NRSG 311 Unit 4 – Discussion Board CTU
In a world where technology is growing vastly, there is a demand for patient education to be available on electronic devices rather than just paper after-visit summaries. Empowering patients to get involved in their education has proven to help patients make decisions pertaining to their healthcare (Crawford, et al., 2017). Utilizing an iPad to have patients watch pre-selected hospital discharge videos prior to discharge from the hospital is one way to reach patients and help answer their questions prior to them going home. Implementing technology into healthcare is only one-third based on technology and the rest varies based on the culture and operations of the department (Hebda, et al., 2018).
Implementation of a new process: Implementing bedside tablets for inpatient patients to watch discharge educational videos enhances the traditional educational materials covered by the discharging nurse. According to Fenske, (2019), “Tablet computers were made available to access reputable, easy to understand health resources during the educational processes upon diagnosis and continued treatment at the hospital” (p. 110). Once the staff is on board with the new implementation at hand, education and training begin prior to “go live”. This enhancement in education helps patients to not feel so overwhelmed getting all the discharge information at one sitting as the patient can choose when to watch the required discharge videos prior to leaving the hospital and saves the nurses time spent on discharge processes.
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Education/Training: Education begins with teaching all the staff how to navigate the bedside tablet/ iPad. Staying current with unit specific policies and procedures is part of the continuous education for the iPad discharge teaching. Staff must stay current in HIPAA compliance as well since each bedside tablet is individually checked out to patients to access their medical record and the nurse must clear all the data after each patient use. Nurses also should be well versed in the discharge educational videos, so they are prepared to address patient questions.
Evaluation/Review and Revision: After evaluating the addition of the bedside tablet to the department patients and nurses were satisfied with the education at their fingertips at all times. Patients also liked the feature that let them log into their electronic medical record to see their current profile including medications, vital signs, consent forms and notes. The iPad raised concerns with HIPAA in the sense that other patients would use the iPad after patient discharge however once patients set their password it protected their information for the duration of their hospital stay and then the nurse would just clear the data and recheck out to the next patient. There is a department that helps with any malfunctioning or broken equipment.
Resources
Crawford, T., Roger, P., & Candlin, S. (2017). The interactional consequences of “empowering discourse” in intercultural patient education. Patient Education and Counseling, 100(3), 495–500.
Fenske, R. F. (2019). Tablet Computer Use at the Bedside in a New Patient/Family Education Program. Journal of Hospital Librarianship, 19(2), 110–128.
Hebda, T. L., Czar, P., & Hunter, K. (2018). Handbook of Informatics for Nurses & Healthcare Professionals (6th Edition). Pearson Education (US).
Primary Discussion Response is due by Thursday (11:59:59pm Central), Peer Responses are due by Saturday (11:59:59pm Central).
Develop an outline for a plan for implementing and evaluating a technological resource or health information system to improve patient care delivery or improve patient safety in a clinical setting. Explain the regulatory and ethical practices needed to ensure the integrity of the use of the planned information system in the health care setting. Respond to 2 other posts from your colleagues.
Discussion Board Rubric
The Discussion Board Grading Rubric is a scoring tool that represents the performance expectations for the discussion. This Discussion Board Grading Rubric is divided into components that provide a clear description of what should be included within each component of the discussion. It is the road map that can help lead your discussion.
For assistance with your assignment, please use your text, Web resources, and all course materials.
In 2020 when the COVID-19 pandemic overwhelmed hospitals, Kaiser Permanente patients that would have been admitted into the hospital were instead sent home with supplies and a home monitoring smart phone application (app). As published in The Permanente Journal, (Hyunh, 2021) “The Southern California region of Kaiser Permanente developed a COVID-19 Home Monitoring program as an alternative to hospital admission to decrease hospital bed days and mitigate the adverse effects of a surge” (para. 1). Hospitals were filled with critically ill patients and in-patient beds were reserved for the sickestl. At home the patient would enter their symptoms and vital signs at regular intervals and abnormal results would trigger a health care provider (HCP) to make a telephone call to the patient to determine if they needed an in-person appointment or to go to the emergency department (ED). Inherent in this was several regulatory and ethical practices that had to be put in place to allow for effective healthcare.
Implementation of a new process. In the ED when the HCP determined a patient met the criteria for home monitoring a case manager was assigned to that patient while in the ED. The case manager was responsible for interviewing the patient and determining if they were eligible based on certain criteria. The single most important criteria was access to a smart mobile device, phone, tablet, or computer, plus the ability to input data into the device.
Education/Training: The case manager would educate the patient and or family on how to use the app while in the ED. The patient was given a pulse oximeter and blood pressure cuff and instructed on their use. The ED staff were trained and educated on the criteria needed to be eligible for home monitoring. Staff were also trained to respond to the information entered via the app and how and when to contact the patient directly. Patients and family were educated as to why the home monitoring program was in place and the benefits and disadvantages to its use. Paper handouts in Spanish or English were given to the patient. Interpreters were made available. The app is password protected to ensure sensitive protected health information (PHI) is safe. If a patient failed to enter information that would also trigger a response from the HCP.
Evaluation/Review and Revision: The date evaluated by Kaiser Permanents suggests that home monitoring can be done safely. Initially nurses were hesitant to discharge patients home that they clinically felt should be hospitalized, but as the pandemic worsened it was evident that this was a valid option. The Permanente Journal states, “Most of the patients enrolled were Hispanic/Latino (59.0%), followed by white (18.7%), Asian (9.0%), and black (7.6%)” (Hyunh, 2021, Table 1). Ethically in the interest of equity further research should be done to determine why such a disparity exists between those two groups, questions such as, were less Black people treated for COVID than Latino or does the former have less access to smartphone technology? Recent research published about pulse oximeter’s reliability when used with patients with darker skin leads to further questions if they lead to poorer outcomes for these groups.
Huynh, D. N., et al., (2021). Description and Early Results of the Kaiser Permanente Southern California COVID-19 Home Monitoring Program. The Permanente journal, 25, 20.281. https://doi.org/10.7812/TPP/20.281
DB Unit 4
Introduction: The use of Ultraportable Handheld Ultrasound (HHU) has become more commonplace as the machines have evolved to become smaller and less expensive for facilities to purchase (Thavanathan et al., 2020). These devices can be used for a multitude of purposes at the bedside. In an ED they can be used for focused assessment with sonography for trauma (FAST) exam, cardiac ultrasound and to aid in placement of vascular access to name just a few (Thavanathan et al., 2020). Point of care ultrasound (POCUS) is becoming the standard of care in most emergency departments and the use of HHU is streamlining the process (Malik et al., 2021). HIPAA concerns regarding the images and patient data entered the device are dealt with the downloading of data to the facilities PAC server in most cases (Malik et al., 2021).
Implementation of a new process: The use of small handheld ultrasound devices in inpatient settings, such as the ED, to lessen delays in evaluation of potential life-threatening problems as well as aid in delivery of care more quickly to patients.
Education/Training: Healthcare providers depending on their role would need to receive initial training on the equipment, as well as annual demonstration of competency in it’s use. The ability to utilize the ultrasound machine would be dependent on the healthcare provider’s job description, training level as well their scope of care.
Evaluation/Review and Revision: When HHU was first introduced in the ED at my facility there was push back by providers who doubted that the images would be as good as traditional ultrasound. That concern was decreased over time as the providers used the device and could judge the quality for themselves. Another concern was since the device is very portable, management was concerned it would become misplaced. Labeling the device with our department helped with those concerns, however eventually the solution that was settled on was to place the small device in our automated supply cabinet so that the user’s name would be linked to the device being removed from the cabinet.
References:
Malik, A. N., Rowland, J., Haber, B. D., Thom, S., Jackson, B., Volk, B., & Ehrman, R. R. (2021). The Use of Handheld Ultrasound Devices in Emergency Medicine. Current emergency and hospital medicine reports, 9(3), 73–81. https://doi.org/10.1007/s40138-021-00229-6
Thavanathan, R. S., Woo, M. Y., & Hall, G. (2020). The future is in your hands – handheld ultrasound in the emergency department. CJEM : Journal of the Canadian Association of Emergency Physicians, 22(6), 742-744. https://doi-org.coloradotech.idm.oclc.org/10.1017/cem.2020.449
We are currently in the process of implementing the use of iPads in each patient room. The idea is for them to be able to fill out their own admission questions, upload and digitally sign consents, view their charts via the My Chart feature, and facetime with their doctors if they are in isolation with Covid. They will be able to read doctors notes, view their current and past lab results as well as any imaging results, view their MAR, and view their inpatient itinerary.
We aren’t the only hospital hoping to integrate this technology into healthcare. We understand that there are risks associated with this, particularly with concerns over the security of the information (Moyle et al, 2020). I’m hoping that the benefits outweigh the risks and that patients will benefit from the increased access to their own information. I hope it gives them more agency over their care.
Implementation of a new process: We are trialing these on our Birthways and Med/Surg units first. When we get an admission, we grab an iPad from the dock at the nurses’ station and use it to scan the QR code in the patient’s chart. This syncs the iPad with the patient and their room.
Education/Training: Each nurse had to attend an in-person class and complete computer-based learning modules.
Evaluation/Review and Revision: Overall our patients like having immediate access to their labs, doctor’s notes, and imaging results. As nurses, we’ve noticed some hiccups with the admission feature on the devices. For starters, we have many patients who are older and not familiar with the technology and struggle with the process. Our admission process requires many questions that the nurse must ask face to face anyway so the iPads don’t really save us a lot of time regardless of patient comfort with technology. We’ve also run into some issues with the consents not uploading properly and with patients accidentally taking the iPads home. Because of these hiccups, we’ve put the project on hold as our management works with IT to address and troubleshoot solutions to these problems.
References
Moyle, W., Jones, C., Murfield, J., & Liu, F. (2020). “For me at 90, it’s going to be difficult”: feasibility of using iPad video-conferencing with older adults in long-term aged care. Aging & Mental Health, 24(2), 349–352. https://doi-org.coloradotech.idm.oclc.org/10.1080/13607863.2018.1525605
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NRSG 311 Unit 4 – Discussion Board CTU
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