Module 1

1) Introduction...
Hello everyone and welcome to my blog; a special hello to my BS to DNP cohort. We practically have our first of three years completed! That’s right, after some twenty years in nursing, I’m back in school. In May of 2011, I hope to have completed my Doctorate in Nursing Practice (DNP) degree in the Family Nurse Practitioner program. Most of my career has been in the hospital in the areas of heme/onc, emergency care, and adult and pediatric critical care. With this program of study I will have lots to learn about primary care.

2) Need to know...
As a graduate level nurse, I don’t want to be left behind the wave of information technology. I want to take full advantage of it all. I believe in the many benefits as they relate to reducing errors, dissemination of information, and research capabilities.

3) What has and is happening in my clinical arena...
Way before Obama’s stimulus to further the momentum of a national system of electronic medical records, we have made strides in Utah. We had computer charting when I worked as a nurse in Shock Trauma Respiratory ICU (STRICU) at LDS Hospital in the late 80’s. From what I understand, Intermountain Healthcare has sort of developed their own system. It is still in existence and is slowly spreading throughout the corporation. Back then, our q 2 hour assessments were completed on the computer. Medication charting included Medical Information Buses (MIBs) that tracked IV pump drip rate changes and infused volumes. All of this along with a graph of vital sign recordings printed out at the end of the shift. Nifty. The current version of the electronic medication charting “eMAR” is finally making it to the Pediatric Intensive Care Unit (PICU) at Intermountain Healthcare’s Primary Children’s Medical Center where I now work. It is said to greatly reduce errors by its inclusion of a scanned bar code check system prior to delivery of the medication to the patient. It is somewhat more cumbersome than our ‘old way of doing things’. This is in part, I believe, due to the fact that it was developed from the DOS based system that I used in the 80’s. Regardless, I am in support of further integration of a computer charting system in the PICU. The benefits, as stated above, outweigh the hassle.

4) IT in my clinical area...
In addition to this nurse charting, our ICU team of docs and NP’s enter their plan of care on a computerized tracker and many providers utilize computerized progress notes that may include photos of wounds, etc. Their consistent format and legible print make them much easier to read. These documents are also accessible to a broader range of team members inside and outside of the hospital. Information from a patient’s hospital stay can more readily be disseminated to the patient’s primary care providers who will continue care once the patient has been discharged. Primary care physicians can readily look up their patient’s lab values or reports of procedures completed within the Intermountain Healthcare system. I can imagine the benefit (clinical and research) if this were to occur on a national level. I am also fearful of breaches of security on a national system. At Intermountain Instacares, computerized scripts are utilized. Wow, what a difference! My handwriting is so poor I relish in the idea of incorporating electronic scripts and notes into my practice.

5) Promoting quality care...
If set up in a way that information can be readily queried, structured/coded clinical data can promote quality care through QI and research efforts. I’ve done a number of projects throughout the years ranging from carpal tunnel inducing paper tabulations to ACCESS database queries. I would much rather support efforts to enter data into a database than attempt to tease data out of paper documentation.

We are on our way to riding the peak of the IT wave.