NURSING INFORMATICS MIDTERM
settings.
INFORMATION TECHNOLOGY SYSTEM APPLICABLE IN
NURSING PRACTICE
A. Hospital and Critical Care Applications
- There are a lot of information technology applications
applicable in the hospital. It can be branched out based on the
major functional departments in the hospital such as in the
Administration, Clinical, and Nursing. In the administration
department, lets say for instance, the admission of the patient
and retrieval of clinical records uses computer applications to
make the work effective and efficient. In this discussion, we
focus on the critical care aspects and how the nursing division
benefits from the information technology.
- Below is the list to sum up the various applications of
information technology in this setting particularly focusing on
patient care:
⚫ Process store and integrate physiological and diagnostic
information from various sources.
⚫ Present deviations from pre-set ranges by an alarm or an
alert
⚫ Accept and store patient care documentation in a
lifetime's clinical repository
⚫ Trend data in a graphical presentation
⚫ Provide clinical decision support through alerts alarms
and protocols Provide access to vital patient information
from any location both inside and outside of critical care
setting.
⚫ Comparatively evaluate patients for outcomes analysis
Present clinical data based on con oriented views.
- Information technology applications described in this unit are:
Physiologic monitor including: arrhythmia and hemodynamic
monitors mechanical ventilators critical care information
systems (CCIS).
PHYSIOLOGICAL MONITORING SYSTEMS
Physiological monitors were developed to oversee the vital
signs of the astronauts. By the 1970's these monitors found
their way into the hospital setting. Physiologic systems consist
of 5 basic parts:
1. Sensors
2. Signal conditioners
3. File to rank and order information.
4. Computer processor to analyze data and direct
reports.
5. Evaluation or controlling component to regulate the
equipment or alert the nurse.
MICROPROCESSORS
⚫ Physiologic signals are typically of very small amplitude
and must be amplified, conditioned and digitized by the
device in in preparation for processing by its embedded
microprocessors. It analyzes information store pertinent
information in specific places, and controls the direction
in reporting. It also alerts nursing personnel through a
report, an alarm or a visual notice.
⚫ Monitoring systems also store various data elements
with a time stamp derived from the monitoring system's
internal clock.
⚫ Physiologic monitoring systems typically have modern
platform allowing the selection of various monitoring
capabilities to match the needs of a variety of clinical
⚫ More specialized monitoring capabilities such as
intracranial pressure or bispectral index monitoring are
also in modular format.
⚫ Physiologic monitors are usually built to incorporate both
arrhythmia and hemodynamic monitoring capabilities.
HEMODYNAMIC MONITORS
Machines under the human machine interface used
specifically for the following:
1. Measure hemodynamic parameters closely examine
cardiovascular function.
2. Evaluate cardiac pump output and volume status.
3. Recognize patterns (arrhythmia analysis) and extract
features.
4. Assess vascular system integrity Evaluate the
patient's physiologic response to stimuli.
5. Continuously assess respiratory gases (capnography)
6. Continuously evaluate glucose levels
7. Store waveforms
8. Automatically transmit selected data to a
computerized patient database
THERMODILUTION TECHNIQUE
⚫ The bolus must be injected within 4 seconds Amount of
solution must be accurate Temperature of the injective
must be measured and accurately maintained Catheter
must be properly placed.
⚫ Computer must have the appropriate computation
constant Bolus must be injected at the appropriate time
in the respiratory cycle
The process of thermodilution:
The influence of these user-related issues is negated by using
heat of a thermal filament embedded in the catheter to
replace the injectate. An alternative means of measuring
cardiac output noninvasively if provided by thoracic electrical
bioimpedance. Four sensor are positioned on the neck and
thorax Monitoring these changes permits measurement of
stroke volume indices of contractility such as velocity and
acceleration of blood flow, supraventricular rhythm and index.
Using bioimpedance as a factor integrated with analysis of the
finger blood pressure waveform has also been demonstrated
as a method of cardiac output measurement.
PULSE OXIMETRY
- A critical piece of hemodynamic information involves the
availability of oxygen to bodily tissues. The standard for
measurement of blood's oxygen saturation is co-oximetry.
Pulse oximetry is a noninvasive method of measuring oxygen
saturation that also uses spectrophotometry. Light is emitted
through a pulsatile arteriolar bed and then detected by
photosensor.
Anticipated Problems
Largest contributor to alarms in the ICU caused by:
1. blood pressure cuff
2. tourniquet
3. air splint that may cause venous pulsations.
4. limits the sensors ability to distinguish between
arterial or venous blood pressure while pulse oximetry
provides a measure of oxygen delivered to the tissue, mixed
venous oxygen saturation provides a measure of the amount
of oxygen used by the patient.
-These problems usually cause nurses to spend more time in
troubleshooting and can lead to less hours doing the necessary
bedside care. To prevent these from happening, it is important
for nurses to become familiar with the user guide of the
respective machines specifically on the troubleshooting part.
Some pulse oximeters are more sensitive as compared to the
others, some need specific charging times, and some are more
durable than the others.
TELEMETRY
- Hemodynamic monitoring can take place at the bedside of
can be conducted from a remote location via telemetry.
Telemetry allows for the continuous monitoring of patients
usually outside of the ICU. Telemetry monitoring is susceptible
to signal loss.
- Remember that computer-based hemodynamic monitoring
offers the critical care nurse a wealth of information that does
not replace clinical judgment.
ARRYTHMIA MONITORS
- Computerized monitoring and analysis of cardiac rhythm
have proved reliable and effective and in detecting potentially
lethal heart rhythms. A key functional element is the system's
ability to detect ventricular fibrillation and respond with an
alarm. SYSTEM TYPES Detection Surveillance Diagnostic or
Interpretive.
- What's the difference? In a detection system, the criteria for
a normal ECO are programmed into the computer.
Interpretive systems search the ECG complex for five
parameters Location of QRS complex Time from the beginning
to the end of the ORS Comparison of amplitude, duration, and
rate of QRS complex with all limb leads P and T waves
Comparison of P and T waves with all limb leads.
- Basic Components of arrhythmia Monitors sensor signal
conditioner cardiograph Pattern recognition Rhythm analysis
Diagnosis Written report.
CRITICAL CARE INFORMATION SYSTEMS
- A CCIS is a system designed to collect store, organize, retrieve,
and manipulate all data related to care of the critically ill
patient. CCIS is the organization of a patient's current and
historical data. CCIS allows the free flow of data between the
critical care unit and other departments. Provides a rich
repository of patient information that can be integrated for
use i our outcomes management. Each patient's data can be
accessed from any terminal or workstation. This capability can
extend across units and departments or be restricted to a
single unit.
-CCIS include: Patient management service length of stay
mortality readmit rates. Prognostic scoring systems can be
integrated to facilitate assessing the severity of an illness. The
CCIS can use the healthcare organization's system to schedule
patient care activities, treatment, and diagnostic testing)
VITAL SIGNS MONITORING
- Vital signs and other physiologic data can be automatically
acquired from bedside instruments and incorporated into the
clinical database Data can be incorporated into flow sheets
with other data elements such as laboratory results body
system assessment findings problem lists.
CIS also includes:
- Diagnostic Testing Result Results can be displayed in flow
sheet such as Laboratory Radiology Cardiology results
Clinicians can also access picture archival information.
CLINICAL DOCUMENTATION
- Clinical Documentation to support the process of Physical
assessment finding, As the care environment requires
frequent assessments, these flowsheets may be configured to
e extensive data collection. Flowsheets may also be organized
by body system. All disciple document patient assessment
findings into the CCIS. Automatic calculation of physiological
can be performed.
DECISION SUPPORT
- The CCIS can provide alerts and reminders to guide care in
accordance w evidence-based guidelines. Point of care access
to knowledge bases that contain information evidence-based
guidelines of care, drug information, procedures and policies.
Data can be integrated with patient information.
MEDICATION MANAGEMENT
- Can facilitate the medication administration process.
Medication administration of flowsheets incorporate the use
of bar code technology.
INTERDISCIPLINARY PLANS OF CARE
-Special flowsheets incorporating required treatments and
interventions may be provided. Workflow management
solutions that help orchestrate all of the numerous,
simultaneous processes.
PROVIDER ORDER ENTRY
- Electronic entry and communication of patient orders can
help clinicians improve communication, streamline processes,
facilitate care, and can help clinicians all providers in managing
quality.
COORDINATION AND SCHEDULING OF PATIENT CARE
ACTIVITIES
-Critical care flowsheet is a predominant display format for
CCIS the goal of CCIS is to have as much information integrated
into the system as possible to obtain a comprehensive picture
of the patients.
B. COMMUNITY HEALTH APPLICATION
- Collective term for the methodical application of information
science & technology to community & public health process
- Focuses on the health information system of the community,
it is centered on the majority part of the public.
- Emphasizes the prevention of the disease, medical
intervention & public awareness.
- Fulfills a unique role in the community, promoting &
protecting the health of the community at the same time
maintaining sustainability & integrity of health data &
information.
Goal of Community Health Informatics
- Effective & timely assessment that involves monitoring &
tracking the health status of populations including identifying
& controlling disease outbreaks & epidemics.
COMMUNITY HEALTH APPLCATION SYSTEM
- Encourages optimal application of computer system,
computer programs & communication system for the benefit
of majority of individuals, families & community.
NURSING INFORMATICS: COMMUNITY HEALTH
APPLICATIONS:
- Support & improve collaboration among the doctors,
community health provider & patients. Informatics is very
useful in monitoring & tracking the health status of the
community. The goal of community health informatics is to
attain an effective & timely assessment that involves
monitoring & tracking the health status of populations
including identifying & controlling disease outbreaks &
epidemics.
- Advantages of using this system, the tracking & detection of
the disease in the community will easy because we can easily
track the spread of it, & the communication among the nurses
& other health care provider will be strong.
- The community health center should really use this kind of
system because I experienced how the health centers record
& updates of information of the people in the community &
believe it or not it takes us to weeks to do it from letter A-Z.
- A sample of informatics use in the Philippines is the Philippine
Integrated Disease Surveillance and Response (PIDSR). It is a
multi-faceted public health disease surveillance system that
provides public health officials the capabilities to monitor the
occurrence & spread of diseases.
GOAL:
Strengthen the surveillance and response capabilities at each
level of the health system by building local capacities and
leveraging strengths and areas of expertise through
partnership and coordination.
VISION:
To improve the availability and use of surveillance and
laboratory data so that public health managers and decision
makers can plan for and carry out more timely detection and
response to the leading causes of illness, death and disability.
FUNCTION:
Information from Philippine Integrated Disease Surveillance
and Response (PIDSR) is expected to be used for the
following purposes:
⚫ Facilitate collecting, managing, analyzing, interpreting,
and disseminating health-related data for diseases
designated as nationally notifiable.
⚫ Develop and maintain national standards, such as
consistent case definitions for nationally notifiable
diseases applicable across all the provinces and cities.
⚫ Maintain the official national notifiable diseases statistics.
⚫ Provide detailed data to control programs to facilitate
the identification of specific disease trends.
⚫ Work with cities & provinces and partners to implement
& assess prevention a control programs.
⚫ To improve the availability & use of surveillance and
laboratory data so that public health managers &
decision makers can plan for & carry out more timely
detection & response to the leading causes of illness,
death & disability.
A. AMBULATORY CARE SYSTEMS
- The ambulatory care nurse focuses on patient safety and the
quality of nursing care by applying appropriate nursing
interventions, such as identifying and clarifying patient needs,
performing procedures, conducting health education,
promoting patient advocacy, coordinating nursing and other
health services, assisting the patient to navigate the health
care system, and evaluating patient outcomes.
- The ambulatory care covers a wide range of services that can
be offered to patient that need medical attention. by
integrating the ambulatory care information system in the
nursing practice will really help in making the work easy like
the processing of data and information and the billing &
charges and etc.
- There are advantages of the ambulatory care information
system like first, the access of medical records of patients to
health care providers, second, the nurses will be able to give
quality care and improve workflow, reduce medical errors,
and lastly the management and monitoring of the billing,
doctors' fees, prescriptions and many more.
- One of the most important responsibility of a nurse is to
make sure that the patient receives the care that he/she
needed and with the use of this system i believe the quality of
care can be given.
AMUBLATORY CARE:
- Covers a wide range of health care services that are provided
for patients who are not admitted overnight to a hospital.
The effective transformation of data can be integrated to the
other processes to transform it into knowledge.
The ambulatory care nurse and other health care provider
should be capable enough to implement the process
effectively.

- These services are performed at outpatient clinics, urgent

care centers, emergency rooms, ambulatory or same-day
surgery centers, diagnostic and imaging centers, primary care
centers, community health centers, occupational health
centers, mental health clinics, and group practices.

AMBULATORY CARE INFROMATION SYSTEM

- Provides automated processing of data and information such
as allergies and medical alerts, patients accounting system
such as charging, billing, discounts and concessions,
diagnostics imaging treatments, and etc.

- With this system, the patient waiting time is optimized

through effective queue management.
EMERGENCY PREPAREDNES AND REPONSE
- It involves one-time registration required per visit. It also
- Same with the objective in the application of informatics in
facilitates the management of doctor’s schedule.
Community Health, the over all objective is public health. The
only difference is the focus and level of prevention. In
- Advantages:
Community Health, the focus of the use of informatics is on
⚫ Real-time and easy access to patient’s medical records by
the promotive and preventive side while in emergency
healthcare providers.
preparedness and response focus on the mitigation and
⚫ Improved workflow, which allows more time for
control of emergencies. The use of informatics here is much
comprehensive patient counseling and review.
wider and critical. The need for information in real-time is very
⚫ Reduced errors with the availability of various
crucial in saving the lives of many.
automation engines – drug interaction engine; medical
alert engine; patient billing engine, etc.
- Based on Weiner and Slepski (2012) The modern movement
⚫ Automated and integrated back-end process such as
toward HIE could go a long way to expanding information
pharmacy, billing, purchasing, inventory management,
outreach to victims of disasters and humanitarian crises.
etc.
Although not the primary reason for the legislation that has
⚫ Improved clinical outcome analysis – enhanced research
provided such sanctioned growth in electronic care records,
productivity through data mining and facilitate
for once an unintended consequence has a possible positive
institutional handling of managed care challenges in a
effect. Other efforts to expand and upgrade communications
timely manner.
to all populations have benefits for the disaster community as
⚫ Improvement in hospital inventory management.
well. As an example, radiofrequency identification (RFID)
⚫ Better monitoring and management of costs –
technology holds such promise with early prototypes tagging
prescription, consumables, doctor’s fees, etc.
victims with treatment and other information. Longer range
RFID tags and readers will make it possible to continuously
- Issues in Ambulatory Care Information System:
track victims as they move through the system from
⚫ Increased accountability
evacuation to treatment facilities (National Research Council,
⚫ The need for continuous support
Committee on Using Information Technology to Enhance
⚫ Privacy and confidentiality of information
Disaster Management, 2007)
⚫ Accessibility and security of data and information
⚫ Integration and support to the other system
- Improved decision support and resource tracking/allocation
tools bring added intelligence to the disaster situation.

- For example, better available collaboration software and file

sharing have benefited the recent business world and can
The Role of Nurse Using Information System in the
serve to better reduce duplication of effort during times of
Ambulatory Care System
disaster.
- The very basic objective of the automated ambulatory care
- At the same time, distributed emergency operation centers
information system is to easily integrate the data to the other
provide resources in a less centralized manner that aids in the
data and easily translate these data into information.
distribution of planning, coordination, and scheduling.

- Computer-assisted decision-making tools and intelligent
adaptive planning provide alternatives to decisions that are
typically made in a vacuum.
- Bio surveillance is a key capability of obtaining and
maintaining situational awareness before and during a health
emergency.
- Early recognition and understanding of departures from
human, animal, plant and environmental baselines, including
detection of novel occurrences, is necessary to give early
warning and save lives; however, detecting deviations from
the norm is complicated because of the complexities of
systems and variables and the multiple stovepipes that exist.
- Many efforts are underway to improve data collection,
sharing, and analysis.
- Informatic and technology solutions such as smartphones,
tablets, and other wireless devices may help gather signals to
detect potential incidents earlier, regardless of the cause, and
communicate ear warning and critical updates and foster
electronic information exchange worldwide.
- Rap detection is critical to save lives and improve incident
outcomes, and the United States serves a key role as part of a
global surveillance network.
TELEHEALTH
-is different from telemedicine in that it refers to a broader
scope of remote health care services than telemedicine.
- According to Mayo Clinic (2020), Telehealth is the use of
digital information and communication technologies, such as
computers and mobile devices, to access health care services
remotely and manage your health care. These may be
technologies you use from home or that your doctors uses to
improve or support health care services. Consider, for example,
the ways telehealth could help you if you have diabetes. You
could some or all of the following:
⚫ Use a mobile phone or other device to upload food logs,
medications, dosing and blood sugar levels for review by
a nurse who responds electronically
⚫ Watch a video on carbohydrate counting and download
an app for it to your phone.
⚫ Use an app to estimate, based on your diet and exercise
level, how much insulin you need.
⚫ Use an online patient portal to see your test results,
schedule appointments, request prescription refills or
email your doctor.
⚫ Order testing supplies and medications online.
⚫ Get a mobile retinal photo screening at your doctor's
office rather than scheduling an appointment with a
specialist.
⚫ Get email, text or phone reminders when you need a flu
shot, foot exam or other preventive care
- The goals of telehealth, also called e-health or m-health
(mobile health), include the following:
⚫ Make health care accessible to people who live in rural or
isolated communities.
⚫ Make services more readily available or convenient for
people with limited mobility, time or
⚫ Provide access to medical specialists.
⚫ Improve communication and coordination of care among
members of a health care team and a patient.
⚫ Provide support for self-management of health care.
TELEMEDICINE
- refers specifically to remote clinical services, while telehealth
can refer to remote non-clinical services.
- is a subset of telehealth that refers solely to remote clinical
healthcare services.
- It involves the use of software and electronic
telecommunication technologies to provide clinical services to
patients at a distance without an in-person visit.
INFORMATICS IN THE THE TIME OF COVID 19
SUPPORTING THE DAY TO DAY
- Information Technology (IT) and informatics specialists (IS)
are integral to all emergency actions taken by health care
organizations during a pandemic. This includes addressing
supply chain and labour shortages, business partner
considerations, telecommuting, enhanced physical and
technological security, continuity and disaster recovery
planning, and monitoring supplies of personal protective
equipment (PPE) (AEHIS Incident Response Committee, 2020).
Specific attention is also required from IT and IS to organize
the following:
⚫ Mass notifications - digital experts often spearhead
innovations in mass notifications to ensure staff are
updated immediately as the crisis evolves. “Healthcare
systems may want to ensure that they test their mass
communications systems and procedures to ensure that
they can get critical information into the hands of staff as
quickly and efficiently as possible” (AEHIS Incident
Response Committee, 2020).
⚫ Client Information - IS experts have found innovative
ways to provide COVID-19 support to clients in some
health organizations. For instance, Siwicki (2020)
described how the Montefiore Health System in New
York City harnessed chatbot AI technology to support
client information. "Staff wanted to offer patients the
ability to be directed to Montefiore information, but also
be in a position to get answers to key questions they had
about COVID-19. Being in New York City, they were facing
an increasing coming into doctors' offices, an increased
demand for services, and coming into emergency rooms
and hospitals. Chatbot technology offering to provide
value to patients and direct them to the care they need”
9p.1)
⚫ Client teaching - IS experts may also be involved with the
development promotion and prevention teaching
materials that target COVID-19. infographics, handouts,
videos, games, and other interactive and engaging
instance, IS may work with organizations such as the
Public Health Age produce infographics to educate the
public on Social Distancing.
⚫ Privacy of Health Data - IS and IT also dedicate a lot of
energy to ensure stock stay safe: this includes protecting
 their personal health information (PHD employee data. It
also entails securing organizational systems and
education potential COVID-19 inspired scam and
malware attempts. As well, policies al in the time of a
pandemic should be reviewed and revised as necessary.
One potential policy tips are available through the US
system, as a bulletin: HIPAAP Novel Coronavirus System
⚫ Equipment disinfection - all equipment used within
health organizations must be protected and disinfected if
used more than once, including electronics - attention is
needed to address sanitation of mobile devices that are
handed off by between shifts or handed from patient to
patient" (AEHIS Incident Response com 2020).
⚫ System Interoperation - EHR based rapid screening
processes, laboratory to clinical decision support,
reporting tools, and patient-facing technology related to
Covid 19 are all supported by system interoperability. A
great paper addressing this function is available from
Reeves et al., (2020).
APPLICATIONS IN EVIDENCED BASED NURSING PRACTICE
- Evidence-Based Nursing Practice refers to the process
of collecting, processing, and implementing research
findings for the improvement of patient outcomes,
clinical nursing practice, and/or work environment.
- It helps in providing the highest possible quality of
care at the most cost-efficient manner.
- The practice also enables nurses to incorporate
clinical expertise and current research to the data and
turn it into a useful basis in the decision-making
process.
- The use of information technology allows a more
efficient facilitation in the applications in Evidence-
Based Nursing Practice such as the computerized
nursing care plan, use of clinical pathway, clinical
practice guidelines, and e-journals that provide the
latest and up-to-date accessible literatures that can
be used as support for new evidence-based nursing
practice projects
COMPUTER GENERATED NURSING CARE PLANS
- Nursing care plans or NCPs as we use them in our
conversations with our colleagues, have been
introduced to us during our stay in the nursing school.
- It has been used extensively inside the academic
institution as an essential teaching tool to present the
value of planning patient care, which has been also
reinforced by the Joint Commission on Accreditation
for hospitals (JCAH).
- But in actual clinical settings, it is difficult to find
completely written nursing care plans. If in any case
that a written care plan is found, they can be
incomplete, outdated, rarely used for determining,
care and infrequently relied upon as a means of
communicating problem management from one shift
to another.
- The nurses view the care plan burdensome, as it is
time-consuming paperwork preparation or revision
of the plan is low in practice settings (Dharmarajan
and Gangadharan. 2013).
- It is with this practice that the initiation of a
computer-generated nursing care plan was done.
- The computer-generated nursing care plans
promotes the value of planning care but at the same
time addresses the burden of the workload NCPs can
consume from the nurses.
- It works by providing a template that nurses can
work on and modify based on the individual cases of
their clients
NURSING CARE PLANS OR NCPS
- contains all relevant information about a patient’s
diagnoses, the goals of treatment, the specific
nursing orders (including what observations are
needed and what actions must be performed), and a
plan for evaluation, over the course of the patient’s
stay, the plan is updated with any changes and new
information as it presents itself, NCPs
COMPUTER GENERATED NCPS
- These NCPs are products of nursing informatics
system capable of comparing actual assessment
findings of patient entered to the system versus a
present database/program that has built in care plans.
ADVANTAGES OF COMPUTER GENERATED NCPS
⚫ Can import certain data as part of nursing assessment
from other areas of the system
⚫ Uniformity of nursing diagnoses throughout a health
care facility
⚫ Provides selection of nursing interventions based on
diagnoses
⚫ Accessibility of the NCP for evaluation
⚫ Time saver
⚫ Space saver
DISADVANTAGES OF COMPUTER GENERATED NCPS
⚫ Nursing diagnoses maybe limited to the current
database version of a specific EHR system
⚫ Maybe difficult for less tech nurses
⚫ Computerized NCPs are only as good as the actual
patient assessment of the nurse utilizing the system.
⚫ Risk for total data loss if system crashes.
CLINICAL GUIDELINES
- AKA clinical protocols, clinical practice guidelines
(CPGS) medical guidelines, practice guidelines
evidenced-based documents that serve as decision
making guidelines
CLINICAL GUIDELINES:
⚫ Diagnosis
⚫ Treatment
⚫ Monitoring
⚫ Developed by governing bodies of specific field or
deputized authority
⚫ AHA for Cardiac related conditions and management
⚫ RITM for communicable disease
 ⚫ WHO as the global healthy authority
⚫ Uses visual aids like algorithms and flowcharts
CLINICAL PATHWAYS
- Care pathways are considered to be one of the best
tools hospitals can use to manage the quality in
healthcare concerning the standardization of care
processes, since they promote organized and
efficient patient care based on evidence. It has been
proven that their implementation reduces the
variability in clinical practice and improves outcomes.
- Care pathways are also known as Clinical or Critical
pathways. A care pathway is a multidisciplinary
healthcare management tool based on healthcare
plans for a specific group of patients with a
predictable clinical course, in which the different
tasks or interventions by the professionals involved in
the patient care (physicians, nurses, pharmacists,
physical therapists social workers etc.) are defined,
optimized and sequenced either by hour (ED) or day
(acute care). Outcomes are tied to specific
interventions.
PRINCIPLES OF GOOD CLINICAL PATHWAY GUIDELINE
CLARITY
- All terms are clearly defined
- -No gray areas that may confuse a health provider
- E.g. A CPG provides you an interview or course for
patient SBP – 130 mmHg, but does not offer an
alternative for 130 mmHg
Compatibility
- All components must be accepted by various concern
principles
- E.g. A CPG states that a nurse, in the absence of a
physician for more than 3 minutes, may by himself
administer 1 ampule of Epinephrine on a crashing
patient – this is unacceptable in nursing practice.
Clear Rationales
- A good CPG also provides rationales for every
recommendation
- Evidenced-based
bSensitivity to practical issues
- Not simply because a resource is available, a CPG
should outright recommend it.
- Culture, economy and other logistics should be
considered
- E.g. A CPG recommending the use of complete first
aid kit by company x where the product may be too
expensive for the population or not available
BENEFITS OF CPGS
⚫ HELPS IMPROVE HEALTH OUTCOMES
⚫ CAN POTENTIALLY REDUCE MORTALITY AND
MORBIDITY FOR CERTAIN CONDITIONS IMPROVE
CONSISTENCY OF CARE
⚫ MAY IMPROVE FREQUENCY OF PERFORMANCE OF
PROCEDURES FOR PATIENT MANAGEMENT AND
CARE
⚫ PROMOTES STANDARDIZATION OF CARE
⚫ MAY HELP REDUCE HEALTHCARE COSTS
LIMITATIONS OF CPGS
⚫ GENERAL PATIENT APPROACH
⚫ REQUIRES IN-DEPTH UNDERSTANDING AND
INTERPRETATION OF SCIENTIFIC EVIDENCES BY
GUIDELINE DEVELOPERS RECOMMENDATIONS IN
THE GUIDELINES COME FROM PROFESSIONAL
OPINIONS OF THE MEMBERS OF THE GUIDELINE
DEVELOPMENT COMMITTEE
⚫ NEEDS MAY NOT BE PRIORITIZED CORRECTLY
CRITICAL/CLINICAL PATHWAYS
WHAT ARE CRITICAL/CLINICAL PATHWAYS?
- SET OF STRUCTURED, MULTIDISCIPLINARY PLANS OF
CARE DEVISED TO AUGMENT OR SUPPORT THE
IMPLEMENTATION OF A CLINICAL GUIDELINE OR
PROTOCOL
- RANGE OF SCOPE CAN BE AS FOCUSED UTILIZATION
OF MEDICATIONS TO SOMETHING MORE COMPLEX
LIKE A COMPREHENSIVE PATIENT MANAGEMENT
PLAN
- FIRST INTRODUCED IN 1990 IN THE US AND THE UK
- EVIDENCE-BASED
COMPONENTS OF A CRITICAL/CLINICAL PATHWAY
TIMELINE
- A PATHWAY SHOULD CLEARLY DEFINE THE
COVERAGE AS WELL AS OTHER TIME ELEMENTS TO
BE CONSIDERED IN ANY OF THE STEPS OR
PROCEDURES IT RAS.
CATEGORIES OF CARE
- PATHWAYS BROW SETS OF CARE TOGETHER
ACCORDING TO DISTACT CATEGORIES WHICH MAY
MYCLUDE, BUT NOT LINITED TO THE FOLLOWING:
⚫ ASSESSMENT
⚫ DIAGNOSIS
⚫ DIET THERAPY
⚫ NURSING CARE
⚫ MEDICAL REDIMEN AND ETC.
 INTERMEDIATE AND LONGTERM OUTCOME CRITERIA
- PATHWAYS PROVIDE CLEAR EXPECTED HEALTH
OUTCOMES THROUGH A LIST TO AID THE
HEALTHCARE PROVIDER IN EVALUATING CARE AND
PATIENT RESPONSE.
- OUTCOME CRITERIA ALSO SERVE AS SYSMPOST FOR
HOPS IN DETERMINING WHAT TO DO NEXT FOR A
PARTICULAR PATIENT.
VARIANCE RECORD
- PATHWAYS REQUIRE DOCUMENTATION OF
VARIANCE.
- VARIANCE - A QUALITY THAT IS DIVERGENT OR
INCONSISTENT WITH THE EXPECTED OUTCOME
How to document variances? (Institutional guidelines may
apply and not strictly confined to the guidelines below)
1. Similar to DAR (Data, Action, and Response) format,
we utilize VAO (Variance, Action, an Outcome) to document
variances.
2. Variance - includes all subjective and objective data
observed by the nurse to be outside of the pathway
management of the patient's case.
3. Action - includes all interventions used to address the
variance.
4. Outcome – includes all patient care outcomes after
the interventions were performed to address the variance
Important Note:
- Variances are not something to be taken negatively.
It may increase health care costs due to the
management of these variances that are outside of
the clinical pathway, but over time as these variances
become common and established a pattern, then it
can be included in the clinical pathway depending on
the institution's approval and analysis of the situation.
If sooner or later it becomes part of the clinical
pathway, then the health care costs will be controlled.
Remember, the clinical pathways are not final. It
always gets revised frequently depending on the
institution, as our healthcare environment is dynamic.
Collaboration within all members of the healthcare
team is a must to ensure a smooth and proper
implementation of these clinical pathways.
BENEFITS OF PATHWAYS
⚫ EVIDENCE-BASED
⚫ IMPROVE MULTIDISCIPLINARY COMMUNICATION,
TEAMWORK AND CARE PLANNING
⚫ WELL-DEFINED STANDARDS FOR CARE
⚫ HELP IMPROVE CLINICAL OUTCOMES FOR PATIENTS
⚫ CAN HELP ENSURE OPTIMUM CARE AND PROVIDE A
MEANS OF CONTINUOUS QUALITY IMPROVEMENT
⚫ MAXIMIZE RESOURCES
⚫ CAN BE INTEGRATED INTO MOST EHR SYSTEMS
LIMITATIONS OF CLINICAL PATHWAYS
⚫ MAY SEEM TO DISCOURAGE PERSONALIZED CARE
⚫ PROBLEMS ARISE WITH THE ADVENT OF NEW
APPLICABLE TECHNOLOGY. DOES NOT RESPOND
WELL TO SUDDEN CHANGES IN A PATIENT'S
CONDITION
⚫ CHALLENGES CURRENT HABITS AND PRACTICES
ONCE INTRODUCED
WHAT ARE E-JOURNALS
⚫ E- JOURNALS OR ELECTRONIC JOURNALS ARE
PERIODICAL PUBLICATIONS IN DIGITAL FORMAT AND
CAN BE FOUND IN THE INTERNET.
⚫ FREE ACCESS OR REQUIRES A SUBSCRIPTION
BENEFITS AND LIMITATION
⚫ SEARCH TOOLBARS
⚫ FILTER OPTIONS
⚫ DATA IS PORTABLE
⚫ SOME E- JOURNALS HAVE EMBEDDED LINKS TO
RELATED CONCEPTS FOR SUPPLEMENTAL READING
⚫ E- JOURNALS CAN BE INTERACTIVE. SOME HAVE THE
OPTION TO EMAIL THE AUTHOR TO INITIATE
DISCOURSE OR CONSULTATIONS. MOST PRINTED
JOURNALS HAVE AN ELECTRONIC VERSION
⚫ NOT ALL JOURNALS ARE FREE TO ACCESS
⚫ REQUIRES CONNECTIVITY
⚫ MAY LED TO BULK DOWNLOADING OF JOURNALS
DURING RESEARCH WITHOUT INITIAL FILTERING OR
SCRUTINY
⚫ LIKE WITH PRINTED JOURNALS, REQUIRES
CRITIQUING OF SEARCHED CONTENT.
⚫ LIMITED LOCAL (PHILIPPINE) NURSING JOURNALS
E- JOURNALS
⚫ American Journal in Critical Care
⚫ American Journal of Nursing
⚫ International Journal of Nursing Practice
⚫ International Journal of Nursing Care
⚫ Journal of Clinical Nursing
⚫ Nursing Research
⚫ Philippine Journal of Nursing - (e-journal versions
available at http:// www.pna-pin.com
The difference between Clinical Pathway and Clinical Guidelines (Kumar, 2020)

Clinical Guideline Clinical Pathway Practice Protocol

Focuses on Specific clinical The quality and co- Treatment.
circumstances. ordination of care.
What is it? Systematically Structured, A suggested course
developed statements multidisciplinary of treatment and or
to assist practitioners plans of care. treatment service
and patient make for a specific
decisions about diagnosis, functional
appropriate health deficit or problem
care. area.
What does it do? Makes specific Supports the Highlights major
recommendations on implementation of therapeutic points.
health care and links clinical guidelines Identifies choices of
these to research and protocols difference courses
evidence or paths of
treatment. Suggests
other diagnosis that
could be considered
as treatment
progresses.
How does it Provides a summary Provides detailed Provides a logical
work? and appraisal of the guidance for each flow of
best available stage in the interventions.
research evidence or management of a Provides detailed
expert consensus. patient. recommendations
Highlights the that build on those
strength of the made in guidelines.
evidence underlying
each
recommendation.
Who uses it? Clinicians/Medical A multidisciplinary Specific
Doctor, patients and clinical team. clinicians./Medical
third parties, Doctors with
Specializations.
Also known as…. Guidelines Clinical Integrated Care Protocol
Practice Guidelines Pathways Best Practice
Multidisciplinary Treatment Protocol
Pathways of Care
Pathways of Care
Care Maps