Current Topics in Nursing Informatics

 Hello Class,

 

The healthcare world around us is quickly approaching a society that is strictly dependent on technology. One of the common issues that I have noticed is the lack of power plans that would make the job much more efficient for all of the medical staff involved. There are many benefits to the use of power plans including consistency of orders, correct near misses, help meet core measures, and help with the increase in nursing burnout related to electronic medical records. There are very few downfalls to the use of increase of power plans but can be difficult to educate all of the staff members on and get them on board with the changes. I would like to discuss my experience in the emergency department and the positive impacts that would happen thanks to this implementation. 

The first benefit mentioned is consistency of orders. This comes into play many times and I just recently experienced an example of this. It becomes very important to need the same order set on every patient. The example that I mentioned is an 80-year-old female that entered the emergency department with the chief complaint of altered mental status. The patient was immediately presumed to be a stroke rule out due to the primary complaint and that was not the case at all. Thankfully, we had an order set for a chief complaint of altered mental status and realized that there was more to this story than meets the eye. Two of the orders within the “power plan” set was both an alcohol and drug level. Little did we know that someone who was 80 years old would have a blood alcohol level of 345 and drunk to the point of confusion. This is one prime example of the importance of consistency with power plans.  This process would significantly decrease the possibility of a near-miss. 

Another very important property of the implementation is the satisfaction of the nursing staff. The difficulty of the electronic health record has been directly linked to decrease in nurse satisfaction and nurse burnout. Any way that we can find that will simplify the workload of the nursing staff is a step in the right direction. One way that this power plan will increase nurse satisfaction is by influencing nurse autonomy by allowing the nurses to begin completing orders on the patient prior to the physician even seeing the patients. Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. (Rao, Kumar, & Mchugh, 2016) Utilizing power plans allows the nurse to implement an order set under the supervision of a physician and allow the increase in throughput process for the emergency department. This process will also improve the outcomes of patients and increase their satisfaction during their stay, The American Medical Association (AMA) not only recognizes widespread burnout among physicians, but also provides a number of resources for those experiencing burnout throughout the healthcare spectrum. (Harris, Haskell, Cooper, Crouse, & Gardner, 2018)

The final, and most important and, positive correlation with power plans is the impact it can have on patient safety. Working in the emergency department, there are many times where quality metrics play a huge role in the aspect of core measures of an organizations/facility. This may stem from many perspectives and can be related to heart attacks, strokes, septic patients, long bone fractures, etc. The example that I can utilize in this scenario is that a stroke patient must receive a CT scan within 15 minutes at my facility and have a National Institutes of Health Stroke Scale (NIHSS) within 30 minutes of admission to the emergency department. The likelihood of a physician being present in this scenario is very high, but gives the freedom of the triage/accepting nurse, depending on mode of arrival, to implement the stroke order set and meet the government-set standards in order to receive/maintain a certification already set in place by the organization. The organization I work for currently employs a stroke coordinator that observes all of this data and is happy to announce when the quality metrics are not met by the emergency department or even that by the floor once the patient is admitted. Allowing the nursing staff to implement this power plan will allow not only the nursing administrators to observe the process and make changes accordingly but will also allow the nursing staff to complete the actions in a timely manner due to protocol within the organization.

 Now that we have discussed the tremendous benefits that the implementation of power plans will allow, we must also discuss both how we will implement the changes and the potential complications of the changes. The facility I am employed at has power plans for many diagnoses, but not all of them. What they have done to implement this process is to obtain volunteers from both the medical and nursing staff in order to determine what is necessary for each of the power plans. The “task force” will evaluate the diagnosis and come to the conclusion of what orders are needed for the particular incoming patient and what the physicians feel, comfortable with the nurse implementing without guidance. The task force will be a very important factor when implementing the power plans into daily practice.

Another important factor, and probably the most difficult, is the difficulty involved with training the staff on the power plans that are being implemented. There are many nurses that have been in their profession for an extended amount of time and are very hesitant to change. Any small modification will require education to every staff member involved. One of the ways that I have educated my staff in the past was by hosting mandatory staff meetings and requiring the staff to sign acknowledging that they both received and understand the new documentation education being provided to them. I know that this sounds punitive but once the staff sign saying that they understand the material, they are responsible for responding to these circumstances accordingly. Nurses experience a much higher rate of burnout when they are exposed to high-stress environments related to the electronic health record so decreasing this stressor is a top priority in the implementation of power plans. (Khairat, Xi, Liu, Shrestha, & Austin, 2020) 

One challenge that will be faced, as mentioned previously is the presence of “old schools nurses.” These are the nursing staff member that will continuously operate incorrectly once the process is implemented and require more molding to conform to the power plan method. Many of these nurses will require both performance and chart reviews to ensure that they are both meeting quality metrics and performing at an acceptable level. Due to previous experience, I have realized that many nurses are hesitant to change, but are much are satisfied and at ease once they experience the positive outcomes that power plans can bring to them. 

 

Thank You,

Mark

            

 References:

Harris, D. A., Haskell, J., Cooper, E., Crouse, N., & Gardner, R. (2018). Estimating the association between burnout and electronic health record-related stress among advanced practice registered nurses. Applied Nursing Research, 43, 36-41. doi:10.1016/j.apnr.2018.06.014

Khairat, S., Xi, L., Liu, S., Shrestha, S., & Austin, C. (2020). Understanding the Association Between Electronic Health Record Satisfaction and the Well-Being of Nurses: Survey Study. JMIR Nursing, 3(1). doi:10.2196/13996

Rao, A. D., Kumar, A., & Mchugh, M. (2016). Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue. Journal of Nursing Scholarship, 49(1), 73-79. doi:10.1111/jnu.12267