WEEK 6

NCM 110
Nursing Informatics

MIDTERMS
 PRACTICE APPLICATION
 Critical Care Application
 Community Health Application
 Ambulatory Care Systems
 Critical Care Application

 Standards for Practice

 Information Technology & the actual
work for nurses
 Healthcare Collaboration
 Progress in Practice
 Community Health Application

 Community Health System Development

 Public Health
 Data Sets
 Omaha Systems
 Community Health Intensity Rating Scale
 Home Health Info System
 Telemedicine
 Ambulatory Care System

 Application
 Financial Benefits
 Administrative Benefits
 Clinical Benefits
 Role of the Nurse Using Informatics
Concepts in the Ambulatory Arena
 Objectives
1.Identify information technology applications in critical care
2.Understand the basic components of arrhythmia monitors and physiologic
monitors
3.Describe how hemodynamic monitoring systems are used in critical care
settings
4.Understand the capabilities, purposes, types, benefits and issues of critical
care information systems (CCISs)
5.Describe the relationship between hemodynamic monitoring systems and
CCIS
6.Identify trends in monitoring & computerized information management
7.Identify special-purpose applications available
Can you identify the
equipments in this photo,
name at least 5.
Who among you wants/dream of becoming an ICU Nurse?
 Critical Care Nursing- is a nursing
specialty that deals with human
responses to life-threatening problems
(Lewis,2004). It is a multidisciplinary
healthcare specialty that care for
patients with acute, life-threatening
illness or injury.
 Critically Ill Patient- is physically
unstable with real or potential life-
threatening health problems
requiring continous intensive
assessment and interventions (AACN,
2003).
 They can be found in a variety of settings due to
increased patient acquity & an aging population,
historically, they are cared for in the critical care
units (CCUs).
 Thus arise the need for a technologically intense
environment geared to the monitoring and support
needs of these patients. Embedded in much of that
technology are microprocessors- which permits
gathering, processing & storage of large volumes of
clinical & financial data.
 Saba and McCormick in 1986 estimated that the
volume of data collected by nurses in critical care
settings on a daily basis was as high as 1500 data
points.
 PROBLEMS:
 Data must be readily accessible at the point of
care.
 The demands for cost-effective care continues
to increase.
 Resource shortages, both staff and time,
increase the difficulty of data management
 SOLUTION: IT offers solution through
manipulation of large volume of data &
presenting them in meaningful ways to
guide quality and cost-effective decision
making.
Based on the sheer volume
& complexity of the
technology, the
information management
needs of the critically ill
patient require different
technology resources than
those of other patient care
areas.
Developments
The advantages of these automated physiologic
monitoring systems resemble the advantages of electric
nursing documentation: better control or patient observations
to improve assessment, intervention and evaluation of patient
care.
These systems focus heavily on collecting, storing, and
displaying physiologic data. Usually, these systems are
integrated into electronic patient documentation systems that
address the nursing process and provide support for all facets
of documentation. The functions, purposes & benefits of these
nursing process capabilities are the same.
Information Technology Capabilities and Applications
in Critical Care Settings
1. Process, store, & integrate physiologic and diagnostic
information from various sources
2. Present deviations from preset ranges by an alarm or
an alert
3. Accept and store patient care documentation in a
lifetime clinical repository
4. Trend data in a graphical presentation
5. Provide clinical decision support through alerts, alarms
and protocols
6. Provide access to vital patient information from any
location, both inside and outside of the critical care
setting
7. Comparatively evaluate patient for outcomes analysis
8. Present clinical data based on concept-oriented views
Information Technology Applications and Functions
typical in the critical care environment include the
following:

1) Physiologic monitors, including arrythmia &

hemodynamic monitor

2) Mechanical ventilators

3) CCISs
1. Physiologic Monitoring System
l 1960s - in the NASA programs, physiologic monitors
were developed to oversee the VS of the astronauts
l 1970s- these monitors found their way in the hospital
settings, replacing manual methods of gathering patients VS
l 1980s- technology become more cheaper, smaller &
powerful.
l 1990s- focus of development have shifted to integration
of monitoring data into information system

In fact, many monitoring vendors introduced clinical

information systems into their standard product lines.
Basic Components of Physiologic Monitoring Equipment

a. Sensors (pressure transducer, ECG electrode)

b. Signal conditioners- to amplify or filter the display device

( amplifier, oscilloscope, paper recorder)

c. File to rank and order information ( storage file, alarm signal)

d. Computer processor- to analyze the data & direct reports

( paper reports, storage for graphic files, summary reports)

e. Evaluation or controlling component to regulate the equipment

or alert the nurse ( notice on the display screen, alarm signal)
Hemodynamic Monitors

- Advanced hemodynamic monitoring systems allow for

calculation of hemodynamic indices & limited data storage.
- can be invasive or noninvasive
- Invasive catheters-are typically used to measure & monitor
various pressures & cardiac output.
- Noninvasive monitoring methods-are increasingly common
example: pulse oximitery-oxygenation measurement,
measurement of cardiac output via Doppler
Hemodynamic monitoring can be used to:

1. Measure hemodynamic parameters

2. Closely examine cardiovascular function

3. Evaluate cardiac pump output and volumes status

4. Recognize patterns (arrythmia analysis)& extract features

5. Assess vascular system integrity

6. Evaluate the patient’s physiologic response to stimuli

7. Continually assess respiratory gases

8. Continuously evaluate blood gases and electrolytes

9. Estimate cellular oxygenation

10. Continuously evaluate glucose levels

11. Store wave forms

12. Automatically transmit selected data to a computerized patient

database
 2. Mechanical Ventilator
- is a machine tthat generates a controlled flow of gas into a
patient’s airway

- Oxygen & air blended accordinf to the prescribed inspired

tension (FiO2), accumulated in a receptacle
within the machine, and delivered to the patient using one
of the many modes of ventilation

The ability to initiate, maintain and wean from the ventilator

is the responsibility of the RT

As soon as you initiate the ventilator you must be thinking

of how you wean the patient off
 2. Mechanical Ventilator

MECHANICAL VENTILATION- is a therapeutic

method that is used to assist or replace
spontaneous breathing

It is any means in which physical devices or

machines are used to either assist or replace
spontaneous respiration
 2. Mechanical Ventilator

4 MAJOR INDICATION:

a) Need for high levels of inspired oxygen (hypoxic

respiratory failure)
b) Need for assisted ventilation (hypercapnic
respiratory failure or surgical procedure
c) Protection of airwarys against aspiration
d) Relief from upper airway obstruction
Positive Pressure Ventilation
 CCISs- Critical Care Information Systems

CCIS- is a system designed to collect, store, organizer, retrieve and

manipulate all data related to care of the critically ill patient.
-it is focused on individual patients and the information directly
related to the patient’s care.
Primary purpose: the organization of a patient’s current & historical
data for use by all care providers in patient care.

The power of modern CCIS is its ability to integrate information from

a variety of sources & to manipulate that information in meaningful
ways.
The CCIS should include data & information from bedside
devices; results from ancillary departments, medications,
orders, physical assessment findings gathered from the
clinical team, and comprehensive plans or care to guide
patient care. Integration of data results in a more complete
representation of the patient’s status & can promote safety,
quality and efficiency in patient care.

The hospital infrastructure of interfaces between medical

devices and the CCIS allow the free flow of data between
the CCU and other departments.
VIDEO on CCIs