How does nursing data quality relate to decision support?
The quality of nursing data in relationship to decision support is critical. As Mollie Poynton related in her Captivate presentation much of the data that is collected by nurses ends up on notes in the pockets of their scrubs. Nurses need to have a place that they can import data as well as extract it in a timely manner. According to the chapter 10 reading by Androwich and Kraft, when making critical clinical decisions, clinicians depend on the reliability, accuracy, and timeliness of the information. I see that one of the area that would be a benefit for the quality of nursing care would be an interdisciplinary support in medication orders. Medication errors are a major problem. When a nurse has several patients, who each have multiple medications, it can be very time consuming to make sure all of the medications are the right dosage and often the original orders by the physicians are terribly written. I know when I worked as a floor nurse, medications were checked against several paper check lists: the cardex, the pharmacy printout, the physicians orders. A med would be added, one would be discontinued, a subtle dosage change would take place. Having a CDSS that was used by physicians, pharmacy, nursing etc. would help track changes, alert to any problems, and possible medication discrepancies. According to Androwich and Kraft, "Nurses need access to current knowledge at the point-of-care delivery where it is useful: in clinics, at the bedside, in homes, offices, and in research that makes contribution to evidence based practice." Having access to a CDSS for medications alone would help in all these areas. I know that larger health care facilities probably are already doing this, but it needs to be something that any nurse in any location can have access to when caring for patients.
Sunday, March 22, 2009
Module 4 Question # 1 part 2
How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?
I think the first step is to realize that we as humans make mistakes. Making mistakes in the health care profession can unfortunately have irreversible effects. Anything that can enhance our decision making quality must be considered. I think the next step is in analyzing our own tendencies in using heuristics and biased practices. It is easy to have something work for you and therefore feel comfortable in using it again, and again, without realizing what evidence you really base your use of it on or if another technique would work better. Treating patients take the ability to make quick decisions, but the quality of these decisions must be best practice. I can see that in today's information explosions that tapping into EBP is essential in supporting our profession. The use of a CDSS does not take the place of experience and intuition, and the ultimate decision of care, but having access to electronic libraries, medical dictionaries, drug formularies, expert opinions and patient databases as discussed in chapter 10 (Androwich and Kraft) in real time is an advantage that our patients deserve. Nursing practice must be on the cutting edge of technology and our own EBP must be made available to other health care entities.
I think the first step is to realize that we as humans make mistakes. Making mistakes in the health care profession can unfortunately have irreversible effects. Anything that can enhance our decision making quality must be considered. I think the next step is in analyzing our own tendencies in using heuristics and biased practices. It is easy to have something work for you and therefore feel comfortable in using it again, and again, without realizing what evidence you really base your use of it on or if another technique would work better. Treating patients take the ability to make quick decisions, but the quality of these decisions must be best practice. I can see that in today's information explosions that tapping into EBP is essential in supporting our profession. The use of a CDSS does not take the place of experience and intuition, and the ultimate decision of care, but having access to electronic libraries, medical dictionaries, drug formularies, expert opinions and patient databases as discussed in chapter 10 (Androwich and Kraft) in real time is an advantage that our patients deserve. Nursing practice must be on the cutting edge of technology and our own EBP must be made available to other health care entities.
Module 4 Question # 1 part 1
How did the readings influence your perception of your own clinical decision-making?
The readings gave me a new perception of how I make my clinical decisions. I definitely need to get the support that Computer-based Clinical Decision Support System can offer. In reading the material I first had to understand the full meaning of the term Heuristics. After understanding it more clearly as being defined as: Educated guesses, optimal solutions, problem solving, trial and error, and rules of thumb; I felt I could understand the Captivate presentation and the readings. In the Captivate presentation that Mollie gave, I realized that I am one of those nurses who has felt that if I didn't know the answers I felt less than adequate and unsure of my education. Depending on intuition and experience, or asking a more experienced health care provider has been the way I have primarily done things. I have always attended re- certification classes and gone to seminars yearly and the fact that I have always continued my education has helped my practice as well. I also subscribe to several journals, but as much as I use the Internet, I do not have a CDSS. This may be due to my non-traditional clinical setting in occupational health where I am the only health care provider and the company I work for is very tight in spending money. They feel that having just the Internet is enough and I do use it extensively, but not as efficiently as I could with a CDSS. Since my company pays for my tuition I plan to present what I have learned to my employer and request we get a CDSS. I feel that I can help them see the importance of this.
In the Thompson article, I found the information on Combating overconfidence interesting. I have a physician who come once a month and I look forward to interacting with him, but he tends to ignore the detailed knowledge that I have concerning a patients I am having him see and often jumps to his own conclusion before giving me a chance to have input. He is not interested in consulting with me or teaching me from his more advanced knowledge base. For example, I see a particular patient several times a week and he may see him twice a year, but he jumps to a quick diagnosis upon seeing one elevated blood sugar for example and then leaves, disregarding the other signs and symptoms I present for his opinion. I ended up sending this patient out for a neurological consult. He has Meniere's disease. When my opinions and research has been disregarded because "I am just a nurse " it certainly undermines my confidence. I would like to be treated more professionally.
I also enjoyed the material on Hindsight that Thompson (2003) gives. I felt it was important advice to make sure that as nurses we make sure we do the work-up before we come up with our prognosis. If a patient has already been diagnosed with diabetes for example, we tend to look at everything from that point of reference having priori knowlege as Thompson (2003) explains.
The readings gave me a new perception of how I make my clinical decisions. I definitely need to get the support that Computer-based Clinical Decision Support System can offer. In reading the material I first had to understand the full meaning of the term Heuristics. After understanding it more clearly as being defined as: Educated guesses, optimal solutions, problem solving, trial and error, and rules of thumb; I felt I could understand the Captivate presentation and the readings. In the Captivate presentation that Mollie gave, I realized that I am one of those nurses who has felt that if I didn't know the answers I felt less than adequate and unsure of my education. Depending on intuition and experience, or asking a more experienced health care provider has been the way I have primarily done things. I have always attended re- certification classes and gone to seminars yearly and the fact that I have always continued my education has helped my practice as well. I also subscribe to several journals, but as much as I use the Internet, I do not have a CDSS. This may be due to my non-traditional clinical setting in occupational health where I am the only health care provider and the company I work for is very tight in spending money. They feel that having just the Internet is enough and I do use it extensively, but not as efficiently as I could with a CDSS. Since my company pays for my tuition I plan to present what I have learned to my employer and request we get a CDSS. I feel that I can help them see the importance of this.
In the Thompson article, I found the information on Combating overconfidence interesting. I have a physician who come once a month and I look forward to interacting with him, but he tends to ignore the detailed knowledge that I have concerning a patients I am having him see and often jumps to his own conclusion before giving me a chance to have input. He is not interested in consulting with me or teaching me from his more advanced knowledge base. For example, I see a particular patient several times a week and he may see him twice a year, but he jumps to a quick diagnosis upon seeing one elevated blood sugar for example and then leaves, disregarding the other signs and symptoms I present for his opinion. I ended up sending this patient out for a neurological consult. He has Meniere's disease. When my opinions and research has been disregarded because "I am just a nurse " it certainly undermines my confidence. I would like to be treated more professionally.
I also enjoyed the material on Hindsight that Thompson (2003) gives. I felt it was important advice to make sure that as nurses we make sure we do the work-up before we come up with our prognosis. If a patient has already been diagnosed with diabetes for example, we tend to look at everything from that point of reference having priori knowlege as Thompson (2003) explains.
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