This paper is about “Improving Sepsis Collaboration through computer documentation.”
Preventing and treating the life-threatening infection that is sepsis requires one of the most rapid reactions from healthcare professionals regarding time. Thus, identifying and documenting sepsis cases becomes another critical step in the patient’s healing process, requiring a specific set of skills and ultimate collaboration from doctors and nurses alike.
Despite paper-based databases remaining the traditional way of going about protocol, using advanced and modern means of documentation presents newer, undiscovered aspects of utility. Hence, the presented Nursing Informatics (NI) project at Northwell Health will focus on the ways a shift from paper to computer databases can be achieved, as well as the benefits of this within treating sepsis.
Nursing Informatics Project
The need for a computer-based documentation approach within Northwell Health was identified based on multiple factors, concerned not only with modernizing the attitude of healthcare professionals towards the documentation process. A study by Perez (2013) states that the “results of adopting innovation and the improvements effected by its implementation go beyond the adoption process” (p. 89). While the mentioned study deals mainly with educative nursing systems, their apperceived benefits may transfer well onto the presented documentation procedures. Considering all this, along with the fact that Northwell Health does not have a computer-based sepsis protocol, creates the need for a project that will construct the possibility of such a changeover.
The project objectives will include:
- The creation of a sustainable computer-based sepsis documentation protocol to be used within Northwell Health.
- The identification of those, who would benefit from such computerization of the documentation process.
- An establishment of the project’s priority within Northwell Health and, thus, the need for its timely implementation within the organization.
- The codification of specific values of success evaluation through using a devised rubric.
- The determining of those responsible for the project’s implementation.
An argument should be made about the need for a computer-based order. Computerization allows for an enhanced response time, which becomes vital in life-threatening cases, and studies have found that electronic documentation surpasses hand-written protocol in speed (Schachner et al., 2016). This fact alone may be enough to give computerization an advantage over slower, paper-based methods, as the positive effects on patient’s health far outweigh the negative repercussions.
Cost of human resources, however, becomes an essential factor to consider before attempting a changeover within the means of a protocol that is central to the healthcare system. Not only does switching over to computer-based databases require the creation of fitting software, its testing, and continuous development throughout implementation, but it also calls for staff training and briefing. Costs of computerization seem to continue increasing because even digital information will require storage.
Additionally, some investigations also argue that “differences in mortality outcomes, if they exist, appear small across [computerization] studies,” seemingly highlighting computer-based protocol as lacking the promised efficiency (Moja et al., 2014, p. 16). However, even a slight positive change in patient mortality already allows entertaining the idea of medical record computerization since it becomes an advantageous step in improving the system of health care.
Thus, two biggest concerns regarding computerization are highlighted that consist of system effectiveness and cost, which play a decisive factor in plan implementation. A study by Forrester, Hepp, Roth, Wirtz, and Devine (2014) has demonstrated that computerization and a decrease in the paper trail have generally brought about “lower costs and improved medication safety” (p. 347). Therefore, not only does computerization have a lower price in comparison to paper-based protocol but it also helps efficiently organize the healthcare process and heightens medical safety.
Nurses receiving digital training have proven to demonstrate both, high levels of software literacy among staff and increased nurse inclusivity in the administrative side of the healthcare process (Schachner et al., 2016). These presented factors align with the variables that affect project implementation, which may be defined as application convenience and result verification (Perez, 2013). The competence of computer-based protocol has already been presented above in relation to both an increase in the quality of care provided and cost difference in comparison to paper-trail databases.
The effect of decreasing the so-called paper trail on sepsis identification has already been identified as having a positive impact on patients’ health. Well-being productive outcomes may be defined as a reduction in treatment time through the curtailment of documentation error and medical transgressions, as well as a decline in protocol writing and perception times. Additionally, faster reaction times to sepsis cases become more probable, with more rapid documentation allowing doctors and nurses to interact directly with the patient, which increases the quantity and quality of administered healthcare.
The influences of inopportune sepsis treatment result in “long hospital stays (median = 10 days), discharge to long-term care settings (20%), and death (25%)” (Novosad et al., 2016, p. 867). Expediting sepsis treatment through its rapid documentation, thus, allows for faster patient recovery through not only its identification but also the collaboration of healthcare professionals in its treatment. Therefore, both medical professionals and seekers of aid within the healthcare system may be identified as those benefiting directly and indirectly from sepsis protocol computerization.
From within the healthcare system, professionals that will benefit from computerization such as doctors, physicians, and, most importantly, nurses may be highlighted. The importance of nurses and their future use of computer-based documentation may be presented through the fact that they are the most avid users and creators of patient-related documentation (Clynch & Kellett, 2015). Therefore, easing the protocol process, especially considering that it may take 20% of the nurses’ time, creates not only job efficiency but also employee satisfaction within the target personnel (Clynch & Kellett, 2015, p. 222). Furthermore, healthcare professionals overall will be presented with a faster and simplified access to patient information, which is an essential factor in sepsis treatment.
The importance of this project should not be underestimated in comparison to other attempts to improve the healthcare system mechanism. A study by Clynch and Kellett (2015) focused on the impact of human error in medicine has shown that documentation takes up a significant portion of doctors’ time, which may be combatted by developments in computerized protocols. Thus, the issue of incident codification becomes one of the most important and most requiring solving, especially considering that there is no necessity for a complete revamping of the system but only its remodeling.
A fluid volume reassessment, which demonstrates a strong emphasis on the significance of the patient within the healthcare system, may be presented in table format to illustrate the project’s sustainability and effectivity. The table was created relying on the evidence displayed in a presentation by Friedman and DaCosta (n.d.). The critical points of the process are:
- Take and document the patient’s vitals, obtain blood cultures (before prescribing antibiotics);
- Administer IV fluid to the patient, control the process’ completion and volume of fluid;
- Take vital signs a second time, protocol lactate levels.
|Hour||Time||Blood pressure||Heart rate||Respiration rate||Pulse rate||Body temperature||Fluid Volume||Lactate levels|
Attainment of success should not just focus on reaching the goals set systematically in the presented research but should rely on the creation of a rubric to measure that, which is quantitative. Of such calculable values, it is possible to highlight two, with one of them being the percentage of implementation of the devised computer-based sepsis documentation protocol throughout Northwell Health.
The second measurable quantity would be that of sepsis treatment time through a comparison of the speed of reaction before/after implementation, calculated in time per aided patient. Factors relating to project priority and stakeholders may be effectively extended from doctor-nurse opinion questionnaires about the subject. However, the success of this project should be defined not only through its perceived utility but also through an assessment of the implementation effort against positive results, to be calculated from the suggested above metrics.
Reporting the Results: To Whom?
The institution of a separate group, or multiple ones, with a defined group leader, may seem necessary for the success of such a project, which will help achieve ultimate collaboration between system-developers and healthcare professionals. Equally as important remains the assignment of those responsible for the assessment of the results and thus playing a role in the evaluation of the advantageousness of the project. Thus, the creation of such a system of group collaboration within Northwell Health becomes vital to the success of the project, as without appropriate evaluation no outcome may be devised. It would seem practical to place this project under the responsibility of the Sepsis Education Program at Northwell Health, due to the perceived goal alignment.
The partnership instituted between healthcare professionals through the development of a computer-based system of documentation can ultimately lead to faster response time to life-threatening cases, such as sepsis. Through the establishment of appropriate software, training, and a decrease of the infamous paper trail, which slows down aid administration, patients’ health may be positively affected. The highlighted in this research goals and suggested rubrics of evaluation could be implemented to appropriately develop and modernize the health care system by creating efficient ways of communication between doctors, nurses, and patients alike.
Clynch, N., & Kellett, J. (2015). Medical documentation: Part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation. International Journal of Medical Informatics, 84(4), 221-228. Web.
Forrester, S., Hepp, Z., Roth, J., Wirtz, H., & Devine, E. (2014). Cost-effectiveness of a computerized provider order entry system in improving medication safety ambulatory care. Value in Health, 17(4), 340-349. Web.
Friedman, I., & DaCosta, N. (n.d.). Northwell sepsis collaborative evidence based best practice. Presentation. Web.
Moja, L., Kwag, K., Lytras, T., Bertizzolo, L., Brandt, L., & Pecoraro, V.,… Bonovas, S. (2014). Effectiveness of computerized decision support systems linked to electronic health records: A systematic review and meta-analysis. American Journal of Public Health, 104(12), 12-22. Web.
Novosad, S., Sapiano, M., Grigg, C., Lake, J., Robyn, M., Dumyati, G.,… Epstein, L. (2016). Vital signs: Epidemiology of sepsis: Prevalence of health care factors and opportunities for prevention. Morbidity and Mortality Weekly Report, 65(33), 864-869. Web.
Peltonen, L. M., AlHuwail, D., Ali, S., Badger, M. K., Eler, G. J., Georgsson, M.,… Lewis, A. (2016). Current trends in nursing informatics: Results of an international survey. In W. Sermeus, P. Procter & P. Weber (Eds.), Nursing informatics 2016: EHealth for all: Every level collaboration – From project to realization (pp. 938-393). Washington, DC: IOS Press.
Perez, G. (2013). The adoption of information systems innovation: Study of a learning support system and its adoption in the medical education field. International Journal of Auditing Technology, 1(1), 75-90. Web.
Schachner, M., Gonzalez, Z., Sommer, J., Recondo, F., Gassino, F., Luna, D., & Benitez, S. (2016). Computerization of a nursing chart according to the nursing process. In W. Sermeus, P. Procter & P. Weber (Eds.), Nursing Informatics 2016: EHealth for all: Every level collaboration – from project to realization (pp. 133-137). Washington, DC: IOS Press.
Trends and Issues in NI Research and their Impact on Nursing Practice
The presented project is reliant not only on providing appropriate beneficial results to the health care system but also aims to aid the identification and quick overcoming of NI drawbacks. Nursing informatics, having unified nursing practice and data management, has created an unprecedented change in the duties and responsibilities of healthcare professionals and still requires more study. Thus, NI implementation and amendment requires a deep understanding of its current trends in both utilization and research.
While NI permeates different spheres of health care, not all aspects of it receive equal research attention. Research by Peltonen et al. (2016) demonstrates an apparent lag in the analysis of NI theory in relation to its other domains, with theory receiving a mean research interest of 3.6 on a 1-10 scale (p. 939). In comparison, administrative NI studies attract a mean interest of 4.3 and NI in clinical practice and education both have a mean of 4.5 (Peltonen et al., 2016, p. 939).
Thus, NI trends remain skewed in favor of research perceived to be more practical in the medical field or having tangible results, which align with Perez’s (2013) proven H6 and H7 hypotheses of innovation. Result verification (H6) and visibility of implementation (H7) were subsequently presented as respectively the most and least influential factors, with H6 having a statistical hypothesis test value of 7.240863 and H7 having one of 1.683489 (Perez, 2013, p. 88). Thus, the fulfillment of this project carries additional research benefit, encouraging further NI studies.
The impact of NI research on healthcare provision should not be underestimated; numerous studies help judge not only the practical value of these projects but also appraise their immediate influence on patient-doctor and patient-nurse relations. An improvement in any of the connections mentioned above, including inter-professional relationships between nurses, physicians, and so on, should result in a positive change in the quality of health care received by the patient.
NI projects allow for quicker lines of communication and action in the event of life-threatening conditions. The example of the Computerized Provider Order Entry System demonstrates a cost efficiency of $18 million, as well as 1.5 million fewer errors and 14500 less drug-related mishaps (Forrester et al., 2014, p. 345). Therefore, improving sepsis collaboration through computerization of the process should yield practical results through a positive development of the factors mentioned above.
The use of the proposal encourages research in NI clinical practice application, furthering its popularity trend and contributing to additional topic research and development. With both practical and hypothetical results viable for study, the project at both retains functional soundness and has a direct effect on health care quality, professional cooperation, and modernization of the hospital system. Its value is thus distributed through a dichotomy of theory and practice, creating a proposal promoting both NI utilization and scientific investigation.