Clinical Decision Support and Perioperative Peripheral Nerve Injury: A Quality Improvement Project.

Decision support at the point of care has been demonstrated to be an effective tool in providing a safe environment and improving patient outcomes. The operating room is typically an area where advanced technology is introduced to nurses on a regular basis. This quality improvement project focused on preventing a peripheral nerve injury, which is an example of a postoperative adverse event that is considered preventable. Injury of a peripheral nerve is the result of compression, hyperextension, flexion, or ischemia surrounding the nerve. The goals for this project were to improve the knowledge of peripheral nerve injury of the operating room nurses, design and implement a peripheral nerve injury assessment screen that could provide decision support within the operating room record, improve the nursing documentation of peripheral nerve injury interventions, and (long term) decrease the incidence of peripheral nerve injury. A decision support screen within the operating room record was designed to supplement the operating room nurse's risk assessment for peripheral nerve injury. The components of this project involved a preliminary and postproject surveys on peripheral nerve injury knowledge, an educational presentation, and a retrospective random review of nursing documentation in the operating room electronic health records. Project results demonstrated a significant increase in nursing documentation of peripheral nerve injury interventions (63%-92%) and a positive attitude toward their exposure to basic decision support (P = .046). Recommendations for future studies and establishing a standardized coding system for peripheral nerve injury identification were identified.

Nursing as a learning discipline: a call to action.

The advent of the electronic health record and numerous mobile, wireless tools with the capacity to capture, store, and transmit prodigious amounts of data, both using and creating evidence-based content and analytics for clinical decision support, requires that all care providers rethink approaches to care delivery. The nursing profession is called to acutely appreciate and support the vision of documentation systems that provide optimal decision support at the point of care, represent nursing knowledge, and are also capable of capturing care delivery outcomes that can be used to inform future care and improve the health of the public.

Applying human factors analysis to the design of the electronic health record.

The healthcare industry is automating clinical documentation at the point of care - taking us from paper documentation to an electronic health record (EHR). Designing user-friendly, intuitive systems is challenging, and has motivated hospitals to evaluate and adopt new and safer practices to help reduce the contribution that technology plays in healthcare error. To accomplish this, healthcare is evaluating how other industries, like aviation, have successfully applied human factors to system design. Recent healthcare research has demonstrated the potential value of human factors in information technology (IT) projects. This article provides a synthesis of research on the application of human factors to the design and development of the electronic health record and makes apparent the need for human factors education for nurses and IT professionals involved in EHR design.

Modeling nursing interventions in the act class of HL7 RIM Version 3.

The proposed Health Level 7 Reference Information Model (HL7 RIM) Version 3 is the foundation for expressing data to be communicated across health care information systems. The general objective of this analysis was to examine whether the RIM supports the expression of nursing interventions, considering both terminological and structural perspectives. The Nursing Terminology Summit Interventions Group focused on patient education about breast cancer, an intervention that differs sufficiently from other medical processes already considered by HL7 and represents issues surrounding both definition and execution of nursing process. Relevant actors, actions, and action relationships were culled from use cases and modeled into the proposed RIM structure and attributes by using modified instance diagrams. This method was effective and reproducible, and the RIM proved to be an adequate model for supporting breast cancer education. Additional interventions must be studied to fully assess the adequacy of the model to support all aspects of nursing process and terminology.

Innovative educational strategies to prepare nurse executives for new leadership roles.

Distance education has grown over the last decades. As technology has improved, so has our ability to provide students with education options. Excelsior College has taken advantage of this digital age to bring together global nurse leaders and given them the opportunity participate self-paced learning at home. Excelsior is a leader in online education and now has expanded by offering masters courses with a specialty in clinical systems management and health care informatics to nurses worldwide.