HealthMay 09, 2016

The new nursing: Leveraging technology to advocate for safety

National Nurses Week 2016 is May 6-12. Follow events and discussions at #SafeNursesRock. Nursing has come a long way since its humble beginnings.

We nurses are no longer the obedient caretakers of the infirm, subservient to the will of the physician. Nurses are now recognized as an integral part of the multidisciplinary care team, alongside doctors, pharmacists, respiratory and rehabilitation therapists, including physical and occupational therapy.

A quintessential foundation to the nursing profession's philosophy has always been to treat the patient as a whole. In more recent years, the medical community has come to realize the value of treating patients as more than just a disease process, instead considering the whole person — and sometimes their family or community — as the recipients of care.

In an effort to keep up with the demands of new treatments, medications, and procedures, the practice of nursing has had to evolve to maintain its place in this system. Some of the biggest advantages that nurses have at their disposal in the pursuit of patient advocacy have been recent advances in technology.

Electronic medical records (EMR)

  • The jump from paper to computer chart may have been a struggle, but ultimately it has yielded great rewards:
    • The ability of any provider to access all parts of the record from anywhere, even from home in some cases, greatly improves continuity of care.
    • Historical data from previous visits as well as data from other facilities are available all in one convenient place without having to play tag with a fax machine to get records sent over.
  • Electronic order entry reduces the reading and transcription errors that were common with poorly written orders or directions.
  • Hand-off report is made simpler and more consistent with an automatically generated report system.
    • This consistency reduces the likelihood of missing important data when giving report to other nurses or another member of the inter-professional team.

Electronic Medication Administration Records (EMAR)

  • Potentially the best improvement to patient safety in recent years.
  • Removes the potential for many of the errors that were common with paper MARs:
    • Typed orders reduce the possibility of giving the wrong drug due to illegible handwriting
    • Likewise it solves many issues related to incorrect dosing by making numbers and units easier to read.
    • Medication orders are verified by pharmacy in real time with each new order, rather than in daily batches,, as paper MARs sometimes were.
  • Hospitals are now transitioning to bar code scanning systems to further reduce errors:
    • A patient’s ID band is scanned to verify he or she is the correct patient
    • The medication is scanned to verify drug, dose, route, and time
    • Pop-up alerts notify the nurse giving the medication of mismatches with any of the five rights at the time of administration
  • Many EMARs also include links to useful information right on the drug order:
    • Links to drug references, like Lexicomp, give nurses instant information about the medication including:
      • Appropriate dosing
      • Common side effects
      • Nursing considerations for administration
      • Drug infusion interactions for IV medications
    • Some EMARs even include links to teaching guides for the medication that supplement nursing education for their patients.

Procedure guides

  • When a nurse is unsure how to perform a procedure or skill, he or she needs a resource:
    • A facility’s policy should be checked first, but that may not always give step-by-step information.
    • Electronic resources, like Lippincott, provide easy-to-understand information about how skills should be performed.
    • They also include patient teaching handouts for use in discharge planning and patient education.

With the combination of readily accessible information and a strong standing in the patient care team, nurses are empowered to stand up for their patients. Nurses are the last line of defense a patient has against all of the potential harms this system can bring to bear. With easy access to repositories of clinical knowledge, nurses are better equipped to challenge orders that are not appropriate for the patient or situation.

Practitioners have come to recognize that nurses are better prepared than ever before to offer insight into the treatment plan, and most will welcome the discussion that ensues when a nurse questions why a particular treatment is chosen. There have been many improvements made over the years to make it easier for nurses to provide the level of safety for which they strive and to allow them to be the type of advocate for their patient that drove them to become a nurse in the first place.

Ari Newman, RN, BSN, CCRN, is a clinical instructor and nurse educator for a large health system in Cleveland, Ohio. He has been in nursing for 12 years, eight of them in emergency rooms across Cleveland, as well as in Las Vegas. Newman has also worked in a cardiovascular ICU recovering open heart surgeries, and he has spent the last two years in education, working to improve the knowledge and level of care delivered by nurses across the system.

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