Policy and Ethical Issues Related to IT

It is always good to be reminded of the responsibility we have to maintain confidentiality and privacy.  Technology provides improved access to storage and retrieval of records, but we need to be cautious about who these records are shared with.  The article "10 Tips to Secure Your Laptop" offers advice on keeping our information safe, as well as information we may have stored on the laptop.

It was also good for me to learn more about computer risks.  I have heard about (and had) viruses and worms, but didn't really understand the differences.  I'm not sure about you, but spam drives me crazy.  It was also good for me to learn about Trojan horses, Logic bombs, Bacteria, and Phishing.  Next time one of these comes across my computer, I'll better know how to deal with it.

Module 5 - Clinical Decision Support Systems

I enjoyed learning more about clinical decision support systems (CDSS).  As I have attended wound care conferences, I have seen various software systems written specifically for wound care programs.  Initially I felt they would not be very helpful, but I have come to realize that they offer many benefits for improving the care of our patients, evaluating treatments, creating reports, and generating bills.  We currently free-text most of our documentation.  Implementing a CDSS would likely improve our documentation, and provide uniformity among our clinicians.  The lessons learned from the information in this module has made me even more aware of the benefits of such a system.  My clinical decision making could definitely be improved with the use of a CDSS.

Wound/Ostomy Nurse

I work with children and babies.  Specifically I oversee a team of nurses who provide wound care and ostomy care for these patients.  We do a lot of teaching, mostly to parents, but on occasion to patients themselves.  Often times patients are sent home before a wound is healed.  In these instances we teach the family how to care for the wound, change the dressing, and provide nutrition for improved healing.  We also teach them to contact their primary care physician or our team for any concerns and teach them what to be concerned about. 

Many of our patients have new gastrostomy tubes.  Parents are usually nervous about caring for these.  We teach them how to take care of their child, and what to do if the tube gets pulled out.  

Like adults, children and babies sometimes need to have an ostomy created.  These are usually temporary in the pediatric population.  Despite the temporary nature, it is a difficult adjustment.  We teach the parents about the digestive tract, how to care for the ostomy, and what to expect. 

All health care providers are involved in education.  The more education we can give to our patients and families, the more comfortable and competent they are in their care at home.

Information Retrieval

You used an electronic index, a guideline index, and a web search engine to retrieve information relevant to your clinical problem. Compare and contrast your results. Which resources were useful/ not useful for your information retrieval task, and why?

I used both Pubmed and CINAHL electronic databases to run similar searches.  Pubmed produced a larger number of articles.  Approximately half of the articles produced by the CINAHL search provided full-text articles.  There were very few full-text articles available from the Pubmed results.  I then ran a search on Google using similar criteria (including RCTs and meta-analysis).  This produced thousands more articles (466,000), was much faster, did not require multiple screens or access through the university library, and had immediate full-text for all articles that I clicked on.  The AHRQ site provides sites that have guidelines developed by specific organizations from clinical evidence.  I would consider this the most trusted site for evidence-based information.  

Begging for Technology

I was hired into my current position 41/2 years ago, and promptly began - oh yes- hand writing notes.  However, I did have an amazingly tech-savvy boss who hooked me up with the electronic medical record in the hospital.  What an improvement!  I was then able to type my notes, print them off, sign them, and place them in the charts.  Shortly thereafter we collaborated on a new note.  I provided the parameters, he provided the programming knowledge, and our electronic note was created, including the ability to import pictures into the note itself.  These were uploaded into the electronic medical record, printed out in full color and, placed into the chart.  Providers and staff were truly impressed.  Eventually we were able to eliminate the need to print the typed note, but continue to print the picture note and place in chart.  Anyone with access is able to sign into the patient's chart, click on our consults, and read all of our notes. 
Another aspect of my position is participation on the corporate wound and skin team.  In an effort to standardize our documentation, we have been petitioning for wound charting program.  We determined the needs of our various hospitals and clinics, then investigated several companies.  After much discussion and evaluation, we made our decision and submitted a request to our corporation.  We are currently waiting for approval and purchase, following which we will take the necessary steps to implement the product into our practices.  Once established it will need to be maintained and updates made as needed.  These are some of the ways to be involved in system development.

Module 1 - This is Me

My name is Linda Neiswender.  I am in the Clinical Nurse Leader Masters Program.  I work at Primary Children's Medical Center where I have been developing a wound and ostomy program for the past 4 1/2 years.  I am a certified pediatric nurse and recently completed my certification is wound, ostomy and continence nursing.  Completing this certification will now allow me to focus on my studies  here at the university.
Information management is essential in all areas of nursing.  As a graduate level nurse it will be even more important as I search out information to apply to my area of expertise and as I manage the information.  Databases are useful in finding out what research has been done on the use of new products and treatments.  I will also be able to establish more efficient patient and department records.
We currently document in the patient's electronic record.  We use an Excel document to import pictures of the wound, along with our documentation.  This is uploaded into the patient's record.  When not using a picture we use free-text.  We use a scheduling program to schedule patients in our outpatient clinic.  On a corporate level we are exploring the possibility of purchasing a wound charting program.  These would enable us to document, run searches, keep statistics, generate reports and billing statements, among other functions.