Summary Nursing Informatics for Advanced Practice (NR)

MediCalc Application Critical Appraisal Stephanie Moore Chamberlain University NR: Nursing Informatics for Advanced Practice Dr. Flore Jesuca June 14th, 2020 Name The name of the application that I will critically appraise is MediCalc. Author ScyMed Inc. is the company that created the application with the help of Board-certified physicians in the United States. A. Arturo Rodriguez is the Editor-in-chief of the application. He is also the founder, President, and CEO of ScyMed. He became interested in the application of information technology to medicine and has developed many clinical software programs (ScyMed, 2020). He is also still a practicing physician in Houston Texas and is pioneering new software to help all medical providers. Endorsement MediCalc is not endorsed by the Food and Drug Administration or any other government agency. No medical professional organization or academic institution has endorsed the application, but the website states that the application was developed by Board-certified physicians. Operation The application can be accessed by either platform, mobile or web-based. Both platforms have its pros and cons. It is also functional in either platform, but may be more convenient to access on the mobile platform. On the other hand, it offers a print feature which may be more user friendly on the web-based platform especially if the provider practices at different facilities around different printers. For these reasons, I would deduce that the platform a user chooses to use is highly specific and individualized based on their needs. Aesthetics The information on the surface is easy to use and user-friendly. However, when you actually click into the clinical formulas, equations, and algorithms, it is difficult to figure out which number goes where and exactly what number it is seeking for a novice user. If you are not familiar with the equation or formula, you will have to look at the directions to figure out what information to compute where. On the other hand, the scales are straight-forward and easy to input the information without looking at any directions. It is also difficult to use if you are not familiar with all of the abbreviations but the application has a tab labeled abbreviations where the user can look up any unknown abbreviations. Purpose The application states it is “the standard for clinical calculations and quantitative analysis in Medicine.” It also touts that it provides a unique reference and is the most comprehensive medical calculator system. It features more than 1000 calculator panels and provides immediate access to core medical knowledge with the most comprehensive and integrated repository of clinical algorithms, equations, scores, and formulas (ScyMed, 2020). Clinical Decision Making This application is not a diagnostic program but rather a software program that computes and processes clinical information. It contains many equations and formulas that can be utilized to assist in the diagnostic process. It provides many different calculators along with detailed rationales and explanations so the provider can comprehend the results of the calculator. If applied correctly when making a diagnosis, the many different calculators can provide great assistance to the provider in the clinical decision-making process. Safety The is definitely potential for patient harm. Changes in medicine, science, evidence, human error, different interpretations could contribute to the application of wrong information (ScyMed, 2020). Also, the user must always review the calculations, especially with the conversion of units. Research on different applications has found variations in unit conversion practice and must always be verified (Hussain et al., 2019). The application specifically states that users should only use the information as guidelines and should check formulas, equations, and confirm manually the output results performed by the application (ScyMed, 2020). Privacy/Security The application does not contain any private health information that could be connected to a patient, so there is no privacy statement or setting. None of the information is encrypted, shared with third parties, or on social networks. User The application is intended for licensed physicians, nurses, physician assistants, nurse practitioners, and other qualified healthcare professionals (ScyMed, 2020). Distribution It is designed to be used globally by all professionals in the healthcare industry. Is has not been developed just to be used locally but providers all over the world could find this application useful. Credibility The application states that the developers checked all of their sources and deemed them reliable. It also states that the functionality of the systems is accurate and complete in every aspect but the user still needs to verify all information and outputs (ScyMed, 2020). The application also contains a disclaimer that they shall not be liable to the user or anyone else for any inaccuracy, error, omission, or damages, regardless of the cause (ScyMed, 2020). Relevance The application was last updated in 2018 and some information may be out of date. Every user must take heed to the disclaimer and verify all information and output to make sure the patient is not harmed. Clinical Scenario The following clinical scenario takes place in a private practice setting. The patient is a female geriatric patient aged 72 years old. The patient has a history of hypertension, coronary artery disease with prior heart attacks with stent placement, diabetes, stroke, and multiple falls. The patient presents to the cardiologist office with the complaint of dizziness and palpitations. The provider performed an electrocardiogram and discovered the patients’ rhythm was atrial fibrillation. The provider now must consider the patient’s medical history and if it is appropriate to prescribe the patient an anticoagulant at the point of care. To do this, the provider will use the MediCalc application and will utilize the CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk and also the HAS-BLED Score for Bleeding Risk in Atrial Fibrillation. The provider will navigate to the Cardiology tab and then find each scale mentioned. The provider will then answer the questions taking the information from the patient’s history and hit calculate. The scale will then compute the information and provide results which the provider can utilize when determining the best course of action. The first scale CHA2DS2-VASc score shows that the patient scored 6 points. According to the scale, any score greater than or equal to 2 points put the patient at high moderate risk of a thromboembolic event. Research has shown that higher CHA2DS2-VASc scores were predictive of probable events and patients had poorer long-term outcomes (Su et al., 2018). The next scale the provider will utilize, HAS-BLED, the provider again answers the questions taking information from the patient’s history, and the output results scored 3 points. The application of the points table states that a score of equal to or greater that 3 points is a high bleeding risk. Now the provider must make an educated decision utilizing both scores to determine if the patient should be on anticoagulants to prevent stroke. This decision will be tough for the provider and the information gathered from utilizing the application will have a great impact on the decision because according to the scale, the patient has a high risk for a thromboembolic event, but also a high risk for bleeding. The provider must verify the credibility of the score, but must also take into consideration the patient’s history of a previous stroke, but also previous falls. This application will definitely help the provider in the clinical decision-making process.