Electronic Information At The Bedside, And Barcode Scanning Essay

Record-keeping and documentation are a hugely important part of nursing practice that unfortunately is often overlooked. Good record-keeping is in fact an essential element of being a good nurse. This assignment will discuss the importance of record-keeping in the healthcare setting. Record-keeping is vital for three main functions of nursing. It facilitates communication, promotes safe and appropriate nursing care and meets professional and legal standards (CRNBC 2008). These purposes and other important functions of record-keeping will be described in this assignment. The professional and legal implications of poor record-keeping will also be outlined. The topics will only be briefly and broadly discussed due to word count

Steele, A. M., & DeBrow, M. (2008). Efficiency gains with computerized provider order entry. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches AHRQ publication no 08–0034-4, vol 4. Technology and Medication Safety Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from http://www.ahrq.gov/qual/advances2/

There are many other potential patient safety benefits from implementing a bar code-enabled point-of-care technology (BPOC) system in addition to reducing medication errors. When these systems are implemented to their fullest capability they can improve the safety of blood transfusions and laboratory specimen collections. Less obvious benefits, such as increased satisfaction of nurses in their daily work, can also be realized. The technology reduces the nurses' paperwork burden, freeing nurses to spend more time interacting with patients and providing higher-quality care. A BPOC system can also provide a sense of protection to nurses, easing the level of stress. In turn, this can reduce nursing turnover, a growing and increasingly expensive problem in

In the journal article, The Impact of an Integrated Electronic Health Record Adoption on Nursing Care Quality, they discuss how technology can improve quality of care. With electronic health records, nurses can document while at the bedside. Their study confirms that the use of electronic health records can improve patient quality of care (Walker-Czyz, 2016.)

Dimensions in which technology are improving and expanding and are ever evolving, the following are some of the current ways in which patient safety is being enhanced; Patient identity, the use of barcodes and other such identification systems ensures that the provider is providing the correct care to

While there is a learning curve associated with moving from paper charting to on line documentation of nursing care, there are a few measures that can decrease the amount of time spent in front of the computer. In order to avoid time spent frequently logging into the system there are security features that can be used such as finger print technology and employee badge swipe technology. Instead of writing notes on paper and then recording in the computer nurses are encouraged to complete documentation at the patient bedside at the time of patient care

In the modern world technology is everywhere and it affects everyone’s daily life. People are constantly attached to cell phones, laptops, and other electronics, which all have affected how people live their lives. Technology is also a large part of the healthcare system today. There are many electronics and technologies that are used in health care, such as electronic health record, medication bar code scanning, electronic documentation, telenursing, and there are many more forms of technology that impact nursing. One technology that stands out is the electronic health record. The electronic health record, also referred to as EHR, is an electronic version of a patient’s chart, and it contains is a list of the patient’s current medications, allergies, laboratory results, diagnoses, immunization dates, images, treatments, and medical history (“Learn EHR Basics,” 2014). The purpose of the electronic health record is to have a patient’s health care record available to health care providers nationwide, but the patient can decide who has access to their record (Edwards, Chiweda, Oyinka, McKay, & Wiles, 2011). The electronic health record is a very important technology in health care and it impacts nurses, nursing care, and has a significant impact on patient outcomes.

Today’s healthcare is changing, and more hospitals are commencing to go paperless using computers for both medical records and charting. Computers are widely accepted, in personal and professional settings. It is an essential requirement for computer literacy. Numerous advances in technology during the past decade require that nurses not only be knowledgeable in nursing skills but also to become educated in computer technology. While electronic medical records (EMR’s) and charting can be an effective time management tool, some questions have been asked on how exactly this will impact the role and process of nursing, and the ultimate effects on patient safety and confidentiality. In order to

The goal of this literature review is to increase our knowledge about technology use in practice and to identify where there is need for improvement. Information technology seems to be a widely discussed topic these days and most nurses have no clear idea how it can transform the way we do things on an every day basis. We will also look at the impact technology has on nursing, patients, and colleagues. We will then focus on a specific nursing setting, in this case the emergency room. This literature review is organized to grow on each independent section so that you, the reader, can form your own opinion, but take with you the universal understanding of how information technology will lead us down a new and exciting career path.

This paper will identify the use of Electronic Health Records and how nursing plays an important role. Emerging in the early 2000’s, utilizing Electronic Health Records have quickly become a part of normal practice. An EHR could help prevent dangerous medical mistakes, decrease in medical costs, and an overall improvement in medical care. Patients are often taking multiple medications, forget to mention important procedures/diagnoses to providers, and at times fail to follow up with providers. Maintaining an EHR could help tack data, identify patients who are due for preventative screenings and visits, monitor VS, & improve overall quality of care in a practice. Nurse informaticists play an important role in the

The purpose of this paper is to identify and describe two health information and communication technologies (HICTs) and how they aid nurses in supporting safe, quality care, facilitating continuity of care and care coordination, and partnering with patients and families to increase participation in health care. HICT involves electronic creation, storage, exchange, and analysis of health information to advance delivery of health care. Widespread use of HICT within the healthcare industry can achieve the following goals: improve healthcare quality and safety, reduce costs and health disparities, enhance clinical research, and ensure security of patient health information (McGonigle & Mastrian, 2015). Several examples of HICTs include: electronic medical record systems, electronic prescribing, consumer health applications, and telehealth (Agency for Healthcare Research and Quality [AHRQ], 2015). Integration of HICTs in healthcare settings is valuable for all clinicians, but most importantly nurses as they are primary caregivers.

At a practice level, the importance and guidance of the Code of Conduct, Code of Ethics and NPA are demonstrated on a daily basis with regard to the issues of documentation, informed consent and open disclosure, and confidentiality. With respect to documentation, nurses must be able to document patient assessments and responses in an accurate, comprehensive and confidential manner and record all observations objectively. Informed consent and open disclosure are also major legal issues nurses face daily. It refers to the communication between the patient and health professional that results in the patient's agreement to undergo a specific procedure and requires that the patient has thoroughly understood the procedure, implications and risks prior to giving written consent.

Documentation plays a vital role in research, education, quality assurance and reimbursements for both patients and providers (Okaisu, Kalikwani, Wanyana, & Coetzee, 2014, p. 1). The importance of documentation is not lost on any RN, but continuity in what is recorded and what is absolutely necessary to have in a patient’s record is not always met.

Ineffective nursing documentation compromises patient safety and can result in serious or even fatal errors. Nursing documentation is essential to practice and is defined as everything entered into a patient’s electronic health record or written in a patients’ record (Perry, 2014). The goal of effective nursing documentation to ensure continuity of care, maintain standards and reduce errors (Perry, 2014). Nurses are accountable for their professional practice which requires documentation to effectively reflect the care that clients receive. The College of Nurses of Ontario (CNO) states that nursing being regulated health care professionals are accountable for ensuring that their documentation is accurate and meets the practice standards (College of Nurses of Ontario, 2009). Effective documentation strategies to reduce errors include; documenting in a timely fashion, using correct abbreviations and spelling, correcting documentation errors appropriately and ensuring that handwriting is legible. The purpose of this paper is to explore these strategies in greater detail with the goal of improving the care nurses provide to their clients to enhance safety.

In today’s medical field technology plays a big role when it comes to patient care. Technology is huge when it comes to giving the patient the best type of quality care when they are in the hospital. In the old days people would just write it down on a sheet of paper and record it by hand, which caused mistakes. Now with the Electronic Health Record those mistakes are drastically declining. Statistics have shown that using the Electronic Health Record has lowered Nursing mistakes as well as improved patient care. Our society has progressed through the years and has been introduced with the Electronic Health Record which has drastically improved our health care system. The Electronic Health Record provides great communication between