Recent orders
Hospital Electronic Media Records Implementation
Hospital Electronic Media Records Implementation
Completeness and Relevance for Learning Assessment
Apparently, the main objective of the integration of technological applications to solve user needs, such as handling institutional records through the application of information systems, is improvement of efficiency, accuracy and precision (Chaudhry, Wang and Wu, 2006). An EMR within the hospital setting touches on the actual integrity of the medical profession in terms of how health procedures dependent on patient data proceed. It is expected that the information system proposed by the proposed EMR model must pass the fundamental criteria of efficiency, accuracy and precision improvement when compared to the manual system. Alternatively, the implementation plan must fit in the expected standard that takes care of smooth technological integration, institutional organizational compatibility, transition management, flexibility, knowledge, and software solution.
Assessing the status of the application of the EMR at Betsy Johnson Regional Hospital for its relevance in terms of learning outcomes, there are several missing items for a standard model. On one hand, the time used to put together the EMR design is just six months which could implicate the rest of the system implementation. On the other hand, internal expertise was entirely applied in the completion which poses questions on the competitiveness of the final product. It could have taken a better direction if an assessment was conducted to reveal cost benefit analysis position interrogating outsourcing alternatives. In this respect, only EMR software is reported to have involved a vendor from outside the hospital, with unclear role and connection o the set team. Internal design issues however may have prompted the use of internal resources and expertise to the advantage of the institution. Relevance and completeness can therefore be assessed on the generation of resources and competence applied amid successes elsewhere in the generation of the best possible product.
Implementation Weaknesses
Apparently, the most talked about constraint in any information system such as EMR involves financial inadequacy by the implementing institution. Once the funding obstacle is overcome at some level however, the most potent challenge is usually the integration into the existing system as well as the acceptability with which the human resource adopts the new system (Blumenthal and Glaser, 2007). At Betsy Johnson Regional Hospital, the system challenge of implementation and possible resistance of the sudden change is not highlighted. Whereas approval or rejection may not necessarily be a measure of openly aired views as sought by the institution during discussion forums, evidence of a deeper approach to facilitate actual delivery of expected response is not availed. Alternatively, a systematic rolling out of the implementation is usually required in such systems which are apparently not present in the detail of actual implementation.
Generally, phases of implementation assist the management to cater for system failures during the transition and such cautionary element is lacking in the approach taken at Betsy Johnson Regional Hospital. The access of the information on the established EMR potentially seemed risky in terms of unauthorized access where it was alleged that unauthorized access could compromise the privacy of the patients on the database. However, the improvement of the site can be approached from the security of the system, which would dispel any fears of intrusion. The safety of the system is paramount to the performance of the entire EMR adopted and available technologies deal with the issue of intrusion pretty well. It therefore follows that if the final product which the team came up with was not able to cater for the security of private information, it needed an overhaul that would raise the confidence levels.
Inhibition of Assessment
In terms of assessment of the product after the implementation phase was kicked off, there are specific and inherent challenges that Betsy Johnson Regional Hospital must have anticipated. The initial challenge expected in the assessment of the EMR progress touches on the determination of the success of integration during the transition period from the old to the new system that embraces information system. During the interim period, success may not be guaranteed and system failures are generally supposed to be expected. Whereas failure should not be a positive aspect in any project, the anticipation and the responses launched thereon may determine the success of assessment for the entire implementation of the new system (Cusack, McGowan and Poon, 2008). The authors recommend formative assessment which may not necessarily reflect positive results in the interim, rather the process effectiveness.
Inhibition of such a smooth transition in the implementation is largely expected to be in form of the attitude and preparedness that all employees cultivate in case of failures. It is usually advisable to facilitate a program that takes care of such failure such as gradual introduction of the system through phased implementation. Contingency allowance in such a system is equally important in the implementation just as it is in the incorporation of all needs of the EMR. Apparently, the management of the implementation aspect is supposed to be cautiously handled as it can result in a crisis where the old and the new systems are not working at all and the institution is caught up in the mess. It may be important to expect that old system rejection of change particularly with the employees may hinder a smooth implementation. Alternatively, assessment of the implementation may face similar resistance from the old system resulting to false results. To cater for such resistance inhibiting a smooth implementation, staffing reorganization might be implemented (Miller, 2009).
Adapting the EMR (additions, subtractions, emphasis)
According to Miller (2009), the new system proposed for EMR implementation is expected to face some laxity of employee embrace attitude, face challenges of organizational structure and routines as well as slow integration into the system. The EMR product for Betsy Johnson Regional Hospital must be approached on the perspective that takes care of the internal needs of the hospital with special treatment to the missing links for a successful implementation. In the optimization element for design and its implementation, it would have been advisable for the Betsy Johnson Regional Hospital EMR technical team to ensure the addition of; outsourcing of experienced personnel in order to reduce risks of failure, a detailed structure of phases of the implementation program, specific staff reorganization plan to handle risks of rejection and possible failure and distinct reviews for the separate implementation phases.
The assumption that the IT team composing the technical team was competent enough would have been abandoned and a review past experiences with design and implementation of EMR systems used to guide in new project staffing needs. In terms of subtractions to be effected in the implementation of the program at the Betsy Johnson Regional Hospital, the entire implementation program would be wiped off and replaced with one responsive to the proposed additions and implementation program. Emphasis would need to be focused on the expertise in the initial design where the best possible experience in such programs will be sought. To back up the expertise element, it will equally be important for a thorough analysis of the current internal system and base the design and the implementation program on the findings of the analysis.
Roles of Hospital Officials in EMR Implementation
The implementation program must bring on board the top most leadership of the Betsy Johnson Regional Hospital in order to rally behind the best possible response from all the employees.
i) CEO (Chief Executive Officer)
It is the mandate of the CEO to ensure that the management and the entire institution back the proposal to have a new system based on EMR. Whereas this might be more meaningful in the beginning than at any other point in the implementation, constant assurance of the support of all the management levels may favor a successful implementation than when there is no assurance at all. The CEO must at all time follow up the progress of the EMR processing to show the seriousness with which the institution holds the project. Provision of resources to the program is the responsibility of the CEO with the relevant authority in charge of resource allocation.
ii) CIO (Chief Information Officer)
In terms of technical assistance concerning the internal information needs, the CIO must be an integral player in the determination of the progress of implementation. The role of the CIO in the determination of the team composed to handle issues of the EMR is important since technical matters of the task ahead must pass through the office. Constitution of the relevant team and rallying resources needed in the implementation may require the assistance and input of the CIO as the best official understanding the process. Other roles during routine implementation and reviews for the CIO may include; system configuration, access authorization, usage monitoring and advising the institution on the necessary system changes (Miller. 2009).
iii) Nursing Administrator
Integration of the system into the medical aspects of the institutional service delivery must have word and advice of the nursing administrator. Implications on the health of patients upon the reliance on the system must be handled by the nursing administrator.
References
Blumenthal, D. & Glaser, J. (2007). “Information Technology Comes to Medicine,” N Eng J Med, 356:2527-2534
Chaudhry, B., Wang, J. & Wu, S. (2006). “Systematic Review: Impact of health information technology on Quality, Efficiency and Costs of Medical Care,” Annual International Medical Journal, 144: 742-752
Cusack, C., McGOwan, J. & Poon, E. (2008) “Formative Evaluation: A Critical Component in HER Implementation,” American Medical Informatics Association, 15(3):297-301
Miller, L. (2009). Planning and managing an electronic records management programme: Module 2. London, UK: IRMT
Impacts of Adverse Events
Impacts of Adverse Events On Nursing Practice
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Adverse events refer to unintended complications resulting in prolonged hospital stays, disabilities, or death. This is an issue of healthcare management and it indicates patient safety in a particular hospital. Adverse events have significant impacts on nursing practice. Nurses may be legally liable for adverse events that occur on their watch.
According to “The Joint Commission Journal on Quality and Patient Safety”, this is a continuing problem in healthcare services. The incidence and prevalence of adverse events in hospitals have risen dramatically during the past decade. However, “The Joint Commission Journal on Quality and Patient Safety” notes that the amount of information available to nurses concerning how to deal with them is limited. The article emphasizes that nurses need knowledge about the problem and ways of preventing it from happening again. Nurses should also be made familiar with the legal ramifications of these events so they can better handle them on their own accord.
My experience with adverse events on nursing practice is rather vast. According to the American Nurses Association (ANA), as a registered nurse, I am expected to provide care and treatment for patients in any situation. I am also responsible for managing the possibility of complications. However, many adverse events occur that are considered preventable. “The Joint Commission Journal on Quality and Patient Safety” suggests that nurses should report any patient safety issues or incidents they encounter and advocate change in hospital processes.
I have experienced some cases wherein adverse events occurred during my shift. One of them was when one patient who developed hypertension suddenly went into cardiac arrest. The patient was also diagnosed with coronary artery disease. He had a history of smoking and drinking. The patient suffered a myocardial infarction (or heart attack) while the nurse on duty was conducting his vital signs assessment. The nurse was not ready on time to provide monitoring and intervention to this patient. The nurse, therefore, failed in managing the care of this patient.
Adverse events can occur at any time and usually occur when nurses are busy with other patients. It is also possible for them to happen when nurses are conducting assessments or changing shifts.
Adverse events also have great impacts on the general organization and structure of a hospital. Some hospitals require nurses to take charge in order to prevent adverse events from happening, especially when the hospital is part of a larger organization (Wu et al., 2020). For example, if the organization has a policy in place to prevent adverse events, then nurses are expected to follow that policy and not violate it.
Nursing care can be very difficult and challenging for any nurse. However, adverse events are extremely worrisome for all nurses as they affect the safety of patients. The reason why so many adverse events occur is because there is no definite system of nursing care that everyone follows nor guidelines on how to handle these instances.
During this Corona Pandemic, there have been major adverse effects where many patients died across the world (Dutta et al., 2021). The problem of adverse events is a major issue to the medical personnel and nurses alike. Adverse events also affect nurses as well. Nurses can be subject to claims for negligence or malpractice if they are not able to respond appropriately and effectively. These adverse effects from the pandemic have also affected my nursing practice. My role as a registered nurse requires me to always be ready for any emergencies that may occur. I have to be prepared for any possible complications that may occur in the patients under my care.
The Joint Commission Journal on Quality and Patient Safety also notes that “nurses must remain vigilant at all times to ensure safety of their patients.” Failure to do so may cause liability in the hospital’s risk management department. This means that nurses are now held accountable. They have to be responsible and accountable for the care they give to their patients. Nurses are now required by law to report incidents or issues they encounter while attending their patients.
References
Dutta, S., Kaur, R. J., Charan, J., Bhardwaj, P., Sharma, P., Ambwani, S., … & Misra, S. (2021). Serious adverse events reported from the COVID-19 vaccines: A descriptive study based on WHO database. medRxiv.
Wu, A. W., Shapiro, J., Harrison, R., Scott, S. D., Connors, C., Kenney, L., & Vanhaecht, K. (2020). The impact of adverse events on clinicians: what’s in a name?. Journal of Patient safety, 16(1), 65-72.
Impact-of-CSS1
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User interface design needs to follow usability and efficiency guidelines which should target large user base. CSS contains rules which determine how controls and elements are being formatted on the web page. It is the most flexible language as it can be designed outside web page and then applied to it. Therefore a single HTML page can be directed to be presented in different ways, perhaps under different situations. For e.g., CSS can direct the webpage to format itself for a mobile screen or a large widescreen desktop. So instead of coding different HTML pages with its own unique designs and presentation formats, the CSS eliminates that need and instead contains all that information in a single or a few CSS files.
This saves a lot of time for the developers and also reduces the burden on the web server overall optimizing the website as the overall code is lighter which enables faster download times. Also there is a consistency in design, if the designer has to design each page individually for different situations, and then there might be some discrepancies. Such discrepancies are also eliminated as the designs are originating from a single source. Since these designs are centralized, it is also easier to maintain and update.
The book puts light on the fact that CSS can be executed across browsers i.e. both old and new. In addition to this, whenever a new version of CSS is introduced, it gives an easy-to-understand platform to developers. This is so because most of the components remain same and hence there is little learning curve. CSS is a set of rules. But this does not mean that they are difficult to construct or implement. CSS provides a simple rule construct which can be used even with little understanding of its components.
This let designers to focus on the desired presentation of content rather than on learning the tedious syntax and then implement it. CSS allows designers to define rules in any order i.e. it does not matter whether heading rule is defined after a paragraph rule. It is a huge benefit as designers need not to remember the order of tags used in the html. Web designers do not have put write rules in html file. They can very well define them in a separate file and then call the file in html. This feature of CSS adheres to separation of concern property of development world.