“Incidence, risk factors and consequences of ICU delirium” discusses the impacts of delirium in the ICU patient (Ouimet, Kavanagh, Gottfried, & Skrobik, 2007). According to this study, 31.8% of patients reviewed suffered from delirium; delirium was linked to increased ICU stay, longer hospitalization, and increased patient mortality. The risk of delirium was increased in patients who received sedatives and analgesics. Delirium was also more highly associated with hypertension, alcoholism, and severity of illness. It is interesting to note that this article cited a different study that reported delirium in up to 80% of patients. This is significantly higher than the result of this article, which found an occurrence of 31.8%. This demonstrates potential inconsistencies in scoring tools and inclusion/exclusion criteria across various studies. As an ICU nurse, I find it very frustrating when there is a discrepancy between what evidence-based literature reports and what is practiced clinically. ICU patients are routinely given sedatives and analgesics to manage pain while patients are on highly invasive and painful therapies such as ventilators, balloon pump therapy, hypothermic therapy, etc. Acknowledging the data presented in the articles reviewed for this week’s discussion, I pose the question regarding potential solutions and alternatives to this problem? Yes, of course we want to wean the patient off sedation as soon as possible, but when critical patient warrants such medications, what is the alternative? Is it potential to reduce delirium more beneficial to a patient than managing the risk of extensive pain or self-extubation? To share a story that happened just this past week, my unit was caring for a post op open heart patient CABG x3 vessels with extensive pulmonary disease. This patient was extremely hemodynamically unstable, on high ventilator support, and extremely agitated. Without going into much more detail, this patient was on two sedative drips, and still his agitation was uncontrolled. This patient ended up pulling out his endotrachael tube and needed to an emergency reintubation. The surgeon was extremely upset and ordered a third sedative for this patient. Knowing the data associated with sedation and delirium, would this order be beneficial to the patient? Lack of adequate sedation led (in part) to the self-extubation from which could have had fatal consequences. Ouimet, S. , Kavanagh, B. , Gottfried, S. , & Skrobik, Y. (2007). Incidence, risk factors and consequences of icu delirium. Intensive Care Medicine, 33(1), 66-73.

As with any aspect in nursing, technology can be effectively used if utilized in the appropriate manners and can benefit in patient care and safety. I think that healthcare professionals should be open to change and embrace technology, because that is the direction that the healthcare field has already taken. Those who are not flexible to adapt to these changes will be faced with struggles in the future. An example that comes to mind involves the use of paperless charting and electronic physician orders at the facility that I currently work at. A few years ago, these changes were implemented at my hospital. Yes, it was a struggle to adapt and with any new changes there were hiccups in the process along the way. But eventually, we collectively reached out goal of paperless charting, electronic medication administration, and physician-entered orders. These changes help promote patient safety because of safeguarding against medication errors, and reducing the risks of incorrect orders via telephone or verbal orders. Charting is also more effective and easier to manage. Another use of technology that promotes patient well-being is the increasing access to their own medical records. Patients can have access to their laboratory values, diagnostic exams, and have electronic methods of contacting their care providers with questions and follow up information.

The “Digital Trends in Nursing” blog is a comprehensive opinion based blog designed to bring fourth changing technologies and how it is being incorporated into the nursing world.  Unfortunately the blogger (Raney Linck) has not kept up the site, and the most recent post is almost a full year old. With the continued advances in technology, and integration of that technology in healthcare, it is important to remember that changes happen everyday.

I feel like the technology referenced in this blog is becoming more mainstreamed and is available to the masses, not just health care providers.  I feel in the next few months the department I work for will be utilizing the technology available; in fact, today I participated in an inservice for my hospitals new tele robot.  This robot will be replacing the current tele stroke robot, that essentially video conferences a neurologist to a potential stroke patient, and will be used to conduct follow up appointments in the emergency room and connect patients with specialists that would otherwise have to travel to the facility.  This robot, and technology like it, enhances the assessment process, it does not replace it.  It remains the nurses responsibility to be the eyes and ears in the physical room and participate the in advanced assessment process.

It is also important to remember that these technologies are made to enhance the assessment process and do not necessarily replace the need for more “basic” or “primitive” testing; example being an EKG monitors the electrical activity of the heart, but does not replace the importance of auscultating for heart and valve sounds.

It is also important for follow up and proper education if people are bringing these technologies into their homes for self care.  Home health agencies or monitoring companies must be notified to follow up to ensure the patient is truly being cared for and does not have a false sense of safety.  Continual monitoring and health applications could give a better overall picture to the patients daily health status but must be interoperated by a medical doctor and not the redly available “doctor google”.

There is a never ending story of research conducted by multiple agencies, hospitals, and educational centers.  It is important for the health care provider to be alerted to the ever powerful “evidence based practice” research.  Only when research is conducted, tested, and proven in a clinical setting does it become the standard for health care.  As technology advances new tools will be available for clinicians and for people to use at home.  Some pros of mobile technology include the potential for fewer hospital stays, monitoring patients, better recovery outcomes, and an overall better quality of life.  Some cons of mobile technology include false sense of security, interrupted or malfunction of equipment, and poor knowledge of equipment available.

In the hospital I work at, we encourage patients to utilize the technologies available; from blood sugar checks, blood pressure machines, heart rate and oxygen saturation finger probes, and an ACCURATE thermometer.  These are now basic technologies that are common in many homes that, when utilized appropriately, can alert a patient or practitioner of acute health changes that need additional treatments.

Technology….to me…is amazing, wonderful, and once you learn how to use it effectively, is so helpful! I have been using my electronic medical record (EMR) at my job for almost two years and I still learn a new trick and short cut at least every couple of weeks. I have some reservations about the accuracy, generalizability, and the overall safety, but all in all, I feel that these are helpful tools that will only provide practitioners more knowledge right at their fingertips. I have already witnessed the providers searching on their phones for pharmacology.

For my own nursing future, I believe it will make my job easier in terms of finding the necessary information in times that I am unsure. A couple examples are, accessing Epocrates when a patient is on a medication I am unfamiliar with; also, the app for medical Spanish or google translator…I often have patients that have language barriers and with a little help it would make a world of a difference in their understanding and compliance.  A downside that I foresee, is having patients feel a false sense of empowerment with the information and they may either incorrectly self-medicate, or they may come in and argue with me or the providers because they are sure they have what they researched on the internet (I have already encountered this).

I feel like I will use technology more in the next few months because just going through the new apps available enticed me to download more and I am excited to try out my new sleep cycle app. I sleep talk and sleep walk so I have Excessive Daytime Sleepiness (EDS) and I am curious to see my data charted on this app of how often I stir. I also downloaded Medscape which may come in handy as a quick reference for my triages. I like to look things up and figure things out when they are new, so this app will expedite that.

I feel that the patient portals where they enter their data for blood pressure (BP) and blood sugars (BS) will be very helpful for providers if the patients are completing them correctly. This will eventually become a staple of assessments. The app for continuous heart monitoring will also be a helpful assessment tool.

Managing care at home through mobile technology will be extremely difficult for many people. Patients have difficulty operating their BP and BS monitors, let alone all these different devices. I do, however, feel that where there is a will there is a way and if any individual sees the benefits outweigh the costs, they will make stronger attempts at mastering these new technologies.

The safest way to evaluate the effectiveness of these technological advances is by testing them against evidence based data and our assessment skills. The patients will still need to come in for check-ups, this is not a replacement for face-to-face evaluations, this is just a tracker for continuity of care.

There is plenty of research that has been done to evaluate the effect of technology on patient care. Informatics has been a part of nursing for quite some time and the data is always evaluated as part of the nursing process. The more and more technology that is introduced, the more research will be completed.

As I mentioned before, some of the things I can anticipate as a “con” are the patients’ false sense of completely understanding their healthcare needs, the lack of knowledge on how to use the technology properly, the accuracy of their recordings, the accuracy of our technology for each patient, the lack of face-to-face assessments and treating the individual, and more. Some of the “pros” are the continuity of care, the accessibility to information, the patients’ involvement in their care and the encouragement towards health promotion. More pros are the savings in cost for the patient and healthcare agencies, the patients have access to their records faster, and more.

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I think that Nurses will be using technology more and more in the coming years. There are a lot of recent advances in technology that will be used in Nursing. For example the EHR-MU makes it easier to transfer patient records form one facility to another. Also it makes patient medical data more accessible even within the same facility. The federal health mandate around electronic health records have also begun to require that patients have access to their own health information (Linck, 2014).

CPOE is a clinical software application designed specifically for providers to write patient orders electronically rather than on paper. With CPOE, providers produce clearly typed orders, reducing medication errors based on inaccurate transcription (Nursing World, 2014).

There are also ear buds that can measure your heart rate, speed and calories burned per workout while you are listening to music and an iPhone case that turns your phone into an EKG monitor (Linck, 2014).

I think that for me as a nurse it would be beneficial to constantly educate myself about new technology and see if it is something that can help me have better access to information or help my patients. I think that mobile technology can help patients to monitor themselves but it should be recommended with caution as patients may try to self diagnose rather than seek the help of a health care professional.

The pros are that technology help nurses to have better access to information whether it is the EHR, or the internet or looking up medication information. Also with the CPOE this helps to stop medication errors by ensuring accurate transcriptions.

The cons are that new technology can be time consuming to learn and may distract from patient care.

The way that I have seen technology being used for patient education in the hospital is when the nurses can bring up handouts related to patient education that are linked to the patient record based in their current diagnosis. There were many that could be printed out and discussed with the patient like diet suggestions, or warning signs and when to call the doctor.

 

Reference:

Huston, C., (May 31, 2013) “The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 1.

Linck, R (2014). , Digital Trends in Nursing : http://digitaltrendsinnursing.blogspot.com

Technology has definitely brought a change in healthcare and nursing.  A cell phone case with the capacity of an EKG monitor, ear buds monitoring your heart beat and the amount of calories you burn are all incredible interventions (Linck, 2014).  In 2000 the Food and Drug Administration approved the robotic surgery with the da Vinci Surgical System where more complex and delicate procedures can be performed.  It also increase surgery’s to be minimal invasive with the results of a decrease in complications such as infections of the surgical site, decrease in blood loss, faster recovery, and smaller scars (Mayo clinic, 2015).  In nursing electronic charting, electronic MAR, and Krames are just a few of the important electronic programs in daily nursing.  In nursing school and as a new graduate flexibility in learning different charting programs throughout the different hospitals was essential.  Next year at my workplace we will be trained on a new charting program named Epic.

There are pros and cons towards technology and healthcare.  The internet is a quick resource for patients to find out regarding their condition in using websites such as WebMD; however self diagnosis is not the best option.  Follow up care with the primary care physician or specialist needs to be established.  A critical care nurse tried to catch up with the morning medications after the patient had a change in condition and required different procedures.  The nurse in a hurry crushed the medication and administered the medications through the NG tube including the “Do not crush” medication warning listed on the electronic medication administration record.  A crushed extended-release calcium channel blocker was administered to the patient resulting in the patient’s death (Anderson and Townsend, 2013).  Technology is an asset to healthcare and nursing, however it can not replace the human brain.

 

References

Linck, R. (2014, October 8). Digital trends in nursing. Retrieved September 6, 2015,   from http://digitaltrendsinnursing.blogspot.com/

Anderson, P., & Townsend, T. (2013, March). Medication error: Don’t let them             happen to you. Retrieved September 6, 2015, from                                                                 http://www.americannursetoday.com/medication-errors-dont-let-them-                     happen-to-you.

Mayo Clinic. (2015, July 2). Robotic Surgery. Retrieved September 6, 2015, from         http://www.mayoclinic.org/tests-procedures/robotic-                                                         surgery/basics/definition/prc-20013988

 

Digital technology is fast becoming ‘the norm’ in all aspects of our society, and healthcare is no exception.  From having access to healthcare records with a few key strokes to simple things, such as new hands-free and wireless telephones for healthcare staff, technology is making most healthcare professionals’ jobs easier.  It’s great to have a smart device or computer unhand to look up any desired information at a moments notice.  I am by no means ‘a techie’, but I fully embrace  the technological advances and am willing to learn the newest things that come out.

I think that the new EHR’s and healthcare documentation software are making assessment documentation somewhat easier for nursing staff.  With an increasing number of RN’s coming into the workforce that are tech savvy, it is a time saver. However, in regards to the older nurse population, is has made documentation more difficult, as some are not comfortable with computers in general.  EHR’s also require a multitude of man hours for education in order to teach staff how to use the new systems.

Another downside to mobile technology is that it has driven people to seek healthcare advice from internet resources which may, or may not be reliable sources. People need to realize that digital media is a decent starting point, but if they have questions or concerns about health, their primary care physician is the best source.

I see technology used frequently within the hospital setting for patient education.  The hospital uses printed sources from Krames and other similar sites for medications, patient safety, exercise programs, and disease process education.

Digital technology in healthcare is a very exciting idea. Two years ago I had read an article about doctors using cell phones to monitor their cardiac patients. The information was downloaded to the application and transmitted to the doctor in real time to monitor the patient’s heart health. Remote monitoring coupled with Electronic Health Records will provide the health professionals the ability to collaborate with ease and over distance. Nurses and health professionals will half to be computer literate, trained, and kept up to date as changes are made to the platform that the facility is using.

In a journal article written by Sheila M. Gephart, PhD, RN & Judith A. Effken, PhD, RN, FACMI, FAAN, it is indicated that is allows the clinicians to follow their patient when they return home and is cost effective as well. However, they do indicate that as they track and follow their patient’s chronic disease, if the information is not inputted it triggers the need for the clinician to intervene which in most cases in a phone call to remind them to input the data, such as the latest blood sugar. There are concerns about the security of the Electronic Health Records (EHR) as indicated in an article by Seth Foldy (Et al). While they have great things to say about the advancement of information tech as it relates to health care, it also approaches it with the need for serious protections and certification of the protection being used by the facility. They further explain that there are many applications used on cell phones that can give bad information and possibly cause people to delay seeking medical attention when it is needed, as well as making the information that you enter into the app accessible to other third party individuals.

Healthcare technology is growing exponentially and I as well as other nurses will be using and accessing more as time progresses. In many places health assessments done by nurses are a series of questions with check boxes and in some cases you can free-write information. In many respects this is good as it prevents areas from being missed or overlooked, however that being said it is also easy to not elaborate or be as thorough in parts of the assessment. It is up to the nurse to be as thorough as she can and if unable to elaborate in the assessment program she will need to mindful to make a narrative note so that information is not missed. While I am optimistic and excited for the future possibilities that this technology brings, it needs to be approached with caution to insure the protection of the clients information.

References:
Gephart, S. M. (2013). Using Health Information Technology to Engage Patients in their Care. Online Journal Of Nursing Informatics, 17(3), 1-6.
Foldy, S., Grannis, S., Ross, D., & Smith, T. (2014). A Ride in the Time Machine: Information Management Capabilities Health Departments Will Need. American Journal Of Public Health, 104(9), 1592-1600. doi:10.2105/AJPH.2014.301956