This month's issue of American Nurse Today contains an article related to Nurses and the need to advance nursing quality measures for future stages of meaningful use of EHRs. The article reports that Meaningful use in this context provides measureable and effective ways to improve the quality of care for patients.
ANA is concerned that current proposals on the implementation of EHRs address too narrow a spectrum, and sidestep the importance of an approach based on inter-professional measures. ANA endorses a method that cuts across settings, transitions of care, and care episodes and takes into account inter-professional, team-based reporting and shared accountability.
Nurses are the central point for information collection in all environments. They are closest to the patient as they monitor and report status. They monitor patient responses to treatments and interventions. Their voice must be heard in future efforts to establish meaningful use criteria that improves patient care and outcomes.
In her testimony to the Office of the National Coordinator on Meaningful Use, ANA Senior Policy Fellow Maureen Dailey, DNSc, RN, CWOCN, said: "The overarching goal is to be able to achieve predictive modeling and identification of best practices that improve patient outcomes and reduce excessive avoidable cost. The best way to achieve this is through the use of timely, clinically-enriched, harmonized data that promotes patient-centered systems of care."
Patient care coordination is often a point where patient communication "breaks down." Coordination requires that commuication and joint participation in treatments and interventions occur seamlessly and transparently to the patient.
For example, a patient in Emergency Room Triage is being admitted to the hospital. Or a patient is being moved to a room in a different medical unit, or moving from the Operating Room to PACU. Each of these situations requires special handling and coordination across disciplines. The following is a theoretical example of care coordination for patients moving from one location to another in a hospital enviornment.
The Unit Secretary notes the patient's pending arrival to the Nursing Supervisor and updates the Census Board.
Nursing Supervisor assigns patient to a nurse.
Housekeeping ensures the room is sanitized and ready for a new patient to move-in.
Dietary and Pharmacy await orders. BTW, all medications must be ordered or re-ordered when a patient moves to a new unit.
Nurses and Aides ensure needed equipment or supplies are ready for use at the destination (e.g. Suction, O2, etc.).
Physician orders must accompany the patient in ANY move in the hospital, but sometimes the orders arrive at the destination AFTER the patient arrives.
The nurse at the starting location "reports" patient status to the nurse at the destination prior to arrival.
If the patient is accompanied by 1 or several medical devices (e.g. Infusion Pump, Ventilator), Nursing and other disciplines must be ready to make appropriate connections upon arrival.
Each of these scenarios are simple examples of coordination of care. What's not mentioned here is the patient (and their health data) who visits their Primary Care Provider (PCP) and is referred to a Specialist. This is often a point of breakdown because, in the days of paper records, the entire patient history known to PCP is generally not forwarded to the referral. What is sent directly relates to the reason for the referral with a few "need-to-know" pieces of information.
So what happens?
Patient arrives and fills out the "dreaded" 30 pages of patient information and history before being seen by the Referral Doctor. OK, maybe 20 pages. I am exaggerating.
A common problem in this scenario is that not all the medications are known, or OTC medications are not listed, therefore, the new prescriber many not be aware of medication contraindications. I recall a Pharmacist who received new orders and called the prescriber to notify him/her of a potential negative drug interaction. The prescriber changed the script to one that did not have known interactions.
Again, more support for care coordination and its importance to the patient's health. This picture describes a typical office or ambulatory clinic.