In looking at the importance of access to data for nursing decision-making, and considering an issue at my place of employment where I do not always get access to important data, one common scenario instantly comes to mind.
I will actually be leaving my present company and starting a new job next Monday. But in discussing the company I work for now, while there is usually pretty good team communication, there are often times when I have not gotten the data I could use to serve my clients better.
McGonigle and Mastrian (2022) discuss how in healthcare, people operating in their own “silos” can disrupt necessary communication between departments and units. And they discuss how the use of information systems and IT can increase that communication. While these authors discuss things happening in different silos, as more of a thing of the past, this definitely occurs in my agency due to the way our leadership is structured.
My agency does in-home addiction treatment, and the basic team is two Recovery Advisers ( who are like peer support workers) with a team leader of a Care Coordinator (a Nurse or an LCSW).
We are a team, serving an individual client. However, there is also the effect of different silos because the recovery advisors have their own manager and their own processes. Another barrier to communication and access to data is that we also work from home and serve people in their own homes. So, while we may communicate by phone and zoom meetings about individual patients, there is not the same type of situational awareness of patient conditions that a nurse may have while being on the same unit with the patients. So, communication via our technology is key, however, it does not always happen when it should.
One important area where communication could be enhanced through the use of technology is when a client has a recurrence of use (our language for a relapse). When a client of ours has a recurrence of use it is not always instantly communicated to all team members. For example, if a client has a recurrence on a Saturday night, the Care Coordinator may not be instantly notified. By Monday that recurrence should be documented in both a note and a “relapse screening” in the EHR. However, unless the Care Coordinator takes the time to read through every new note on Monday morning (a good idea, but not always possible if an emergent situation pops up first thing Monday) the recurrence may be missed. Any relapse/recurrence is important data for the Care Coordinator to know, especially because there may be serious medical implications. And yet that data is not always transmitted to the Care Coordinator in any sort of timely fashion.
So, the problem is the lack of communication in a timely manner. Nagle et al,. (2017) discuss how Information systems can be used to transmit data to team members and keep communication between teams open, and expedient. And Sweeney (2017) also discusses the importance of utilizing Healthcare Information Systems to better communicate.
The hypothetical improvement or benefit I am suggesting would be to use technology to more instantly inform the care coordinator about a recurrence so they could decide on appropriate action, rather than hearing about it a few days after the fact as often happens. One way this could happen is for the EHR to automatically send out notifications to the rest of the team when a relapse screening is completed. Luxton et al (2011) discuss the use of smartphones and the many benefits as far as self-assessment, and educational opportunities these devices have. And obviously, the most glaring benefit of having a smartphone is communication. My suggestion would be to have an alert to the Care Coordinator’s phone automatically generated and sent as soon as the relapse screening is completed.
Due to the nature of working from home, while also serving people in their homes, the central location of data about the patient is the EHR. This is really true with any agency/facility, but with our agency, it is very important to consider as the team often communicates by updating the patient chart. Realistically people can not just keep reading through charts to keep up to date. So, an alert that is generated by the EHR to give important data to the nurse would really be a good way to use technology to deliver important data to where it is needed.
Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). mHealth for
Mental Health: Integrating Smartphone Technology in Behavioral Healthcare. Professional
Psychology: Research and Practice, 42(6), 505–512. https://doi.org/10.1037/a0024485Links to an external site.
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of
knowledge (5th ed.). Jones & Bartlett Learning.
Nagle, L., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics
Specialist. In J. Murphy, W. Goosen, & P. Weber (Eds.), Forecasting Competencies for
Nurses in the Future of Connected Health (212-221). Clifton, VA: IMIA and IOS Press.
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 2