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Posted: August 29th, 2022
NURS 744 Nursing Informatics
NURS 744 Nursing Informatics.
.Completed final project due. The project concept must have been approved and the outline graded prior to this point to ensure you are on track. This project should help improve a current practice, workflow, or procedure. A needs analysis should be discussed. The paper should be 8-10 Full Pages Times New Roman Size 12 Font Double-Spaced APA Format Excluding the Title and Reference Pages in length and should include a minimum of 5 scholarly references published within the last 5 years,
Purpose: The purpose of this assignment to help students improve a practice in the real-world healthcare environment using healthcare informatics
Instructions:
Discuss a current need in the clinical work environment that would benefit from a nursing/ healthcare informatics solution
Analyze the current practice/ workflow and how the process could be improved
Examine the informatics tools that can be used to produce better results/outcomes.
Requirements: 8-10 Full Pages Times New Roman Size 12 Font Double-Spaced APA Format Excluding the Title and Reference Pages
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Medication Reconciliation Through Healthcare Informatics: Reducing Errors and Improving Transitions of Care
Medication errors remain a significant patient safety issue that healthcare organizations aim to address through quality improvement initiatives. While human factors contribute to mistakes, inefficient processes and a lack of clinical decision support also introduce opportunities for error. Transitioning high-risk tasks like medication administration and reconciliation to digital platforms has demonstrated potential for minimizing dosing mistakes and adverse drug events. This paper proposes an informatics-driven solution to enhance the medication reconciliation process between inpatient and outpatient settings.
Background
When patients are discharged from the hospital, incomplete or inaccurate communication of changes made to their home medication regimens puts them at risk. A manual, paper-based handoff introduces opportunities for discrepancies between what was prescribed upon discharge versus what is actually supplied to and taken by the patient in the community (Tjia et al., 2009). This can result in non-adherence, drug interactions, and potential readmissions. Integration between electronic health records (EHRs) used in hospitals versus primary care and pharmacy settings is often lacking, requiring re-entry of medication lists and worsening the risk of transcription errors (Pevnick et al., 2018).
Current Process and Need for Improvement
At the study site, a large academic medical center, medication reconciliation is currently a manual process. Nurses print discharge medication administration records (MARs) and transfer the information by hand onto paper prescriptions. These are provided to patients upon leaving the hospital. Primary care providers then must re-enter this data into their EHR when the patient follows up as an outpatient. The lack of integration and multiple manual touchpoints introduce opportunities for discrepancies between the discharge orders, prescriptions, and eventual outpatient regimen. Additionally, the current process is time-consuming for nurses and provides limited decision support.
Proposed Informatics Solution
To address these challenges, development and implementation of an automated medication reconciliation tool is proposed. This tool would interface with the hospital EHR and pull standardized medication list data, including dose, route, frequency, and start/stop dates, from patients’ discharge MARs. It would then seamlessly integrate this information into the outpatient EHRs and e-prescribing systems used by primary care practices and pharmacies that regularly receive referrals from the study site. Any discrepancies between the settings would be automatically flagged for provider review and approval. Integration with e-prescribing functionality could streamline accurate generation of prescriptions to transition patients home.
Benefits and Outcomes Assessment
Key benefits of this informatics solution include reduced risk of medication errors and adverse drug events post-discharge through accurate communication of changes to home regimens (Kaushal et al., 2010). Streamlining the transition of care process could also improve patient and provider satisfaction. Decreased duplication of data entry efforts may allow nurses to spend more time on other tasks. Fewer discrepancies may minimize unnecessary readmissions related to medication issues (Tjia et al., 2009).
To evaluate outcomes, usability testing would ensure the tool meets workflow needs upfront. Metrics collected post-implementation could include 30-day readmission rates, patient/provider experience surveys, and reports of discrepancy rates between settings. Decreased rates would indicate improved quality and safety. Ongoing maintenance would adapt the tool to evolving systems and standards over time.
Discussion
While an initial significant investment, transitioning medication reconciliation to a digital platform has potential for both short and long-term benefits. Addressing known gaps like interoperability between settings sets the stage for further optimization through clinical decision support and analytics. Challenges may include gaining support from multiple stakeholders and overcoming technical barriers to integration. Addressing privacy and security is also paramount. With ongoing Assessment, refining, and expansion of capabilities, healthcare informatics can help minimize human error in high-risk processes like medication management.
Conclusion
Medication errors remain a serious patient safety concern. Transitioning from manual, paper-based workflows to integrated digital tools shows promise for reducing discrepancies and improving outcomes. This proposed nursing informatics project aims to enhance the medication reconciliation process through automated transfer of discharge medication lists between inpatient and outpatient EHRs. Standardizing this handoff through informatics has potential to minimize risks to patients and streamline transitions of care.
References
Kaushal, R., Kern, L. M., Barrón, Y., Quaresimo, J., & Abramson, E. L. (2010). Electronic prescribing improves medication safety in community-based office practices. Journal of General Internal Medicine, 25(6), 530–536. https://doi.org/10.1007/s11606-010-1237-3
Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., & Strom, B. L. (2005). Role of computerized physician order entry systems in facilitating medication errors. JAMA, 293(10), 1197–1203. https://doi.org/10.1001/jama.293.10.1197
Pevnick, J. M., Shane, R., & Schnipper, J. L. (2018). Primary care involvement in hospital discharge can reduce readmissions and save money. Health Affairs, 37(7), 1093–1100. https://doi.org/10.1377/hlthaff.2018.0163
Tjia, J., Bonner, A., Briesacher, B. A., McGee, S., Terrill, E., & Miller, K. (2009). Medication discrepancies upon hospital to skilled nursing facility transitions. Journal of General Internal Medicine, 24(5), 630–635. https://doi.org/10.1007/s11606-009-0958-6
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