelines, order sets, pt data reports, documentation templates, and clinical workflow tools Advantages of CDS - pt safety - clinical management - cost containment - administrative function/automation - diagnostic support - support with imaging, lab, and pathology - pt decision support - better documentation - workflow improvement Patient Safety Advantage - reduces incidence of med/prescribing errors and adverse events Clinical Management Advantage - promotes adherence to clinical guidelines, follow-up and treatment reminders, etc. Administrative Function/Automation Advantage - diagnostic code selection, automated documentation and note autofill Diagnostic Support Advantage - provides diagnostic suggestions based on pt data, automating output from test results Support with Imaging, Lab, and Pathology Advantage - augments the extractions, visualization, and interpretation of medical images and lab test results Patient Decision Support Advantage - decision support administered directly to pt's through personal health records and other systems Workflow Improvement Advantage - can improve and expedite an existing clinical workflow in an EHR with better retrieval and presentation of data Pitfalls of CDS - fragmented workflows - alert fatigue and inappropriate alerts - impact on user skill - computer literacy dependence - system and content maintenance - operational impact of poor data quality and incorrect content - lack of transportability and interoperability - financial challenges - user distrust of CDSS Fragmented Workflow Disadvantage - can disrupt existing workflows if they require interaction external to the EHR, or don't match the providers' real world information processing sequences Alert Fatigue Disadvantage - a phenomenon where too many insignificant alerts or CDSS recommendations are presented, and providers start to dismiss them regardless of importance Impact on User Skill Disadvantage - reliance on, or excessive trust in the accuracy of a system Computer Literacy Dependence Disadvantage - may require a very high technological proficiency to use System and Content Maintenance Disadvantage - as practice changes, there can be difficulty keeping the content and knowledge rules that power CDSS up to date Operational Impact of Poor Data Quality and Incorrect Content Disadvantage - may aggregate data from multiple sources that are not synced properly. Users may develop manual workarounds that compromise data Lack of Transportability and Interoperability Disadvantage - face challenges regarding integration with other hospitals or systems, making it inefficient for otherwise high-quality systems to be disseminated and scaled Financial Challenges Disadvantage - setup can be expensive (capital or human resource), and long-term cost-effectiveness is not guaranteed User Distrust Disadvantage - users may not agree with the guideline provided by the CDSS CDS - providing clinicians or patients with clinical knowledge and patient-related information, intelligently filtered or presented at appropriate times, to enhance patient care More Advantages of CDS - provide nurses with appropriate clinical evidence resources associated with accurate patient assessments and test results - makes data quickly available, provides ability to make the right decision at the right time within the right place and to the right person - overall provide lots of helpful resources that make the acquisition of knowledge and subsequent delivery of care that much easier Electronic Form CDS - common; can be designed to guide patient data entry - provides support when completing interviews and observations at admission, during daily care, when performing focused assessments, and implementing interventions - user can access the full scope of assessments and patient care activities; data entry is shared Electronic Form CDS Continued - supports documentation of care by using reusable templates that are available to all appropriate health care providers wherever they work - ex: the section on urologic assessments would be an example of a reusable template Provider Order Sets CDS - contain order sentences to first guide the provider selecting the order details during CPOE and then guides the nurses and therapists who need to interpret and perform the intervention - ex: set of standardized care interventions and patient care orders for a urologic procedure - orders have common order sentences, pre-selected and optional selections for additional orders and are organized under common categories Provider Order Sets CDS Continued - facilitates standard specifications for order sentences - once the provider completes the order set, nurses, pharmacists, therapists, etc. can see them and deliver the ordered care - nurses and all other departments responsible for the orders must be involved in making them before they are put into use Prescriptive Plan of Care CDS - identifies priority problems and patient preferences - plan of care is pre-designed so the nurse can quickly select and modify as needed - based on best evidence and standards - nurse identifies the plan appropriate for the patient respective of their preferences and outcomes Prescriptive Plan of Care CDS Continued - provides the ability to quickly identify pre-selected care orders, add optional orders, or unselect interventions - provides guidance by linking nursing diagnoses, outcomes, and interventions, assessments to evaluate the expected outcomes - functions similarly to the physician's order set, aligns the care within the patient's EMR/EHR Drug Databases CDS - provides all clinical disciplines with drug databases that intersect with the EHR - monitors patient meds for drug-allergy interactions, drug-drug interactions, drug-food interactions, and duplications - provides instant access to drug information for providers and for patient education Bar Coding CDS - primarily used by nurses for administering meds - involves a bar code med scanning device that ensures the right patient, drug, dose, route, and time occur - device links with drug database, giving instant access to drug information to ensure it matches what is ordered Evidence Button CDS - provides information, reference text or a definition for the clinical condition, normal range, intervention, or procedure - information buttons are designed to link nursing or medical definitions, descriptions, or related details to provide clinicians with references at the bedside - provides information from nursing research manuscripts and professional nursing organizations about anticipated drug therapeutic effects and side effects If-Then Logic Module CDS - most complex in design and requires broad representation of experts to develop - requires the use of critically appraised evidence and experts to design the use of data within the work steps of the user - when and if the conditions exist, a synchronous or asynchronous step occurs within the EHR or EMR - when a synchronous one occurs, the user will receive a message detailing what actions are possibilities If-Then Logic Module CDS Continued - when an asynchronous action occurs, the user will not immediately receive a message or notice, but will receive orders, actions, communications, or a potential problem added to the list - when triggered, this module assesses conditions before providing a message that details options and actions or recommends an assessment or intervention - system requires collaboration and clinical expertise Nurses Improving the EMR and EHR - provide input on certain things that can be improved within the EHR/EMR as they are the ones that work with them a lot so these systems can become more developed and more effectively designed to promote a user friendly system EMR - digital version of the pt's chart - information is typically from one practice - if you are seeing multiple specialists, each will likely have their own separate medical record - typically stays within the practice and is not shared EHR - all-inclusive pt record - contains a patient's records from multiple providers and is shared between practices - central component of the health IT infrastructure - without it, a lot of the other technology we use in health care would be useless or less effective EHR and EMR Note - both are considered a database with information about our patient's - there is a reason both are used - when the technology first became available, it was thought the patient information would always be available in an EHR, no matter where the patient went, their records would be available to any provider - many different companies got into the business and created their own EHR's, and they don't all communicate and interact with one another so the complete records can be seen everywhere Benefits of the EHR and EMR - safety, access, efficiency, communication - the Electronic Health Record is the central component of the health IT infrastructure, it is a database for information about your patients - nurses and providers care less about how much the facility receives in reimbursements for using these programs and more about how it improves the care it provides for patients Safety with EHR and EMR - CDS, calculations, interaction checking - the EHR helps us provide safer care for our patients - one way is through calculations as the system makes calculations for us by preventing human error, such as when determining weight based dosages - heparin drip as well: lab values can be entered and the EHR will inform us of the new rate based on the lab values Safety with EHR and EMR Continued - should be used to support us, we should still be doing the math - another example is interaction checking for different infusing fluids - can assess for any interactions to prevent adverse events within the EHR Access with EHR and EMR - pt data, health information exchange - access to information