NURS 6051 Literature Review The Use of Clinical Systems to Improve Outcomes and Efficiencies

NURS 6051 Literature Review The Use of Clinical Systems to Improve Outcomes and Efficiencies

The American Nurses Association (ANA) defines nursing informatics as a nursing specialty that consolidates nursing science with multiple data and analytical sciences. Informatics facilitates the process of identifying, defining, managing, and conveying information and knowledge in nursing practice (Kassam, Nagle & Strudwick, 2017). Nursing informatics work with a diverse group of professionals across the care continuum to bridge the gap between healthcare’s clinical and technical aspects. This paper will discuss a nursing informatics project that I advocate to improve patient outcomes and patient-care efficiency in my organization and how the project will achieve these goals.

The Proposed Project

           My proposed nursing informatics project for the organization is developing a patient portal. A patient portal is a secure online website that offers patients convenient access to their health information using an Internet connection. A patient is provided a secure username and password to access the portal. Developing a patient portal improves patient care efficiencies as patients can easily access their medical information including, Medical history, clinical summaries, medication lists, diagnostic results, and prescription renewals (Sieck, Hefner & McAlearney, 2018). Besides, the patient portal features allow patients to pay their medical bills online, update demographic information, and make appointment requests and reminders. The portal also has secure messaging that is HIPAA-compliant and supports communication between patients and their primary care providers (PCPs) (Sieck et al., 2018). This can significantly ease patient care as patients can consult their PCP from home and save them the frequent visits to the hospital. Furthermore, the portal has a feature of patient educational materials, which allow patients to view health education materials. The feature can help increase health promotion practices among patients and improve health outcomes.

The Stakeholders Impacted By This Project

The patient portal project will impact internal stakeholders such as healthcare providers and external stakeholders such as patients and insurance providers. Healthcare providers, including nurses, physicians, and nurse practitioners, will be positively impacted by the patient portal, which improves the efficiency of patient care and streamlining workflow. According to Zhong et al. (2018), implementing a patient portal in healthcare organizations increases health providers’ efficiency by facilitating effective communication between the PCP and patients. Patients can also register themselves on the portal by entering their details electronically, which eliminates formation and reduces the errors that arise when handling a patient’s medical history manually (Dendere et al., 2019). Additionally, the portal streamlines providers’ workflow through online appointment scheduling and secure messaging, which patients can use for urgent consultations rather than visiting the physician physically.

The patient portal will significantly impact patients since the primary goal is to improve their care and health outcomes. A study by Sorondo et al. (2016) found that having access to patient portals can increase access to health providers and data, contributing to improvements in patients’ functional status and reducing healthcare costs. Patients with chronic illnesses, including geriatrics and their caregivers, may benefit more from using the portal technology than others since they are the highest healthcare consumers. Sorondo et al. (2016) argue that patient portals can facilitate care coordination programs to enhance patients’ self-management and care. Insurers will also be positively impacted since the portal allows patients to pay for the services they have utilized through a secured online platform. Patients can also change their insurance details and access their billing information seamlessly.

Patient Outcomes or Patient-Care Efficiencies This Project Is Aimed At Improving 

The patient portal project aims at improving health outcomes and increasing care efficiency for patients with chronic illnesses and on long-term follow-up. According to Sorondo et al. (2016), integrating healthcare information technology in care coordination can improve health care by increasing patients’ self-efficacy for managing their disease, improving health outcomes, reducing unnecessary health care visits, and reducing administrative costs and time for health providers. The project also aims to improve care coordination for patients with chronic illness on coordinated care. Informatics can improve outcomes for chronic conditions patients by increasing access to primary care and care coordination provided through patient portals and can assist care coordination as a sustainable resource (Dendere et al., 2019). The project will improve care coordination by exchanging information between health providers, patients, and their caregivers. Besides, patient portals have screening and decision tools that can support improving care coordination.

The crucial role that technology plays in enhancing patient safety and care outcomes makes it impossible to overestimate the significance of using it to leverage care interventions across a and facilities. enable providers to use technology for better judgments and informed interventions, minimizing medication errors, encouraging drug compliance, and increasing patient outcomes and healthcare delivery efficiency (Dykes et al., 2017). Providers and healthcare systems use personal health records and portals as crucial tools to assist people who have just received a diabetes diagnosis. These portals give consumers access to health data from an organization’s electronic health record (EHR) and enable them to carry out a number of medical-related tasks, including registering their symptoms and electronically corresponding with their clinicians (Tapuria et al., 2021). The purpose of this study is to offer an annotated bibliography on the effects of patient portals or personal health records for those who have just received a diabetes diagnosis.

In this systematic evaluation of studies on the patient portal for diabetes mellitus, the researchers assess the effect of patient health records on enhancing results from glycemic control treatments. Twelve research on the topic were uncovered by the authors, including five randomized controlled trials and three cross-sectional studies. Both web portals connected to electronic medical records and those specialized in diabetes were required by the researchers. The results demonstrate that web portals help patients communicate with their providers more effectively and maintain better glycemic control. To comprehend patients’ degrees of control better, the authors stress the significance of further study. However, they are clear in their conviction that web portals help these patients’ glycemic control.

According to the study, web portals are crucial for diabetic patients because they enhance clinician-patient communication. Clinical staff members communicate more effectively to provide diabetes care more efficiently. In order to lessen unfavorable disease outcomes, doctors should make use of technology and encourage their patients to use them. The study found that one important takeaway from the use of online portals is that few patients adopt this technology to enhance their own care and self-management of their diabetes. As a result, healthcare professionals ought to be taught how to use it to enhance patient self-care interventions in rural locations.

New technology—and the application of existing technology—only appears in after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

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Nurse informaticists and healthcare leaders formulate . As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

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In this you will review existing research focused on the . After reviewing, you will summarize your findings.

To Prepare:

• Review the Resources and reflect on the within the context of nursing practice and healthcare delivery.

for data and information in nursing practice and healthcare delivery
Analyze challenges and risks inherent in healthcare technology
Analyze healthcare technology benefits and risks for data safety, legislation, and patient care

Analyze research on the application of clinical systems to improve outcomes and efficiencies

The Use of Clinical Systems to Improve Outcomes and Efficiencies

Annotated Bibliography

Lewing, B. D., Hatfield, M. D., & Sansgiry, S. S. (2018). Impact of computerized provider order entry systems on hospital staff pharmacist workflow productivity: a three site comparative analysis based on level of CPOE implementation. Journal of Hospital Administration, 7(1)..

The above study aimed at investigating the effect of computerized provider entry systems on the workflow productivity of staff pharmacists working in three hospitals in Houston, Texas. The research design used was an observational, prospective time as well as motion study. The sample consisted of pharmacists in three hospitals who were observed for one hour three block undertaking 38 different activities. The work categories the pharmacists were observed while undertaking them included distribution, clinical, miscellaneous, and administrative activities. The data obtained from the three hospitals was compared using descriptive as well as comparative analyses using ANOVA and Post-hoc Turkey’s range test.

The outcomes that were investigated in the study included workflow and productivity of the pharmacists while undertaking different tasks. The study also investigated the use of CPOE on time allotment and the comparison of the observed differences in time spent in the implementation of the CPOE system. The results of the study revealed that the use of CPOE the time that the pharmacists spent in implementing short and long-term CPOE activities was shorter when compared to that they utilized in implementing non-CPOE activities. It was therefore concluded that the use of CPOE can improve the work flow and productivity of the pharmacists in clinical settings. It also reduces the time that they spent in engaging in different activities in their settings.

This article has shown the effectiveness of CPOE in reducing the time that healthcare providers spent in engaging in their professional activities in the clinical settings. It has revealed that effective implementation of the CPOE systems can result in easy allocation of tasks and tracking of workflow in an institution of healthcare. Therefore, institutions that aim at improving productivity and efficiency in their operations should adopt the use of the CPOE system. Improved productivity and workflow translates into other outcomes such as enhanced quality, safety, and cost-effectiveness of care.

Okumura, L. M., Veroneze, I., Bugardt, C. I., & Fragoso, M. F. (2016). Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis. Pharmacy Practice (Granada), 14(3), 0-0.

The above study investigated the effects of using computerized provider order entry as well as clinical decision support system to enhance cost saving in the use of cefazolin in surgical units in Brazil. The study was before and after study design. The data on the prophylactic use of cefazolin was compared before and after the implementation of the CPOE and CDSS implementation. The authors believed that the comparative data would enable the accurate determination of the effectiveness of use of these systems. Data analysis was performed on 12-year data on cefazolin use. The 12-year data comprised of the first three years before CPOE and CDSS implementation while the remaining nine years was after the implementation of these systems. The obtained data was analyzed using Spearman rho on-parametric test to determine the use of cefazolin over the period of data collection.

The outcomes that were under investigation in the research included cefazolin use, product cost, and crude cost. The cefazolin use was defined by daily doses/100 bed-days. Product and crude costs were also defined by cefazolin use per 100 bed-days. The authors hypothesized that the implementation of the CPOE and CDSS systems will result in a net reduction in cefazolin prophylaxis use and overall costs incurred in health organizations. The outcomes of the research showed that the implementation of the CPOE and CDSS resulted in a reduction in cefazolin prophylaxis use from 6.31 DDD/100 bed-days in 2002 to 2.15 DDD/100 bed-days in 2014. The analysis also revealed that a lack of implementation of CPOE and CDSS in 2002 would have increased the costs incurred in the prophylactic use of cefazolin from $ 44, 722.99 to $116998.07.

The results from this study reveals that effective implementation of CPOE system has significant organizational benefits. It reduces resource wastage by increasing the utilization of evidence-based decisions in the provision of care. The system also promotes cost-efficiency in the organization. It is also evident from the research that optimum outcomes with CPOE system use can be achieved when combined with other systems such as CDSS. Therefore, health organizations should implement CPOE systems as a way of reducing wastage and cutting their operational costs.

Bucher, B. T., Ferraro, J. P., Finlayson, S. R., Chapman, W. W., & Gundlapalli, A. V. (2019). Use of computerized provider order entry events for postoperative complication surveillance. JAMA surgery, 154(4), 311-318.

The above study was conducted with the aim of determining the effectiveness of CPOE entry events in identifying post-operative complications. The researchers focused on determining the rates of post-operative complications that were identified with the use of CPOE when compared to the use of manual medical review. Cohort study design was used to achieve the objectives of the study. The researchers reviewed 21775 medical records for patients who had undergone surgical procedures at the University of Utah from 2007 to 2017. The data on the sensitivity of the CPOE system in the detection of the complications was analyzed using the logistic regression model. The CPOE-based surveillance system was used to validate the developed models for the identified post-operative complications.

The main outcome of the study was post-operative occurrences of complications. The complications included deep surgical site infection, superficial surgical site infection, organ space surgical site infection, pneumonia, sepsis, urinary tract infection, deep vein thrombosis, septic shock, and pulmonary embolism. The analysis of the obtained data revealed that the sensitivity of the CPOE events in detecting patients who experienced one or more complications was 74.8%, specificity of 86.8%, negative predictive value of 97.55%, and positive predictive value of 33.8%. The use of CPOE events also diminished the burden of manual review of records by 55.4% to 90.3%.

The above study revealed that CPOE could be used to detect and prevent adverse events in the clinical settings. This ability can be seen in its enhanced efficiency in detecting patients who developed post-operative complications. The study also demonstrated that the use of CPOE reduces the workload for healthcare providers. This can be seen in its ability to diminish manual review of medical records. Therefore, CPOE can be used to promote patient safety and reduce workload in healthcare settings.

Lyons, A. M., Sward, K. A., Deshmukh, V. G., Pett, M. A., Donaldson, G. W., & Turnbull, J. (2017). Impact of computerized provider order entry (CPOE) on length of stay and mortality. Journal of the American Medical Informatics Association, 24(2), 303-309..

The above study investigated the effect of CPOE on patient outcomes that included the mortality rate and length of hospital stay. The research was conducted in an academic medical center. The study design that was utilized was a retrospective pre-post study design where data from 66185 patients and 104153 admissions seen over five-year period were analyzed. Regression analysis was used for data analysis. Generalized linear mixed statistical tests were used to control confounders in the research.

The outcomes for this research were three. They included patient outcome variables, mortality, and length of hospital stay after the implementation of the CPOE. The analysis of the obtained data revealed that the implementation of the CPOE decreased the length of hospital stay by 0.90 days. There was also a decline of mortality rate from one in every 1000 admission pre-intervention to three in every 1000 admissions post-study. However, there was a rise in mortality rates in the intensive care units. The researchers therefore concluded that CPOE system can have a predictive value in reducing length of hospital stay and mortality rates in non-acute care settings.

The study has shown that the use of CPOE system improves patient outcomes of care. These outcomes include a reduction in their overall length of stay in hospitals and mortality rates. These improvements have additional benefits such as cost-efficiency and effective use of resources in healthcare. Therefore, organizations that intend to achieve enhanced patient outcomes with their care should consider adopting the use of CPOE system.

Moghaddasi, H., Sajadi, S., & Amanzadeh, M. (2016). The effect of a well-designed computerized physician order entry on medication error reduction. Journal of Health Management & Informatics, 3(4), 127-131.

The above study was conducted to investigate the effect of CPOE on reducing medication errors. The study was informed by the increased cases of medication errors with the use of paper-based prescription orders. This research was a systematic review where articles for use were obtained from databases that included Google Scholar, PubMEd, EBSCO, Iranmedex, Web of Science, and Irandoc. The articles were selected based on their relevance to the objectives of the research. The researchers used 10 articles that were considered relevant for the research.

The main outcome of this research was reduction in medication errors. The reduction in the medication errors was evaluated using the number of adverse drug events reported in the articles that were used in the research. The results of the study revealed that the use of CPOE resulted in a significant decline in the incidences of serious medication errors. It also revealed its use to be associated with a great reduction in the incidences of adverse drug events. However, the researchers noted that these outcomes are largely dependent on the effective design and implementation of the CPOE system.

One of the lessons learnt from the findings of this study is that positive effect of CPOE on patient safety. This can be seen in the reduction of the incidences of medication errors in the study. It can also be seen in the reduction in the events of adverse drug reactions due to enhanced accuracy in the prescription of drugs. I have also learnt that organizations must come up with comprehensive implementation strategy for CPOE to deliver the anticipated outcomes. Therefore, health organizations should consider the use of CPOE in enhancing the safety and quality of care offered to those in need.

Conclusion

The above analysis has revealed that CPOE has positive influence on healthcare. Its effective use results in diverse health outcomes. They include reduction in workload, improvement in safety of care, and reduction in mortality rates in hospitals. The analysis has also revealed that the use of CPOE reduces the hospital stay by the patients and promotes cost-efficiency in the operations of health organizations. However, it is important that the design and implementation of CPOE be done in a careful manner for it to deliver these outcomes.

References

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