Reflective Journal Entry- Week 10

1. Share what you had expected to learn about the topic before beginning the unit.

This week I expected to learn more about informatics and how this applies to the healthcare system. I expected to learn more about how technology can improve nursing care and can ultimately provide greater quality of care and safety for our patients. 

2. What you actually learned from the unit.

I feel like after completing all of the assignments and discussions from this week I learned what I had expected to learn and how to go about solving problems if the technology does not line up or if others are not willing to use this new technology.

3. Discuss your feelings/experiences from the activities (individual and team)?

I really enjoyed the activities from this week. I liked reading other individuals responses to the discussion and how they would solve that situation. I enjoyed this discussion because that type of stuff happens daily in the hospitals where nurses and doctors are not on the same page but need to be. Learning from others will help me when I am put in a situation like this in the future. I also liked evaluating the fact that EMR's are not free of errors. I think it is a common misconception that this is the case, but it was eye opening while I was researching this topic, the different errors that can occur. This made me realize that I still need to be careful using EMR even though I feel like I am covered. 

4. How you will utilize the information learned in your nursing practice.

I will use this information by applying the discussion and case studies into my nursing practice. When these types of situations come up I will better be able to solve these issues because I have already taken the time to think and research how to improve these problems. 

5. You personal feelings about the material covered.

I feel like the information covered this week was very beneficial because it allowed me to learn more about informatics and apply case studies into my daily nursing practice. I feel like the information was relevant to the changes that are being made currently in healthcare. I feel like these case studies would be a great tool to provide to nurses who have been in the field for a longer period of time so that they can also learn the information of how to deal with these situations like I did this week. 

Case Study- Week 10

A newly hired registered Nurse (RN) is assigned to work at the telehealth work center.  The RN is monitoring the in coming data from home-bound (based) patients from arount the county, checking to see if there are any situations which require nursing interventions and taking the appropriate actions. One (1) patient is a type II diabetic. He reports his fasting blood sugar level of 54. Another patient who has congestive heart failure (CHF) and regularly reports in on daily basis does not send in any information (data).

• What is the best course of action for the RN to take regarding the diabetic patient?
• As the nurse I would call the patient and talk to him as soon as possible. First, I would instruct him to not take his regular diabetes medications or insulin. I would tell him to eat something with sugar such as milk and graham crackers if available because this increases blood glucose over an extended period of time. If this is not available he should drink juice, eat jelly, or take a glucose tab to get a spike in blood glucose. Last, I would instruct the patient to call somebody or have somebody that lives with him sit with him until his blood glucose rises, is within normal range, and is stable. I would instruct the patient to check his blood glucose levels every fifteen minutes until they are stable in order to gage if he needs more sugar or not. 
• How should the RN proceed regarding the lack of information from the CHF patient?
• As the nurse I am worried about this patient due to his regular reports every day. At this point I would try to get a hold of the patient by calling their house or cell phone. If I did not get a response I would call his family members or emergency contact to see if they have heard from him and could go check on him. I would also call his primary care provider, or the agency that provides home health for this patient to have them contact this patient as well. 

Critical Thinking- Week 10

The registered nurse (RN) in reviewing orders and completing the medication reconciliation (Med Rec) in the electronic Medical Record (EMR). Med Rec is a process for double checking medications, where the RN verifies that the details of the medications written on the provider's orders match those recorded in the medication administration record (MAR) used by the nurse. During the Med Rec process, several alarms/alerts go off.

• Does the use of EMR guarantee error-free patient care? If yes, why? If no, why?
• The use of EMR does not guarantee error-free patient care. The EMR has the potential to contribute to medical errors if policies and procedures, as well as monitoring of compliance, are not carefully developed and implemented. 
• What types of nursing behavior regarding the use of EMR's might contribute to jeopardizing patient safety?
• Copy and Past (Cloning): Copying information from a an earlier instance and pasting it into the record for a current visit could carry forward information that is neither accurate nor appropriate for the encounter. Copy and paste also runs the risk of duplicating an error multiple times.
• Templates: Although templates can enhance documentation, they may result in inaccurate information fi they are not individualized to the patient. For example, a template for a neurological assessment, with a box for "normal value," would indicate that the patient was alert and oriented to time, place, and person even though the patient was an infant.
• Computerized Physician Order Entry (CPOE): Pre-programmed prescription orders for common drugs and dosages make it easy to selecta n unintended drug or dose from drop down menus. In addition, many EMR systems include routine pop-ups for drug dosages, interactions, and allergies, and with the hectic schedule of a nurse, there is a tendency for them to ignore warnings, routinely override, or even turn off such "patient safety" prompts.
• Untimely Record Modification: If modification to records is not transparent, EMR alterations can potentially be subject to allegations of fraud and incomplete records.
• What are the dangers of excessive system alerts in computer charting systems?
• The nurse could be subject to allegations of fraud and incomplete records. The nurse may not remember exactly what was done or administered, and the specific times that these things happened. If she inputs the wrong times, medications give, or implementations performed this could cause other nurses to have dangerous behaviors as well. 
• How can the nurse guard against the potential effect?
• Establish personal and practice policies regarding electronic order entry.
• Use the systems and policies in place for dealing with orders and charring that occur when the workstation or system is temporarily down.
• Bring out progress notes and evaluate them from time to time
• Beware of generic templates.
• Become familiar with the tracking features of the EMR
• Print out a note to be sure your entries are in your own name.
• Understand how the time-stamp feature works, so that you can time your documentation accordingly.
• Ensure that only appropriate staff members have had access to your patients records.

Reflective Journal Entry- Week 9

1. Share what you had expected to learn about the topic before beginning the unit.

This week I expected to further learn about quality improvement strategies that could be used in a clinical setting to improve the patient care and safety that is provided. 

2. What you actually learned from the unit.

After completing the activities for this unit I feel that I have learned more about benchmarking and the process it takes in order to create a benchmark and continue to improve. Benchmarking is one of the most important quality improvement activities because it is something that can be measured and something for us to work towards. 

3. Discuss your feelings/experiences from the activities (individual and team)?

I enjoyed the different activities for this week. The discussion was interesting and a lot harder than I expected it to be. I thought benchmarking was a simple task, and I did not realize the many steps it takes to create a benchmark. It was an eye opening experience. I also enjoyed the other activities because they were helpful in giving me a good look at myself and the way I do and should handle certain situations. 

4. How you will utilize the information learned in your nursing practice.

I will utilize the information that I have learned from this unit to contribute to the creation of benchmarks and being able to better understand the purposed and improvements that need to be made at my current job. I will also better be able to go through the process of figuring out a way to work around a problem that I am having using the "why" theory. 

5. You personal feelings about the material covered.

I feel like this information that I learned this week is very valuable to me and in my improvement as a nurse. I think this information will help me to better improve the quality of care that I give to my patients to improve their safety. I also think it was a good reminder of the importance of the quality improvement strategies that we have learned so far in the semester. 

Reflective Journal Entry- Week 8

1. Share what you had expected to learn about the topic before beginning the unit.

This week I expected to learn more about quality improvement strategies that I can use in my future career in management positions to better improve the quality and safety for my patients. 

2. What you actually learned from the unit. 

After completing this unit I feel that I have built upon the foundation I had of quality improvement strategies and learned more of these strategies from the different assignments that were presented this week. 

3. Discuss your feelings/experiences from the activities (individual and team)?

I enjoyed the activities from this week because they involved a lot of "real life" type case studies. These really helped me to focus on the quality improvement strategies that I have learned and apply them to these situations. It was also interesting to read about the different strategies that my teammates talked about in the discussion compared to the things that I listed. 

4. How you will utilize the information learned in your nursing practice.

I will utilize this information by using these quality improvement strategies in my every day practice. I can use these strategies to make sure that each of my patients gets the quality care that they deserve. I can also apply the case studies that we have done this week to situations I might face in real life. 

5. You personal feelings about the material covered.

I feel like this information is important for us to learn about whether we end up being nurse managers or not because these helps us to give better quality care to our patients. It is information that can be applied in different situations and things we can educate other nurses on in order to improve the quality of care the unit as a whole is able to give. 

Reflective Journal Entry- Week 7

1. Share what you had expected to learn about the topic before beginning the unit.

I expected to learn about more quality improvement strategies that would help me to better my practice as a nurse and learn how to better manage a unit.

2. What you actually learned from the unit.

After completing this unit I feel that I have built upon the foundation I had of quality improvement strategies and learned more of these strategies from the different assignments that were presented this week. 

3. Discuss your feelings/experiences from the activities (individual and team)?

I enjoyed the activities from this week because they involved a lot of "real life" type case studies. These really helped me to focus on the quality improvement strategies that I have learned and apply them to these situations. It was also interesting to read about the different strategies that my teammates talked about in the discussion compared to the things that I listed. 

4. How you will utilize the information learned in your nursing practice.

I will utilize this information by using these quality improvement strategies in my every day practice. I can use these strategies to make sure that each of my patients gets the quality care that they deserve. I can also apply the case studies that we have done this week to situations I might face in real life. 

5. You personal feelings about the material covered.

I feel like this information is important for us to learn about whether we end up being nurse managers or not because these helps us to give better quality care to our patients. It is information that can be applied in different situations and things we can educate other nurses on in order to improve the quality of care the unit as a whole is able to give. 

Reflective Journal Entry- Week 6

1. Share what you had expected to learn about the topic before beginning the unit. This week I expected to learn about improvement strategies in nursing because that was the title of the module.
2. What you actually learned from the unit. This week I learned about benchmarking and the ways that these strategies can help improve nursing cares on hospital units by comparing to other units or facilities. I also learned about hospital balanced scorecards which help to set goals for healthcare workers to improve their standards of care.
3. Discuss your feelings/experiences from the activities (individual and team)? I enjoyed the discussion this week because I did not know a lot about benchmarking and researching as well as seeing what others on my team said helped me to gain a better understanding of the benchmarking tool. I also liked the case study this week because it was applicable to my current job and made me think about the things that I should change in my nursing care in order to reduce the risk of my patients getting catheter induced UTI's.
4. How you will utilize the information learned in your nursing practice. I will utilize this information by noticing different benchmarks, goals and targets that are in place in my current line of work. Prior to this unit I had not noticed these but after this unit I feel it is really important for me to recognize these so I can implement these into my nursing practice. This could also help my facility because I would be able to point things out that have changed in the standard of care, especially related to urinary catheter insertion and care.
5. You personal feelings about the material covered. Personally, I felt like this unit was beneficial because I am very much a goal oriented person and now knowing about benchmarking I will be able to use this aspect of my personality to better my nursing skills.