UNIT – 1

Introduction To Computer Applications For Patient Care Delivery System And Nursing Practice

1.1 Computer Applications for patient care delivery system

- Patient information
- Record keeping
- Communicating with colleagues
- Devising strategies for patient care
- Interpreting lab results and
- Research

Computerization of health care delivery includes

- Computerization of the medical records popularly known as Electronic Medical Record System
(EMR)
- Electronic Prescription
- Personal Digital Assistants
- Computer Automated Disease Detection such as cancer
- Computerized Theatre Management Applications

Uses of Computers in patient care delivery

- Documentation
- Medical PCs Control medical devices in Imaging department
- Monitoring patients and notifying abnormality by alarms
- Education and Research
- Communication and Telemedicine
- Inventory Control

1.2 Patient care Technology and Care Delivery

- Bed exist alarms

- Warnings in IV pumps that signal occlusions
- Patient initiated call bells
- Self – initiated code alarms
- Cardiac monitor alarms and
- Ventilator alarms

Technology Categorization in Care Delivery

- Direct nursing care delivery technology – barcode medication administration

 - Indirect nursing care delivery technology - Robotics, radio frequency identification, electronic
inventory systems, computerized staffing systems
- Communication technology - EMR, PDA, paging systems, call systems, emergency call bell
- Nurse protective devices – Mechanical lifts, patient transfer devices
- Patient assessment, monitoring and Surveillance -
- Patient assistive devices – stand assist lifts, trapeze bars, patient transfer devices ECD,
wheelchair
- Remote monitoring - Telemedicine and telehealth

Benefits of Technology for Nursing

- Accesibility of data
- Reduction in error
- Oppurtunity to reach all the geographical areas
- Easy Documentation
- Continuity of care
- Better access to evidence

Potential Drawbacks of Technology for Nursing

- Less person-to-person interaction

- Lack of human touch
- Generational difference to adopt to new technology
- Data and security threats

1.3 Use of Computers in Teaching, Learning, Research and Nursing practice

The following are the four major areas in Nursing where the computers are widely used:

-Nursing practice

- Nursing Documentation

- Nursing Administration

- Nursing Research

Computers and four major areas of Nursing

- Nursing practice
To manage information in patient care
To monitor the quality of care
To evaluate the outcomes of care
 Admission Discharge and Transfer (ADT)
Informatics and Technology in nursing practice for patient care

- Nursing Documentation
To provide a plan of care for patients
Efficient communication between clinicians
Direct patient care processes

Important uses

To assess and monitor patients

To document and evaluate patient care
To provide education to patient
To enhance the accessibility of care
To meet and evaluate patient needs
To teach patients about health care technologies
To protect the safety and privacy of patients in relation to the use of health care and
information technologies
To enhance ones own nursing knowledge base

Nursing Administration

Nursing Education : Teaching and Learning

- Computers are used extensively in nursing education

Libraries are computerized
Nursing educationalists use computers in classroom teaching and
For academic record keeping
- In nursing education, computers are used in
Teaching and learning
Testing
Student and course record management

- Teaching and Learning

Access to literature
Computer assisted instructions
Classroom technologies and
Distance learning (online classes)

Nursing Research
 - Identifying the problem for research
- Literature Review
- Conceptual Framework
- Research Design
- Sample Type, Description, Selection
- Research instruments and Data Collection
- Legal and ethical consideration
- Data Analysis methods
- Discussions of Findings, Recommendations, Implications, Summary
- Budget
- References and Bibiliography

1.8 HMIS – Hospital Management Information System

Salient features

- Data is retrieved fast and easily

- Entry of data is easy
- Security of data
- Data Validation is stringent

Short term Objectives

- To reduce costs and improve the accuracy

- Timeliness of patient and care
- Accounting and administration
- Record keeping
- Management reporting

Long Term Objectives

- To build and maintain a patient data base for analysis of data to facilitate decision making
process

Hospital needs to be computerized in

- Admission / Discharge / Transfer

- Pathology test result information
- Radiology test with appointment scheduling
- Special test information system at medical research
- Inventory maintainance of medicine and other applicance
- Issue of medicines of patients
- Communication with external world using E-mail and web technology
 - Patient billing
- Statistical analysis of data for proper utilization of resources

Benefits of Hospital Management System

- Improvement in Doctors productivity

- Reduced patient waiting time
- Eliminating wastage of stationary
- Prompt medical attention
- Accuracy and timeliness of data
- Eliminating any possibility of mixing blood samples
- Authorization check and accuracy of billing
- Extending viewing and printing of test results at remote locations.

Electra

- Patient registration
- Appointment scheduling
- Admission, discharge and transfer
- Bed management
- Wards Management Module
- Patient relations
- Doctor Workbench
- Nursing Workbench
- Operation theatre
- Electronic medical record
- Laboratory Information System
- Radiology Information System
- Pharmacy
- CSSD
- Blood Bank
- Housekeeping
- Health care packages
- Management Information System
- Financial Accounting
- Roster Management
- Patient billing

LCS

- OPD , IPD and Investigation Cases

- Ward Allocation
- Patient Admission
- Patient Shiftinh
 - Deposits and Advances
- Automatic Charge Calculation
- Estimate and Final Billing
- Operation Theatre Scheduling
- Receipts and Refunds
- Discounts and Concession
- Doctor Register
- Patient Discharge
- Patient Inquiries
- Comprehensive Search Engine for Patient Search and Analysis

UNIT - 2

Principles of Health Informatics

• Definition : Nursing informatics is defined as "the use of computers technology to support

nursing, including clinical practice, administration, education, and research."
• Nursing informatics is defined as "the development and evaluation of applications, tools,
processes, and structures which assist nurses with the management of data in taking care of
patients or supporting the practice of nursing."
• Informatics is defined as computer science + information science

- Helps
1. Patients to access more health information
2. Providers to improve the quality of care and
3. Empowers the health administrators for decentralized planning and management
4. Supports policy making and strategic decisions at state and national levels

Nursing Informaticcs (NI) – need

Objective of Health informatics:

- To ensure access to critical patient information at the precise time and place it is needed to
make decisions
- To focus on the management of medical data for research and education

Health Informatics uses :

- Interoparability ( sending, receiving, finding and using of data)

- Use of Information
- Monitoring and Evaluation

Dimensions of Health Informatics

 - Information and Communication Technology (ICT)
- Health Information Management (HIM)
- Health Information Technology (HIT)

Principles of Health Informatics based on the above dimensions

a. Information and Communication Technology (ICT) Principle

 Appropriate consumer use
 Data quality
 Meet Information needs
 Appropriate Technology
 Interoperability
 Workflow model
 Best practices
 Implements Solution

b. Health Information Management (HIM) Principle

 Privacy of personal Health Data
 Information Culture
 Appropriate technology
 Quality
 Best practices
 Principle related to change
 Knowledge of Healthcare
 Safety

c. Health Information Technology (HIT) Principle

 Concepts of Clinical Care
 Knowledge of health information system
 Communication
 Use of health information system in clinical setting
 Architectual relationship
 Electronic decision support
 Consider and address challenges
 Safe use

Benefits of Health Informatics

- Laboratory Results
- Patients history and physical notes
 - Provider Orders
- Medicine Allergies and immunization
- Discharge procedures
- Clinical decision Support
- Improved Administrative Functionality
- Improved Quality and Safety
- Improved Compliance of Accreditation Standards
- Improved Education
- Improved Access to Information

2.2 DATA INFORMATION AND KNOWLEDGE

Data – raw material – associated with the following

- Patient Indentifiers
- Demographics
- Diagnoses
- Procedures
- Medications
- Laboratory Data
- Vital Signs
- Utilization / Cost
- Social Data
- Patient Generated Data

To make use of the different types of data, health organizations need analysts who have expertise in
health informatics. In particular these professionals require the following key skills

- Critical thinking
- Problem-Solving
- Data Analysis and Management
- Communication
- Presentation and reporting
- Projecting and forecasting

Informatics Pyramid
UNIT - 3

Information System

3.1 Information System Definition

Defines as the software that helps organize and analyze data.

IS is the study of complementary networks of hardware and software that people and organizations use
to collect, filter, process, create and distribute data.

Purpose of an information system

- to turn raw data into useful information that can be used for decision making in an organization

Components of information system

- Hardware
The physical components of the technology
- Software
Set of instructions that tell the hardware what to do
- Data
Collection of information
 - People
People involved in the information system
- Process

Series of steps undertaken to achieve a desired outcome or goal

Combining hardware, software, human power and processes, an Information system refers to a network
used to collect, store, process, analyze and distribute data.

Types of Information Systems

1. Operations support systems

2. Management information systems
3. Decision support systems
4. Executive information systems

Benefits of Information systems in health care

- Improve cost control

- Increase the timeliness and accuracy of patient care
- Administration information
- Increase service capacity
- Reduce personnel costs and inventory levels
- Improve the quality of patient care

Nursing Information System

Nursing Information System (NIS) is a part of a health care information system that deals with nursing
aspects, particularly the maintenance of the nursing record.

Information System Architecture

- Considered as a blueprint depicting how the data processing system, telecommunications

networks and data are incorporated. It provide a summarized response to the f ollowing
questions
1. Where to store data
2. What data is gathered
3. How and were the data gathered
4. Which application use the data and how are they related to overall system
5. How is the data transferred

Classification of Information System Architecture

- Client-Server Architecture
 Client
 Requesting machine
 Server
 Supplying machine
These are connected to each other by either a LAN or WAN

- Mainframe Architecture
 User submits data via terminal

- Distributed System

- Web Based Architecture

 Web based softwares

- Cloud Architecture
 Backend Cloud

- Grid Architecture

HEALTH INFORMATION SYSTEM

- Refers to a system designed to manage healthcare data

Primary (or Core) processes

- Admission : disease prevention, inpatient or outpatient event booking and hospitalization
- Anamnesis : definition of patients clinical status from a medical and nursing standpoint
- Diagnosis : definition of patients therapeutic and care plan
- Clinical data
- Discharge and follow-up : patient discharge and possible transfer to outpatient or home care for
follow-up activities

Secondary (or support) processes

- Strategic services : strategy, planning and controlling, supervision of regulations;
- Administrative services: administration and accounting, information systems, quality assurance,
human resources
- Technology services: clinical machinery, biotechnologies, building automation, auxiliary systems
- Sourcing and logistics
- The transfer of data to the ADT system, in the case of transfer to inpatient wards
- The management of all the first aid and discharge activities, including reporting.

Examples:
EMR (Electronic Medical Record), HER (Electronic Health Record)
  Replaces the paper version of a patients medical history

Practice Management Software

 Practice management software helps healthcare providers manage daily operations

such as scheduling and billing

Master Patient Index (MPI)

 Master patient Index connects separate patient records across databases

Patient Portals

 Patient portals allow patients to access their personal health data such as appointment
information, medications and lab results over an internet connection

Remote Patient Monitoring (RPM)

 Remote patient monitoring allows medical sensors to send patient data to healthcare
professionals

Clinical Decision Support (CDS)

 Clinical decision support systems analyze data from various clinical and administrative
systems

Benefits of Health Information Systems

- Data analytics
- Collaborative care
- Cost Control
- Population health management

Best practices for Health Information Systems

- Train employees
- Encrypt data
- Back up data
- Monitor usage
- Buy Insuarnce
- Access vendor vulnerability
- Utilize multifactor authentication

AIM OF HIS
Hospital Information System is designed to manage the administrative, financial and clinical aspects of a
hospital with the aim :

 To achieve the best possible support of patient care and administration by electronic data
processing

GROUPS BENEFIT FROM HIS

A . Physicians

 Introduces Computerized Provider Order Entry (CPOE)

 Improves accuracy and legibility of, and access to, the required patient medications
 Improves Clinicians efficiency and effectiveness through provision of key patient information
(e.g allergies) at
 Time of ordering, plus conflict checking, order checking and online access to best practice
information
 Improves care through the logging of all orders
 Reduces medication error rates

B. Nurses

 Will allow immediate access to orders and results

 Will provide immediate access to patient demographics, medication and test results
 Will provide improved access to information on line (i.e suggested medications or drug alerts)
 Will decrease the need for a paper, decrease errors and patient safety

C. Allied Health Professionals

 Will allow immediate access to orders and results

 Will provide immediate access to patient demographics, medication and test results
 Will provide improved access to information on line (i.e suggested medications or drug alerts)
 Will decrease the need for a paper, decrease errors and patient safety
 Ward and Registration Clerks
 Will provide a single point of contact for patient registration information and reduce duplication
of effort

D. Clinical Benefits

 Provide a common source of information about a persons health history

 Enchance the ability of health care professionals to coordinate care by providing a persons
health information
 And visit history at the place and time that it is needed
 Link information from diagnostic information systems such as X-ray and Laboratory into the EPR
 Strengthen internal and external communication among health care providers
  Eventually be accessible for u se in all of the Manitoba’s academic and community hospitals. As
well as long term
 Care facilities
 Allow care providers access to the patients health history and results between facilities
 Will provide improved access to information on Line (i.e Suggested medications or drug alerts)
 Will decrease the need for paper , decrease errors and increase patient safety

E. Administrative Benefits

 Will provide improved access to information on line

 Will decrease the need for paper , decrease errors and increase patient safety
 Strengthen internal and external communication among health care providers
 Will decrease the need for re-registration of patients across multiple sites

APPLICATIONS OF HIS

- EMR (Electronic Medical Record)

- LIS (Laboratory Indormation System)
- CDS (Clinical Decision Support)
- RPM ( Remote Patient Monitoring)
- MPI (Master Patient Index)

Benefits of Hospital Information System

- Maintains a totally secured database of patients

- Better data access, faster data retrieval, higher quality data and more versatility in data display
- Improves efficiency
- Standardizes the patient record
- Gathers information to meet management challenges
- Educates patients about their diseases and surgical procedures through pictures and animations

Advantages

- Coordination
- Collaborative care
- Accessibility
- Research
- Improved patient satisfaction
- Reduced Operation costs

The Clinical Information System (CIS)

 - A computer based system that is designed for collecting, storing, manipulating and making
available clinical information important to the healthcare delivery process.

UNIT – 4

Shared Care and Electronic Health Records (difference)

Patient Record System

• Patient Record system is central to all the information and communication among health care
professionals
• Quality documentation and reporting enhance the efficiency of patient care.
• Efficiency and accuracy of documentation increasingly relay on computer technology in health care.
• Information management, storage and distribution is fundamental.
Role of information system is challenging.

Record (Documentation)System

• Record means something written furnishing evidence or information.

• Documentation is any written or printed or electronically generated information about patient and
service provided to patient.
• Through documentation nurses communicate their observation, decision, action and outcome of the
actions to patient.

Types of documentation system

I. Paper based documentation system

• 1. Source Oriented Record

• 2. Problem orientated Medical record (POMR)
• 3. Charting by Exception (CBE)
• 4. Graphic Sheets and Flow Sheet
• 5. Variance Charting (VAR)

II. Electronic Documentation

• 1. Electronic Medical Records (EMRS)

• 2. Electronic Health Records (EHR)
• 3. Other Electronic Record Devices
- Personal Digital Assistants
- Computer Automated Cancer detection
- Computerised Theatre Management Application

Electronic Health Records

• An electronic health record (EHR) is an individual's official health document that is shared among
multiple facilities and agencies.

EHR System

• An electronic record of health-related information on an individual that can be created,

gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record contains-

• Contact information
• Information about visits to healthcare professionals
• Allergies
• Insurance information
• Family history
• Immunization status
• Information about any conditions or diseases
• A list of medications
• Records of hospitalization
• Information about any surgeries or procedures performed

Advantages of EHR

• Providing accurate, up-to-date, and complete information about patients at the point of care.
• Enabling quick access to patient records for more coordinated, and efficient care.
• Securely sharing electronic information with patients and other clinicians.
• Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
• Improving patient and provider interaction and communication, as well as health care
convenience.
• Enabling safer, more reliable prescribing.
• Helping promote legible, complete documentation and accurate, streamlined coding and billing.
• Enhancing privacy and security of patient data.
• Helping providers improve productivity and work-life balance.
• Enabling providers to improve efficiency and meet their business goals.
• Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and
improved health.

• EHR system implementation over all benefits the patient care –user friendly, easy access to data,
support existing health care.
• EHR System overall helps the data entry process, learning Artificial Intelligence.
• Lower the manual operation system, EHR based automation-Charting templates and customization.
• EHR easily integrated existing system of billing, claim, processing, scheduling, lab findings, two way
patient data sharing etc.
• Helps to tracking medication history, higher visibility of scope of their practice. This will boost by
reducing more treatment error and benefits in medication management.
• EHR reduces the manual retrieving and enhance medication research.
• Easier access to patient care data enhances the patient involvement is his medical care which leads
better health care outcomes.

Future Trends of EHR

• EHR methodologies to lower the treatment cost and save money.

• Continued to deliver the necessary operations for patients.
• More specialist involvement helps to suitable solutions, quick actions for complex medical
treatment models.
• EHR system slowly transform into digital platform to customers with the users experience.
• Language and voice processing may further streamline the data entry and processing
• Patient care will be boosted by easy access to information in shorter duration with accuracy to
lowering errors.
• Helps in quick decision making and better patient care.
• Tele-health may be combined with EHR service for better service and tracking records.
• Patient care mechanism further boosted through visualizing patient care set up and history of care.
• Chat box also helps integrated platform enabling easily accessibility and solution to both patients
and health care providers.

UNIT – 5

Patient Safety and Clinical Risk

Informatics Technologies and Safety

• Improve communication
• Reduce errors and adverse events
• Increase the rapidity of response to adverse events
• Make knowledge more accessible to clinicians
• Assist with decisions
• technology based forcing functions that direct or restrict actions or orders implemented by
computer technologies.
• Provide feedback on performance

Technologies to Support the medication Administration Cycle

Medication Administration Cycle
• Assessment of need
• Ordering
• Dispensing
• Distribution
• Administration
• Evaluation
• Human Error Factors: Distractions, unclear thinking, lack of knowledge, short staffing, and
fatigue

Five Rights of Medication Administration

• the right patient
• the right time and frequency of administration
• the right dose
• the right route
• the right drug

Technology Integration into Cycle

• Reduces the potential for human errors by:
 • performing electronic checks
• providing alerts to draw attention to potential errors
• Tracks performance

Computerized Physician Order Entry (CPOE) Benefits

• Prompts warn against the possibility of drug interaction, allergy or overdose;Accurate, current
information that helps physicians keep up with new drugs as they are introduced into the
market
• Drug-specific information that eliminates confusion among drug names that sound alike;
• Improved communication between physicians and pharmacists

Technology in the Pharmacy

• Verifying function is computer based, and the medication order is electronically checked via the
knowledge database
• Allergy verification and medication reconciliation with other drugs already in use
• Barcode Medication labeling or RFID Technology
• Assists with dispensing and administration
• Automated dispensing machines
• storage, dispensing, controlling, and tracking

Barcode Medication Administration (BCMA)

• Provides a system of checks and balances to ensure medication safety
• Nurse scans name badge thus logging in as the person responsible for medication
administration.
• patient’s barcode on the patient’s ID bracelet is scanned prompting the electronic system to pull
up the medication orders.
• the bar code on each of the medications to be administered is scanned.
• This technology checks to ensure that the 5 rights of medication administration—right patient,
right med, right dose, right route and right time—are met.

Smart Pump Technology

• Designed for safe administration of high-hazard drugs and to reduce adverse drug events (ADE)
during intravenous (IV) medication administration
• Software is programmed to reflect the facility’s infusion parameters, and includes a drug library
that compares normal dosing rates with those programmed into the pump.
• Discrepancies generate an alarm alerting the clinician to a safety issue.

Clinical Decision Support (CDS)

• Help a clinician select an appropriate medication
• Will ensure that the order is complete (checks for drug interactions, duplications, or allergy
contraindications, the right dose and right route
 • Provides double checks for interactions, allergies and appropriate dose orders during
verification and dispensing.
• Assists with infusion pump programming issues such as incompatibilities during infusion and
proper notation and dispensing when portions of a dose must be wasted.
• Assists with patient identification and current assessment parameters (i.e. blood pressure,
glucose level) that may contraindicate the use of the medication at that point in time.
• Checks for interactions with foods or other medications
• Provides patient education guidelines and printable handouts
• The monitoring functions of the CDS provide a structured data reporting system to track side-
effects and adverse events across the population

Technologies for Home Medication Compliance

• eMedonline
collects patient medication compliance data by scanning package barcodes or RFID medication
tags and using PDA or smart phone technology to send compliance data to the server
• SIMpill® Medication Adherence System
uses web based technology to monitor patient compliance and provide reminders about taking
medications or to refill prescriptions by sending text messages to the patient or caregivers
• Caps of pill bottles may contain RFID tags that monitor and collect data on when the bottle is
opened, or contain flashing time reminders when a dose is due (Blankenhorn, 2010).
• Smart inhalers track asthma medication compliance using a microprocessor that records and
stores medication compliance.
Other CDS Patient Safety Uses
• data collection and data management functions help to ensure quality approaches to patient
health challenges based on research evidence and clinical guidelines.
• may also ensure cost-effectiveness by alerting clinicians to duplicate testing orders, or
suggesting the most cost effective diagnostic test based on specific patient data

PATIENT SAFETY RELATIONSHIP BETWEEN PATIENT SAFETY AND INFORMATICS

• Reduced medication errors
• Continuity of care
• Bar code medication administration
• Smart pumps
• Automated medication dispensing technology
• Retained surgical items prevention technology
• Patient electronic portals
• Telemedicine
• Electronic incident reporting

Expanded RFID Uses

• patient tracking during procedures and testing, or function as part of the EHR communicating
pertinent information to clinicians at the bedside
 • etrack medical supplies and equipment
• imbedded into surgical supplies to automate supply counting procedures
• reduce the likelihood of wrong patient, wrong site surgical procedures
• reducing the potential that a counterfeit medication is inadvertently introduced into the supply,
and providing for efficient medication recalls
• specialized tags can detect temperature fluctuations and thus ensure that the blood or blood
product was stored at the optimum temperature for safe administration

Smart Room Technology

• RFID tag on employee name badge announces to the patient on a monitor exactly who has
entered the room and triggers ‘need to know’ data by caregiver status to be displayed on the
monitor in the room
• Clinicians review patient data in real time and chart at the bedside using touch screen
technologyalert clinicians as they enter the room about procedures that need to be
implemented for the patient and can track individual clinician efficiency and effectiveness by
aggregating data over time

Patient Monitoring Technologies

• Body Area Networks or Patient Area Networks provide the ability to wear a small unobtrusive
monitor that collects and transmits physiologic data via a cell phone to a server for clinician
review
• wireless chip on a disposable band-aid with a 5-7 day battery promises to be able to monitor the
patient’s heart rate and electrocardiogram, blood glucose, blood pH, and blood pressure,
allowing for the collection of important clinical data outside the hospital

Clinical Risk : between patient safety and nursing informatics

• Privacy concern
• Safety risk associated with computerized Physician order entry
• Alert concerns
• Electronic document concerns
• Interoperability concern
• Automated and self populating templates concern

RISK MANAGEMENT
• Risk management is the process to identify and access risk and to apply methods to reduce it to
an acceptable extent
Risk Management Process
• Risk estimation ( Analysis)
• Risk reduction
• Assessment and monitoring

RISK MANAGEMENT – GOALS

 • To eliminate or decrease risk incidence that could have a negative impact
1. On patients
2. On medical staff health as well as
3. On the total medical institution

RISK MANAGEMENT – OBJECTIVES

• Ensure compliance with applicable rules and regulations
• Support decision-making with appropriate risk-based information, thus assisting in enhancing;
the efficiency of operation, the effectiveness of processes and efficaciousness of strategies

RISK MANAGEMENT – STEPS

• Identify the risk
• Assess the risk
• Control the risk
• Review the process

RISK MANAGEMENT – PRINCIPLES

• P – Proportionate to the level of risk
• A – Aligned with other related activities
• C – Comprehensive, systematic and structured
• E – Embedded within healthcare processes
• D – Dynamic, iterative and responsive to change

CLINICAL RISK MANAGEMENT

• Is a specific method of risk management in hospitals that is directly focussed on clinical
procedures and indirectly in patient-related procedures.
• According to WHO, CRM specifically is concerned with improving the quality and safety of
health-care services by identifying the circumstances and oppurtunities that put patienrs at risk
of harm and acting to prevent or control those risks

CRM – COMPREHENSIVE FRAMEWORK

• Health Information Governance
• Safety Risk Identification
• Stake-Holder Involvement
• Informed Decision
• Sufficient training
• Gradual Implementation
• Continuous evaluation and monitoring of patient safety outcomes
• Technology optimization
• Regular technology updates

Common Sources of patient safety issues

Medication errors
Health-care associated infections
Unsafe surgical care procedures
Unsafe injections practices
Diagnostic errors
Unsafe transfusion practices
Radiation errors
Sepsis
Venous thromboembolism (Blood clots)

Principles of Patient safety

- Proper identification of patient and matching to their care elements
- Prevent of patient handover error and safety during transition
- Assessing medical accuracy while giving care to a patient
- Performance of correct procedure at correct body site
- Take appropriate precautionary measures to avoid infection

Different areas of Patient safety

1. Medical safety
2. Surgical safety
3. Electrical safety
4. Laboratory safety
5. Blood safety
6. Fire safety

Actions to ensure Medical safety

1. Illegible writing prescription by doctors
2. Wrong medicines or wrong dose or wrong patient
3. Wrong injection, wrong patient, wrong route of administering medications
4. Check the oxygen flow, check empty gas cylinders
5. Check for clear, written medication guidelines
6. Proper handing over and taking over during change of shift

Actions to ensure Surgical safety

1. Consent of the patient / relative in writing
2. Proper identification of patient, wrist band
3. Proper identification mark of parts to be operated
4. Pre anaesthetic check up
5. Anaesthetic safety
6. Ensure no foreign body left inside
 7. Prevention of surgical wound infection
8. Use of surgical safety proforma in all operations
9. Check safety code if available

Actions to Ensure Electrical safety

1. Safety fuses with each equipment
2. No loose wires or connection
3. Properly plugged and fixed
4. If short circuit, call electrician
5. Electricity backup battery / generator

Actions to ensure Fire safety

1. Use fire proof material for construction
2. Have fire exit in all buildings
3. Smoke detectors and water sprinklers on the roof of all floors
4. Fire extinguishers in all areas
5. Fire hydrants in all buildings
6. Training in fire management

Actions to ensure Blood safety

1. Proper grouping and cross matching

2. Test of HIV , hepatitis and VDRL
3. Proper levelling of group, name of the patient
4. Control of mismatch reaction
5. Standard operating procedure
6. Inform about adverse reactions to blood bank

Actions to ensure Laboratory safety

1. Avoid needle prick and spilling of blood

2. Safety measures in Radiology and Radiotheraphy departments
3. Safety norm guidelines for different areas of hospitals
4. Regular pest control measures
5. Care in handling acids, reagents, inflammable substances
6. Bio Medical Waste management segregation and disposal should be done properly

General measures to improve safety

1. Encourage staff incident reporting

2. Implementing and monitoring improvements
3. Solicit and use patient input
 4. Increase the safety of healthcare professional
5. Monitor points along the care continuum

Health Informatics : Impacts on Patient Safety and Care

1. Easier access to information

2. Adoption of Digital Medical Records
3. Reduction of Drug-Related Errors
4. Improved public health
5. Clinical Decision Support

UNIT – 6

Clinical Knowledge and Decision Making

Clinical Knowledge
Healthcare workers employ clinical knowledge and abilities to help patients improve their health
Importance of Clinical Knowledge for Nurses

Clinical Knowledge is absolutely necessary for the purpose of caring the patients and achieve the
expected outcome.

Sources of knowledge for Nurses

- Scientific Knowledge
Makes a significant contribution to the development and application of nursing practice
- Intuition and tacit knowledge
Probably able to provide examples of employing intuition and tacit knowledge in practice
situation
- Personal Knowledge
Is individual knowledge shaped through being personally involved in situations and events in
practice
- Tradition
Knowledge passed down through generations of nurses form the basis of traditional
understanding

Essential Clinical skills needed for a Nurse

1. Emotionally support other nurses
2. Share Compassion and empathy
3. Excellent Communication skills
4. Remain Professional
5. Ability to adapt
 6. Know when to ask for help
7. Priorities Tasks
8. Strong willed

Clinical Decision Making

Defined as a process of selecting a course of action from among multiple options in order to achieve a
desired outcome.

CDM has been defined as a contextual, continuous and evolving process where data is gathered,
interpreted and evaluated in order to select an evidence – based choice of action

Core skills of decision making

- Pattern recognition ( learning from experience)

- Critical thinking
- Communication skills
- Evidence based approaches
- Team work
- Sharing
- Reflection ( getting feedback from others )

Factors that affect CDM

- Knowing the evidence

- Knowing one’s self
- Knowing the patient and person
- Knowing the environment

The Clinial Decision making process

- Using cues and gathering and analysing patient data systematically

- Making judgements
- Making decisions:
- Evaluating Outcomes:

Knowledge Management

A healthcare knowledge management system creates a more efficient flow of information between all
providers and staff, which can ultimately lead to increased efficiency and productivity.
Benefits
- Empowered Decision making
- Lesser mistakes
- Boost Operational Efficiency
- Secure Collaboration
- Avoid malpractices
- Builds learning Organizations
- Stimulate cultural change and innovations

UNIT - 7

e -Health : Patients and the internet

By strategically combining health IT tools and effective health communication process, there is a
potential to :
- Improve health care quality and care
- Increase the efficiency of health care and public health service delivery
- Improve the public health information infrastructure
- Support care in the community and at home
- Facilitate clinical and clinical decision making
- Build health skills and knowledge

Domains of eHealth

Four general domains of eHealth are as follows

1. Management System
2. Communication system
3. Computerized decision support system
4. Information systems ( web based resources)

Benefits of ICT ( Information and Communication Technology)

- Improves the quality and efficiency of medical services and care

- Improves the quality of care provided and patient outcomes
- Reduces the risk of making errors
- Reduces delays in care
- Improves communication between / among wards and staff

PUBLIC HEALTH INFORMATICS

 - Is the application of information science and technology into public health practice and
research

PHI is defined as the systematic application of information, computer science and technology in areas of
public health, including surveillance, prevention, preparedness and health promotion

It is the systematic application of information, computer science and technology to public health
practice, research and learning.

10 Essentials of e-health

- Efficiency
- Enhancing Quality Care
- Evidence Based Care
- Empowerment of consumers
- Encouragements
- Education
- Enabling
- Extending
- Ethics
- Equity

Benefits

- Monitoring and protection

- Rapid detection
- Early detection
- Improvement in patient safety
- Reducing medication errors
- Improving public health care
- Counselling
- Policy making

UNIT - 8

HIMS

UNIT - 9

Information Law and Governance in Clinical Practice

Refers to a critical process that ensures the effective and efficient use of information within healthcare
[Link] governance in healthcare aligns with business objectives, ensuring regulatory
compliance while maintaining data integrity.

Data Integrity: Building Trust Through Transparency

Maintaining integrity when handling electronic health records plays a pivotal role in building trust
among patients, providers, and stakeholders alike. With solid strategies such as coordinated plans and
good information management practices on board, ensures quality control over every piece created or
received by the hospital, contributing positively towards achieving organizational goals.

Importance of Information Governance in Healthcare

Effective information governance is essential for reasons:

Patient Care: Information governance ensures that healthcare providers have access to accurate and
complete patient information, enabling them to make informed decisions and provide high-quality care.
Data Integrity: By implementing data governance mechanisms, healthcare organizations can maintain
the integrity and reliability of their data, reducing the risk of errors and inconsistencies. Information
governance initiatives support quality of information, which is essential for successful business
operations.

Compliance: Information governance helps healthcare organizations comply with various regulations
and standards, such as USA ‘s HIPAA( Health Insurance Portability and Accountability Act) , by
implementing privacy and security measures to protect patient data.

Seven pillars of Clinical Governance

- Education and Training
- Patient and Public involvement (PPI)
- Risk Management
- Staff management
- Clinical effectiveness and research
- Using clinical information and IT
- Clinical audit

Information Governance Helps

Simplify – create a single over-arching strategy for the entire organization

Accelerate – ensures that the information available to frontline practitioners is up-to-date and accurate
Transform – Move information governance focus from privacy and information security to business and
operational excellence