Amy Birkenstamm

NURS 6051 Discussion Post 1

As an aesthetic nurse injector, I specialize in facial aesthetics as well as wellness for my patients. I own my own medical spa and my team and I strive to give our patients the best care day in and day out. One area in my practice that benefits from access to data is in the case of an adverse event such as blepharoptosis (drooping of an eyelid) due to migraine of neurotoxin. This is rare with an incidence of 2-5% (King, 2016). This can affect patients for up to 3 months, affecting them physically as well as emotionally due to their temporary altered appearance. It is important that all nurses within this scope of practice have access to updated, reliable data to give the best instruction on how to handle these situations in the most informed way possible. 

In recent years, OTC eye drops have been effective to a certain extent in treating blepharoptosis. In more severe cases, patients are prescribed apraclonidine, an alpha2-adrenergic agonist, which causes muscles of the eyelid to contract quickly and elevate 1-3mm (Scheinfield, 2005). In a study included in Journal of the Neurological Sciences, 100% of patients responded with some improvement to their ptosis 20-30 minutes after using apraclonidine (Jankovic, Vijayakumar, and Wijemmanne, 2017). 

In a recent severe incident of ptosis at one of my peers’ business, apraclonidine drops showed little to no improvement for her patient. Data and research was required to find a better option for the patient to find relief while her one eyelid struggled to open. Through her research she found a new FDA approved eyedrop called Upneeq, which works in a similar fashion to the other drops but is more potent. Data findings on Upneeq included an increase from baseline in mean number of points seen on superior visual field, as well as an increase from baseline in upper eyelid elevation (Wilson, 2020). This study was done with 304 patients. With incorporating Upneeq into her care for this particular patient she saw almost immediate and drastic improvement. In this scenario, new data findings helped not only her patient, but also herself and other practitioners around her to work more confidently due to the collection of newer information Discussion: The Application of Data to Problem-Solving. 

References

King, M. (2016, December). Management of ptosis. Retrieved May 28, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300727/

N;, S. (n.d.). The use of apraclonidine eyedrops to treat ptosis after the administration of botulinum toxin to the upper face. Retrieved May 28, 2021, from https://pubmed.ncbi.nlm.nih.gov/15748550/

Wijemanne, S., Vijayakumar, D., & Jankovic, J. (n.d.). Apraclonidine in the Treatment of Ptosis. Retrieved May 28, 2021, from https://www.jns-journal.com/article/S0022-510X(17)30194-6/pdf

Wilson, L. M. (2020, October 01). JAMA ophthalmology PUBLISHES pooled analysis of data from two Phase 3 clinical trials of UPNEEQ™ (oxymetazoline hydrochloride, 0.1% solution) for ACQUIRED PTOSIS. Retrieved May 28, 2021, from https://www.biospace.com/article/releases/jama-ophthalmology-publishes-pooled-analysis-of-data-from-two-phase-3-clinical-trials-of-upneeq-oxymetazoline-hydrochloride-0-1-percent-solution-for-acquired-ptosis/

Amy,

What an interesting scenario! I have little to no knowledge on aesthetic injections. As you own your own medical spa, where do you look for to find the best EBP methods to use? Is this the first time you have ever heard of the first two eye drops not working? Discussion: The Application of Data to Problem-Solving Is there any underlying condition that makes someone more likely to experience an adverse effect like the ptosis? Using informatics to find data on unlikely scenarios is the aesthetic field could help you be ready right when it happens, or you could also use the information to help colleagues working in the same field. Do you already have a protocol or way you access data on your field? Is it all your responsibility to analyze healthcare data too see if it should be applied at your workplace? It is the role of many supervisors or nurses managers to interpret healthcare data and apply it to their work to improve patient outcomes (Duquesne University, 2020). It will be interesting to know your role in using informatics in your business since you are likely very involved in the decision and policy making.

Reference

Duquesne University. (2020, April 16). Nurse leaders using informatics. https://onlinenursing.duq.edu/blog/nurse-leaders-using-informatics-the-past-present-and-future/

The Benefits of Data in Problem Solving

Scenario

 In the Emergency Department (ED), data is consistently used to determine the severity of an emergency. When a patient comes to the ED, the triage nurse asks questions, visually assesses, and performs vital signs to determine the appropriate Emergency Severity Index (ESI) level. The ESI level ranges from 1 (loss of life or limb, most emergent) to 5 (non-emergent). This 5-level triage algorithm prioritizes patients that need to be seen first against those with less urgent conditions (AHRQ, 2020). 

Accessing Data

 During the triage process, the ED nurse rapidly assesses the patient. This involves observing life-threatening visual cues such as a diaphoretic patient holding his chest or an inactive and lethargic infant. Gathering information to determine how the patient appears and behaves alerts the nurse if the patient needs to be rushed into the ED or bumped up in line to be seen immediately by a provider. This visual assessment coupled with objective data such as vital sign measurements taken from the vital sign machine or cardiac abnormalities obtained from an EKG machine allows the ED nurse to assign the most fitting ESI level on the electronic health record (EHR). The EHR’s triage note also allows the ED nurse to write subjective data available to view by the ED team. 

Clinical Significance

            The nurse relies heavily on triage experience and knowledge to help sort through less emergent patients. Oftentimes, the Emergency Department sees patients with conditions that a primary care physician can solve. In 2019, the average cost of treating a patient in the ED with a primary care complaint was about 12 times higher ($2,032 vs. $167) than if the patient was seen in the office by their primary physician (Williams, 2019). Hypothetically, using the ESI data, lower acuity patients could be directed to primary care doctors for their complaints instead of consuming ED resources resulting in longer wait times and delays in treating acutely ill patients (Uscher-Pines et al., 2013). 

Application of ESI Data

 Using the ESI algorithm, once the triage nurse determines which patients have primary care provider complaints, in-house primary physicians could (theoretically) take over care of these patients. These patients could be slotted for times to meet with the primary care doctor instead of waiting for treatment from the ED team. Here, the primary care team could use their own data to take care of these patients and provide the appropriate treatment. This would decrease healthcare spending and fragmented care while improving patient satisfaction and wait times (Kirkpatrick, 2017). 

Conclusion

 Utilizing healthcare technology to enhance Emergency Department visits not only aids patients but benefits nursing as well. As data such as the ESI algorithm is used to differentiate life-threatening concerns from non-emergent ones, treatment can be instituted by the appropriate team allowing ED nurses to focus on their acutely ill patients Discussion: The Application of Data to Problem-Solving.

References

Emergency Severity Index (ESI): A triage tool for the emergency department. AHRQ. (2020, May). https://www.ahrq.gov/patient-safety/settings/emergency-dept/esi.html.

Kirkpatrick, W. (2017, January 2). The consequences of emergency Department Overuse. The Consequences of Emergency Department Overuse. https://wellness.totalaccessmedical.com/blog/the-consequences-of-emergency-department-overuse.

Uscher-Pines, L., Pines, J., Kellermann, A., Gillen, E., & Mehrotra, A. (2013, January). Emergency department visits for nonurgent conditions: Systematic literature review. The American journal of managed care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156292/.

Williams, J. P. (2019). ‘Avoidable’ er visits fuel health care costs. U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2019-07-22/avoidable-er-visits-fuel-us-health-care-costs.

Thank you Marisa.  Good example of the use of technology in health care.

Marisa,

The information gathered through the triage questionnaire and the nurse’s initial assessment of the patient is a great example of obtaining valuable information to make appropriate decisions. This further upholds the statement made by McGonigle and Mastrian (2017) that “nurses must possess the technical skills to manage equipment and perform procedures, the interpersonal skills to interact appropriately with people, and the cognitive skills to observe, recognize, and collect data; analyze and interpret data; and reach a reasonable conclusion that forms the basis of a decision.”

I feel that staff nurses can play an even bigger part in nursing informatics by “monitoring the use of new technology by doing the following: monitoring and maintaining vigilance over data/technologies to identify those that add value to a given health situation; recognizing that nurses, other clinicians and patients may engage and assume responsibility independently and or interdependently for specific data (e.g., remote monitoring, self-monitoring, wearables, appliances)” (Nagle et al., 2017). These practices may also further decrease healthcare spending, wait times, and increase patient satisfaction rates.

Resources

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4^th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 1, Nursing Science and the Foundation of Knowledge” (pp. 8)

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. Retrieved from https://serval.unil.ch/resource/serval:BIB_4A0FEA56B8CB.P001/REF

Marisa,

For starters, great post!  Being a perioperative and post-anesthesia care unit (PACU) nurse, I work closely with the emergency department.  The vast amount of information you provided helped give me a better idea of how the emergency department functions.  One area of your post caught my eye the most, your clinical significance section.  The hospital I work at is bursting at the seams due to the drastic influx of patients.  Although the influx of patients coincides with the vastly changing pandemic, we also see just as many cases for instances that are non-emergent Discussion: The Application of Data to Problem-Solving.  “Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status, lack of access to primary care, lack of insurance, convenience of “on demand care” and the patient’s individual perception of their complaint urgency” (Rocovich, 2012, para. 1).

Over the years, there has been a steady increase in the amount and acuity of patients visiting the emergency department.  Every year, there are over 100 million individuals that seek and receive emergency care. As you stated, triage nurses rely heavily on experience and knowledge to differentiate emergent from non-emergent patients.  “The purpose of triage is to identify patients needing immediate resuscitation, to assign to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures as appropriate” (Wang et al., 2011).  Nurses must identify low acuity patients that could be seen and treated by their primary care physician.  This not only saves hospital resources but makes more time for acutely ill patients.

References

Rocovich, C., & Patel, T. (2012). Emergency department visits: Why adults choose the emergency room over a primary care physician visit during regular office hours? World journal of emergency medicine, 3(2), 91–97. https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.02.002

Wang, L., Zhou, H., & Zhu, J. F. (2011). Application of emergency severity index in pediatric emergency department. World journal of emergency medicine, 2(40, 279-282. https://doi.org/10.5847/wjem.j.1920-8642.2011.04.006

Hello Marisa, I enjoyed reading your very informative post! I agree with you that data is consistently used to determine the severity of an emergency. Due to the understaffing of hospitals, patients are waiting longer than average to be seen by a healthcare provider Discussion: The Application of Data to Problem-Solving. This leads to triage nurses using the ESI to avoid daily care for patients with more critical illnesses (Shelton, R. 2009). As Emergency Department (ED) level one trauma nurse, our ED is always overcrowded, and triage nurses prioritize patients using the ESI. The only downfall of using the ESI is the confusion it brings patients and incorrect triaging base on ESI (Grossmann et al., 2012).

Reference:

Grossmann, F. F., Zumbrunn, T., Frauchiger, A., Delport, K., Bingisser, R., & Nickel, C. H. (2012). At Risk of Undertriage? Testing the Performance and Accuracy of the Emergency Severity Index in Older Emergency Department Patients. Annals of Emergency Medicine, 60(3), 317–325. https://doi-org.ezp.waldenulibrary.org/10.1016/j.annemergmed.2011.12.013

Shelton R. (2009). The emergency severity index 5-level triage system. Dimensions of Critical Care Nursing, 28(1), 9–12. https://doi-org.ezp.waldenulibrary.org/10.1097/01.DCC.0000325106.28851.89

Marisa,

Great post and as a former ED nurse, I can totally relate to the efficient processes of using technology for proper communication amongst all health care providers especially in the emergency environment. Prioritizing and communication is key in order to effectively treat patients and provide the best care and safety.

This scenario is a great example of the benefits of technology. Being able to assess a patients condition sooner rather than later could be the difference between life and death. According to Sweeney, J. (2017),  skills needed include understanding of data collection, storage, and extraction, in addition to an appreciation for the power of data to drive and inform practice”.  This also highlights the importance of continuing education in the medical field so that we can stay current with technology and its advances. “The role of the informatics nurse specialist will continue to evolve at an increasingly rapid rate in the coming years” Nagel et. al (2017).

References

Nagle, L. M., Sermeus, W., & Junger, A. (2017). Evolving Role of the Nursing Informatics Specialist. Forecasting Informatics Competencies for Nurses in the Future of Connected Health, 212-221. doi:10.3233/978-1-61499-738-2-212.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

My concern about the ESI was the variability between assessments. Two different nurses can obtain different results for the same patient. The variability is related to the subjectiveness of the nurse. Despite the variability of the ESI, it is still widely utilized in emergency rooms Discussion: The Application of Data to Problem-Solving. The tool can be challenging when used in hectic and bustling settings or during staff shortages; it is difficult to say that nurses need appropriate training, but experience and continuous education helps to reduce the variability in results.

References

Mistry, B., Stewart De Ramirez, S., Kelen, G., Schmitz, P. S. K., Balhara, K. S., Levin, S., Martinez, D., Psoter, K., Anton, X., & Hinson, J. S. (2018). Accuracy and Reliability of Emergency Department Triage Using the Emergency Severity Index: An International Multicenter Assessment. Annals of Emergency Medicine, 71(5), 581–587. https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S0196064417317456

            Utilizing an Enhanced Recovery After Surgery (ERAS) protocol can decrease the length of stay and postoperative complications. One of the critical data collection elements in an ERAS cardiac surgery recovery program is early ambulation, which my hospital firmly adheres to (Hirji et al., 2021). I currently work in a cardiovascular intensive care unit (CVICU) after recently stepping down from clinical management on our cardiac surgical step-down unit Discussion: The Application of Data to Problem-Solving. Due to the infrastructure issues of the CVICU, transferring post-surgical patients to the step-down unit when ordered is imperative to their enhanced recovery. Early ambulation post-operatively decreases complications such as deep vein thrombosis, pulmonary emboli, improves pain control, decreases the risk of cardiac dysrhythmias, and improves patient independence (Mayor, 2018). Recently with staffing shortages hospital-wide and bed availability, our patients are being held in the CVICU extra day(s) so the nursing supervisor can decompress the emergency department and admit them to our step-down unit. As a manager, it became increasingly difficult to advocate for my patients to the nursing supervisor and articulate the importance of transferring out of the CVICU was. Utilizing data collected by our informatics team to provide senior leadership with information about how prolonged stays in the CVICU caused the increased length of stay and postoperative complications would be beneficial.

Data will need to be collected from all patients who received transfer orders to the step-down unit and not moved out due to nursing supervisor discretion. Patients who remained in CVICU due to medical instability will remain excluded from the data. Discussion: The Application of Data to Problem-Solving To assist with the data collection, the CVICU manager and surgical step-down manager would need to collaborate and devise a system to track patients who did not transfer out when ordered. This data could be collected monthly and presented to the informatics team, also known as the clinical documentation improvement team (CDI), to evaluate. The CDI team could also enlist assistance from case management, who can speak to the impact staying additional days had on the patient’s health, the financial aspect of the patient’s hospitalization, and the discharge plan.

Documentation is vital with hospital reimbursement, and nurse leaders play a significant role in ensuring their departments are documenting accurately. Sweeney (2017) states that without nurse leaders assessing how information is organized in the electronic health record, organizations may not be compliant with the Meaningful Use aspect of the Health Information and Technology for Economic Clinical Health Act (HITECH). Patient-centered care is at the forefront of patients’ successful recovery, and this is discussed preoperatively with all of our cardiac surgical patients. Additional time spent in our CVICU is also met with decreased patient satisfaction requiring management to intervene and provide service recovery. The data collected by the managers, informatics team, and case managers will be used to develop key points to present to senior leadership at my facility to encourage and support timely transfers as ordered. Discussion: The Application of Data to Problem-Solving

References

Hirji, S.A., Salenger, R., Boyle, E. M., Williams, J., Reddy, V. S., Grant, M. C., Chatterjee, S., Gregory, A. J.,                   Arora, R., & Engelman, D. T. (2021). Expert Consensus of Data Elements for Collection for Enhanced                   Recovery After Cardiac Surgery. World Surg (45), 917–925. https://doi.org/10.1007/s00268-021-05964-1

Mayor, M. A., Khandhar, S. J., Chandy, J., & Fernando, H. C. (2018). Implementing a thoracic enhanced                         recovery with ambulation after surgery program: key aspects and  challenges. Journal of thoracic                        disease, 10(Suppl 32), S3809–S3814. https://doi.org/10.21037/jtd.2018.10.106

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics, 21(1).

Dr. Moyers,

I am having a hard time pasting my work so that my reference format isn’t compromised.

No worries Jessica.  Blackboard will often mess up format.

Good response Jessica.  Your post leads me to a question….

Class:

How does data become information?

Dr. Moyers

Dr. Moyers,

Essentially data is a building block to form information that can be documented within a medical record to gain insight into what is going on with a patient (Sadan, 2020). Data collection is essential to providing accurate information. Data is an essential concept within quantitative research (Sadan, 2020). Data is collected in a variety of ways, such as; observations, vitals, questionnaires, interviews, or self-reporting to name a few (Sadan, 2020). From there the data is turned into information. Exceptional collected data can enhance patient findings and lead to possible diagnosis (Sadan, 2020). Once a diagnosis is created information regarding the diagnosis can be provided to the patient. As health care professionals, it is essential to gather the needed data to create an inference about what is going on with the patient.

References

Sadan, V. (2020). Data collection for Quantitative Research. Research Methods in Business Studies, 153–181. https://doi.org/10.1017/9781108762427.013 Discussion: The Application of Data to Problem-Solving