Sample Nursing Paper on The Impact of Nursing Informatics on Patient Outcomes and Patient Care Efficiencies

I conducted my nursing practice in a hospital dialysis unit. It comprised of an outpatient unit and that department accessed the patients’ lifeline. Lifesaving treatment was performed in the unit. Also called renal replacement therapy, dialysis is a procedure entailing the excess contaminants, liquids, solutes, and fluids getting extracted from the blood of certain individuals whose kidneys are unable to operate and naturally execute this action. Furthermore, this treatment actually replaces the work that can be performed by the kidneys. It is one of the major complicated processes for individuals and there are various other problems that need to be discussed in relation to this process. Access patency is one of the key concerns

A concern for people ailing from chronic hemodialysis is the maintenance and prevention of their access clotting. Individuals suffering from End-Stage Renal Disease (ESRD) require the Renal Replacement Therapy (RRT) which is the bloodstream access they need to perform the hemodialysis procedure. Most individuals have the initial access hemodialysis catheter (CVC), which can be positioned in subclavian, femoral artery or jugular. There are several catheter-related concerns that include elevated bloodstream infection risk, reduced blood flow rates (BFR) that decrease the amount of processed blood, and this increases the clotting incidences.

Removing the catheter is the initial priority after a patient is put on dialysis with permanent treatment such as grafting or fistula. If the access is transformed to fistula or graft it is important to conduct maintenance to ensure that optimum BFR can be sustained. If the BFR does not have the appropriate blood volume then the complications including clotting or stenosis will occur and this will affect the patient’s general health. When the blood pressure of the patient is observed with frequent clotting is getting low continuously then it would be helpful to be able to trend the incidences and early interventions can be used to prevent the clotting of the access.

Repeated episodes of clotting because of the low flow of the blood in the access and this happens due to hypotension as this is the major factor through which this can happen. It is one of the most significant factor associated with risk that graft being more susceptible than fistulas due to its composition’s nature. Formation of clots in arteriovenous grafts is due to the flow as low as 600ml/min, where flows can be much lower approximately about 300ml/min, before the formation of clot. There is an effect on the outcomes of patients because of the low flows as there will be a decrease of blood volume being processed for treatment. The reason why the less blood cleaned is because of the less blood flowing through the dialyzer and it will create symptoms like fluid overload, uremia and hyperkalemia (Needleman & Hassmiller, 2015).

The reason of this proposal in to create a plan in which blood pressure trends of the patients can be monitored and it is associated with frequent incidents of thrombosis (clotting). Data can be gathered because of these trends which will allow for early interventions in the prevention of further clotting episodes. There are many benefits for the patients because of this such as the patients will have treatment of better quality and fewer incidences of thrombosis delaying treatments. It will effect on the overall better patient’s outcomes. If there was any program in which the blood pressure of the patient were interfaced into new (TAC) Total Access Care Program then we would be this much able to monitor trends in patency of the access and see trends denoting issues of worsening of clotting or stenosis and provide prior intervention (Kossman & Scheidenhelm, 2015). If there was any way through which we collating the blood pressure and BFR into the TAC program and compiling the trends that it might be possible for us to predict a clotting incident on the rise and provide prior intervention such as angioplasty to reopen the access. This will help the patient through various ways as it can prevent the patients from having delays in treatment, missing treatments and improve the overall quality outcomes for the future.

For this stakeholders are those who are responsible for the completion of this project (McGonigle & Mastrian, 2018). In this case that would be nursing informaticist’s unit manager, nursing staff and data specialists. Stakeholders are also the ones who design the project and their impact is very much on its implementation. They are also responsible for the time required to complete this project and budget. The aim related to patient’s outcome is the reduction of thrombotic events and continuity of care. This would be created by the nursing staff who are already working with the patients, they will coordinate with the data specialists and nursing informatics to develop a program that could interface blood pressures monitored (both pre and post treatment) for the particular specified time as well as BFR maintained during the treatment. This would then utilized to predict potential who are prone to developing clotted accesses and the incidences of thrombosis. This would allow for early intervention such as decrease the potential for poor treatments, angioplasty or missed treatments.

The technologies that can be used in the program are chairside program interfacing with E-Cube or EHR. In every patient’s HER there is a TAC program that used to monitor the access of each patient. Free text informational data such as BFR and blood pressure would be collected then interpreted into trends by a computer program within E-Cube (Karp et al., 2019). It is updated with clotting, surgeries, patient’s appointments and procedures etc. with that there should be another program alongside that compares the correlation BFR along with incidents of access clotting and compares the blood pressures. With this quantitative data analysis, this data and information will look at correlation and relationships related to an outcome. (McGonigle et al., 2018). Topredictive trends can be monitored by looking at correlation between decreased BFR, blood pressures and clotting. It will allow it for early interventions.

Executive sponsor are the ones through which design team would be composed. Executive sponsors can be unit manager and someone who has the ability to remove barriers and authority to remove barriers. Another person who can be an executive sponsor is a team leader inside the unit of dialysis. Expectedly they are the charge team leader and charge nurse because they are the ones with intimate knowledge about the project and have time for that. They also know about all the components related to project. This can also be someone who is good at managing day to day task of the project and has the ability to effectively coordinate with the technical expert and which would be a data specialist, they can also work along with the nurse informatics and would be the clinical leader (Hussey et al., 2015). In the position of clinical leaders nurse informatics fits as they can be in charge of planning the design of project based on the data, purpose of project and source. They will take care of patient’s privacy and security and integrate overall best practice. They can make such programs through which they can transfer data from one system to another and easily maintain a workflow.

If we utilize the knowledge based on the nurse informaticist and applying knowledge in a purposeful way then it would be possible that the quality of care will be improved for patients of dialysis prone to thrombosis (Lee et al., 2017). Working as a team we can show how data specialists and nursing informaticist are an important part as they use their specific skill sets and it can be beneficial for overall quality of patient care.

 

References

Hussey, P., Adams, E., & Shaffer, F. A. (2015). Nursing informatics and leadership, an essential competency for a global priority: eHealth. Nurse Leader, 13(5), 52-57.

Lee, T. Y., Sun, G. T., Kou, L. T., & Yeh, M. L. (2017). The use of information technology to enhance patient safety and nursing efficiency. Technology and Health Care, 25(5), 917-928.

Karp, E. L., Freeman, R., Simpson, K. N., & Simpson, A. N. (2019). Changes in efficiency and quality of nursing electronic health record documentation after implementation of an admission patient history essential data set. CIN: Computers, Informatics, Nursing, 37(5), 260-265.

Kossman, S. P., & Scheidenhelm, S. L. (2015). Nurses’ perceptions of the impact of electronic health records on work and patient outcomes. CIN: Computers, Informatics, Nursing26(2), 69-77.

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Needleman, J., & Hassmiller, S. (2015). The Role Of Nurses In Improving Hospital Quality And Efficiency: Real-World Results: Nurses have key roles to play as hospitals continue their quest for higher quality and better patient safety. Health Affairs28(Suppl3), w625-w633.