Americans should be able to count on receiving health care that is safe. To achieve this, a new health care delivery system is needed a " a system that both prevents errors from occurring, and learns from them when they do occur. The development of such a system requires a commitment by all stakeholders to a culture of safety and to the development of improved information systems for the delivery of health care. This national health information infrastructure is needed to provide immediate access to complete patient information and decision-support tools for clinicians and their patients. In addition, this infrastructure must capture patient safety information as a by-product of care and use this information to design even safer delivery systems. Health data standards are both a critical and time-sensitive building block of the national health information infrastructure. Building on the Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Patient Safety puts forward a road map for the development and adoption of key health care data standards to support both information exchange and the reporting and analysis of patient safety data.

Patient Safety: Achieving a New Standard for Care

http://lib.ajaums.ac.ir/booklist/lancet_Oct-9492_1.pdf

Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. In May 2003, the Department of Health and Human Services (DHHS) asked the Institute of Medicine (IOM) to provide guidance on the key care delivery-related capabilities of an electronic health record (EHR) system. An EHR system includes (1) longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual; (2) immediate electronic access to person-and population-level information by authorized, and only authorized, users; (3) provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; and (4) support of efficient processes for health care delivery. Critical building blocks of an EHR system are the electronic health records (EHR) maintained by providers (e.g., hospitals, nursing homes, ambulatory settings) …

Key Capabilities of an Electronic Health Record System: Letter Report

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)67484-3.pdf

Personal digital assistants in health care: experienced clinicians in the palm of your hand?

Purpose—Clear and complete communication between health care providers is a prerequisite for safe patient management and is a major priority of the Joint Commission's 2008 National Patient Safety Goals. The goal of this study was to describe nurses' perceptions of nurse-physician communication in the long-term care (LTC) setting. Methods—Mixed-method study including a self-administered questionnaire and qualitative semistructured telephone interviews of licensed nurses from 26 LTC facilities in Connecticut. The questionnaire measured perceived openness to communication, mutual understanding, language comprehension, frustration, professional respect, nurse preparedness, time burden and logistical barriers. Qualitative interviews focused on identifying barriers to effective nurse-physician communication that may not have previously been considered and eliciting nurses' recommendations for overcoming those barriers. Results—Three-hundred seventy-five (375) nurses completed the questionnaire and 21 nurses completed qualitative interviews. Nurses identified several barriers to effective nurse-physician communication: lack of physician openness to communication, logistic challenges, lack of professionalism, and language barriers. Feeling hurried by the physician was the most frequent barrier (28%), followed by finding a quiet place to call (25%) and difficulty reaching the physician (21%). In qualitative interviews, there was consensus that nurses needed to be brief and prepared with relevant clinical information when communicating with physicians and that physicians needed to be more open to listening. Conclusions—A combination of nurse and physician behaviors contributes to ineffective communication in the LTC setting. These findings have important implications for patient safety and support the development of structured communication interventions to improve quality of nursephysician communication.

/pdf/nurse-physician-communication-in-the-long-term-care-setting-235j6b8ocd.pdf

Nurse-Physician Communication in the Long-Term Care Setting: Perceived Barriers and Impact on Patient Safety

Perceived Information Needs and Communication Difficulties of Inpatient Physicians and Nurses

Purpose: To explicate (a) the types of economic analyses available to nurses, (b) the measurement of costs in different types of economic evaluations, (c) recommendations for standardization, and (d) the assessment of economic evaluations for evidence-based practice.

Methods: Five types of economic analyses are reviewed. Recommendations for standardization of cost-effectiveness analyses are included as well as a worksheet for use in critiquing economic evaluations for validity and applicability to clinical settings.

Findings: Limited knowledge and a lack of consistent approaches to economic analyses are evident in the nursing and health care literature. However, nurses have not contributed to the conduct of rigorous economic evaluations or research to the extent found in other health care disciplines.

Conclusions: Basing nursing practice on the best available evidence is now the expected standard of care. Applying economic evidence to practice requires understanding the methods used to conduct economic evaluations and to analyze the rigor of such evaluations.

Economic Evidence for Evidence-Based Practice

Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space

Medical errors are common, costly and often preventable Work in understanding the proximal causes of medical errors demonstrates that systems failures predispose to adverse clinical events Most of these systems failures are due to lack of appropriate information at the appropriate time during the course of clinical care Problems with clinical communication are common proximal causes of medical errors We have begun a project designed to measure the impact of wireless computing on medical errors We report here on our efforts to develop an ontology representing the intersection of medical errors, information needs and the communication space We will use this ontology to support the collection, storage and interpretation of project data The ontology's formal representation of the concepts in this novel domain will help guide the rational deployment of our informatics interventions A real-life scenario is evaluated using the ontology in order to demonstrate its utility

Development of an ontology to model medical errors, information needs, and the clinical communication space.

The purpose of this paper is to describe the implementation and evaluation of a two-part approach to achieving informatics competencies: 1) Palm-based student clinical log for documentation of patient encounters; and 2) informatics for evidence-based practice curriculum. Using a repeated-measures, non-equivalent control group design, self-reported informatics competencies were rated using a survey instrument based upon published informatics competencies for beginning nurses. For the class of 2002, scores increased significantly in all competencies from admission to graduation. Using a minimum score of 3 on a scale of 1=not competent and 5=expert to indicate competence, the only area in which it was not achieved was Computer Skills: Education. For 2001 graduates, Computer Skills: Decision Support was also below 3. There were no significant differences in competency scores between 2001 and 2002 graduates. Computer Skills: Decision Support neared significance. Subsequently, the approaches were refined for implementation in the class of 2003.

Christine Curran

Papers

Perceived Information Needs and Communication Difficulties of Inpatient Physicians and Nurses

Economic Evidence for Evidence-Based Practice

Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space

Development of an ontology to model medical errors, information needs, and the clinical communication space.

Informatics Competencies Pre- and Post-Implementation of a Palm-based Student Clinical Log and Informatics for Evidence-based Practice Curriculum