Discussion: The Application of Data to Problem-Solving

Once upon a time, there was an era of paper charting and this was the norm in many health care facilities. There were using MAR and TAR  , I had an opportunity to be part of that generation where health care professionals where  locked in this system .This paper system was very stressful and it was hard to find the information needed regarding patients .Little did we all know that technology was evolving so fast and later on , Many software with EMR and ETR emerged . Now, most hospitals I work for are using Electronic Medical Records (EMR) and life is so much better. Since the implementation of EMR, access to critical information or data has been faster and more convenient for all health care professionals.

In the ICU where our patients are usually in a state of shock or going to it, various data collection sets are used to predict the severity of shock or if a patient is going to septic.  The use of MEWS or Modified Early Warning Score together with laboratory data has provided many hospital units to prevent delay in interventions of critically ill patients (Gardner-Thorpe et al., 2006). My current hospital integrated MEWS with our EPIC EMR which triggers or flags nurses to pay more attention to warning signs of sepsis or shock. The nurses will then contact the Rapid Response nurses to evaluate the patient and interventions are made to prevent further decline in health.

Without the integration of data as a useful source of information to drive nursing interventions, it would take nurses and other health care providers some time to gather information and formulate a solution. With our EPIC system, which is maintained by the Information Systems department, led by a Nursing Informatics graduate, the digital solution to electronic records and retrieval is modeled on the nursing science. McGonigle and Mastrian enumerated the foundations of nursing informatics being knowledge acquisition, generation, dissemination, processing and feedback (2018). These processes drive the current nursing practice model to that of information systems.

Access to a vast collection of data about any medical issues has also been integrated into our EPIC. Medline and Micromedex for drugs are excellent resources that enable the nurses to administer correct medications and know the side effects of each medication that are not familiar to them (Flynn, 2001). As we can see, technology has come a long way to help as a tool for health care professionals to work effectively and safely. 

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Gardner-Thorpe, J., Love, N., Wrightson, J., Walsh, S., & Keeling, N. (2006). The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Annals of the Royal College of Surgeons of England, 88(6), 571-5.

Flynn, M. B. (2001). Nursing and informatics: Implications for critical care practice. Critical Care Nurse, 21(4), 8-8, 10, 14, 16. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search-proquest-com.ezp.waldenulibrary.org/docview/228169558?accountid=14872

Response

Henry, I came into the nursing field just as the nursing field was transitioning into electronic records.  I remember seeing and hearing the older nurse’s frustrations because their generation was not as familiar with using computers.  Wu, Deoghare, Shan, Meganathan & Blondon (2019) reports that electronic health record (EHR) systems that are not easy to navigate through can increase frustration among users, which can result in increased errors.  While transitioning to EHR systems was difficult in the beginning, it was easier once everyone adjusted to the system.  Unlike paper systems, EHR systems allow providers to review lab results and diagnostic tests promptly.  There is less of a chance that records will be misplaced or misfiled when an EHR system is in place.

Ayaad, Alloubani, ALhajaa, Farhan, Abuseif, Hroub & Akhu-Zaheya (2017) conducted a comparative study comparing paper-based records and EHR systems.  What the study showed was that the patients in hospitals that used EHR systems received higher quality care compared to those that did not.  EHR system allows providers to print off a summary of the patient’s condition that can be given to their peers during the change of shift, or when a patient is being transferred to a different unit (Wu, Deoghare, Shan, Meganathan & Blondon, 2019).  This help ensure that the oncoming nurse has all the information available to provide quality care.

References

Ayaad, O., Alloubani, A., ALhajaa, E., Farhan, M., Abuseif, S., Al Hroub, A., & Akhu-Zaheya, L. (2019). The role of electronic medical records in improving the quality of health care services: Comparative study. International Journal of Medical Informatics, 127, 63–67. Doi: 10.1016/j.ijmedinf.2019.04.014

Wu, D., Deoghare, S., Shan, Z., Meganathan, K., & Blondon, K. (2019). The potential role of dashboard use and navigation in reducing medical errors of an electronic health record system: a mixed-method simulation handoff study. Health Systems, 8(3), 203–214. Doi: 10.1080/20476965.2019.1620637

Discussion: The Application of Data to Problem-Solving

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

• Reflect on the concepts of informatics and knowledge work as presented in the Resources.
• Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.

By Day 3 of Week 1

Post a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.

Focus of My Scenario

In my clinical scenario, the danger of surgical smoke goes wholly ignored by my hospital. The surgical staff is constantly exposed to smoke from electrocautery and lasers without apparent care for their occupational health. Ignorance of the situation by surgeons and management is persistent. Examining the basis of such ignorance reveals multiple potential motivations. First, surgeons may believe, and it is frequently said, that there is no danger presented by inhaling surgical smoke. However, there is sufficient and credible evidence to the contrary. Second, there may be a corporate fear associated with the cost associated with smoke abatement technologies. However, the ethical and moral concern associated with cost-based value judgments when it comes to employee safety becomes ugly very quickly. This is especially true when such a clear body of knowledge regarding the issue exists. Third, there may be conflict within the scientific community about the subject. As more contemporary scientific knowledge is revealed, older notions that were once considered as knowledge are laid to rest. In this case, the most strident of the old-school thinkers still demand their say at the cost of so many affected healthcare workers.

Data Use, Collection and Access

The credible data required for a transformative effort in the knowledge of this the subject is current, copious and widely available through Google Scholar, the U.S. Department of Labor Occupational Safety and Health Administration, the National Institute of Health or any reputable research library.

Using Knowledge Derived from Data

Under direct experimentation, exposure to surgical smoke has been definitively shown to increase the risk of lung cancer and may also promote chronic bronchitis, asthma , and emphysema. Increased mortality and increased risk of lung and airway disease are directly tied to biological and chemical pathogens transmitted by the inhalation of the contents of surgical smoke (Karjalainen et al., 2018). According to the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA), upper respiratory tract irritation and visual problems are well-established dangers of repeated exposure to surgical smoke. OSHA has acknowledged that surgical smoke may contain toxic gases that have mutagenic and carcinogenic properties (United States Department of Labor, 2019). According to the research of Sissler et al. (2018), surgical smoke contains biological and chemical pollutants that result in cytotoxicity and pulmonary irritation when inhaled. They feel that their research strongly supports other published research and that surgical smoke is a direct occupational hazard for surgical workers (Sissler et al., 2018). She et al. (2017) stated that surgical smoke contains known carcinogens and has established the inhalation of it as a vector for the transmission of infectious biological particles. Formaldehyde and benzene were shown to exist in surgical smoke at levels that exceed the United States Environmental Protection Agency’s cancer risk index by 1×10^6. They suggested that since the negative health impact of surgical smoke inhalation was so profound and highly carcinogenic in nature, a control measure must be taken (She, Lu, Yang, Hong, & Zhu, 2017). Furthermore, the Association of Perioperative Registered Nurses (AORN) believes that there is sufficient credible data to lobby for changes in the law regarding the protection of surgical staff. According to AORN, Colorado and Rhode Island have already enacted compulsory smoke evacuation laws. Similar efforts will soon become law in Oregon and Tennessee (Azzara, 2019).

References

Azzara, N. (2019, December). Standing up against surgical smoke. Outpatient Surgery. AORN. Retrieved from http://www.outpatientsurgery.net/surgical-facility-administration/personal-safety/standing-up-against-surgical-smoke–12-19

Karjalainen, M., Kontunen, A., Saari, S., Rönkkö, T., Lekkala, J., Roine, A., & Oksala, N. (2018). The characterization of surgical smoke from various tissues and its implications for occupational safety. PloS one, 13(4).                                                               doi:10.1371/journal.pone.0195274

She, S., Lu, G., Yang, W., Hong, M., & Zhu, L. (2017). Health risk assessment of VOCs from surgical smoke. Preprints, 2017070042. doi:10.20944/preprints201707.0042

Sisler, J., Shaffer, J., Soo, J., LeBouf, R., Harper, M., Qian, Y., & Lee, T. (2018). In vitro toxicological evaluation of surgical smoke from human tissue. Journal of Occupational Medicine and Toxicology, 13(12). doi:10.1186/s12995-018-0193-x

United States Department of Labor. (2019). Smoke plume. Retrieved from https://www.osha.gov/SLTC/etools/hospital/surgical/surgical.html#LaserPlume

response

I agree that the danger of surgical smoke is an important issue that is often dismissed. When I switched from outpatient cardiology to plastic surgery, I became aware of the potential long-term health risks of being exposed to surgical smoke. I also felt that smoke evacuation systems were not always used properly in an effort to save money. When considering legal guidelines, it is important that the protection measures are consistent with the data. Similarly, exposure issues continue to surface at the VA, with disability compensation being requested for diseases related to military service. Unfortunately, it seems the data for possible connections between illnesses and exposure to environmental agents is lacking. While various hazards have been reported, data on long-term effects of exposure to surgical smoke are not available (Steege, Boiano, & Sweeney, 2016). According to the National Research Council (n.d.), the need for exposure assessment measures can improve the ability to assess adverse effects from environmental agents. As nurse leaders, it is important to provide clear, supported justifications for changes to existing protocols to encourage adoption of the new policies and procedures.

References

National Research Council (n.d.) Environmental Epidemiology: Volume 2: Use of the

Gray Literature and Other Data in Environmental Epidemiology. Washington (DC): National Academies Press (US). Retrieved February 28, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK233635/

Steege, A. L., Boiano, J. M., & Sweeney, M. H. (2016). Secondhand smoke in the

operating room? Precautionary practices lacking for surgical smoke. American journal of industrial medicine, 59(11), 1020–1031. https://doi.org/10.1002/ajim.22614