Module 4, Response to Another Student's Post

Response to "Module 4 Part 2 Nursing Data Quality" post by Sue V. at http://suevongsikeo.blogspot.com

The point you mentioned about the Hebda reading that states that if staff are proficient in the input device used, then there are less data collection and entry errors is absolutely true. If one doesn't know how to use a computer charting system, for example, then it is not only possible, but likely, that an error will occur. This is negative for all involved, because not only is the computer chart part of the permanent record of the patient, but that information is generally used by other healthcare providers caring for the patient, such as other nurses, doctors, and ancillary staff. If the information is entered incorrectly, decisions could be made incorrectly. If the happens because the staff doesn't know how to use the system correctly, the error is absolutely inexcusable. Where I work, there are required proficiencies and classes that staff have to complete in  order to learn and understand how to correctly use the computer charting system. Even with the classes, errors still occur, however, I can't imagine what might happen if the classes weren't required. Sometimes one might know how to use the basics of a computer charting program, but not understand how to use certain additional features of the program that might help to better the patient care, such as adding patient-specific interventions to a computer charting care plan. Education should be mandatory for all staff where input devices are utilized to avoid these types of errors.

Module 4, Question 2 Response

Nursing data quality is absolutely critical in proper decision support. A good decision is based on evidence and usually that evidence is in the form of data. If the data collected is not correct, complete, or thorough, this opens the doors for errors in decision making and could result in an unwanted or unplanned outcome. In some situations, inaccurate data could even lead to disability or death if the situation is critical enough. Errors in data collection occur easily, whether they be from improper transfer from paper documents to computer charts, poor handwriting on paper charts, wrong patient errors, miscommunications, or other forms. I believe it is the responsibility of each healthcare provider working with each patient to review the most recent data and assure accuracy and completeness. It there is a mistake made due to poor data quality, it is the mistake of all involved. It is also important to assure that data collected from each patient is correct. For example, if a patient is a poor historian, it is important to ask a close family member or friend about medical history, or is a patient can't remember exactly their home medications, the bottles should be brought in so that correct data is collected and correct medication therapy is implemented in the hospital. High data quality and correct data collection and recording is necessary to make appropriate decisions that best benefit each patient.

Module 4, Question 1 Response

The reading helped me to simply pay more attention to the clinical decisions I make. Sometimes as an RN, I feel like the most important and critical clinical decisions are the responsibility of the physician in charge, however, that is not necessarily true. The RN is the health care provider that is with the patient the most and usually the first to recognize the need for an intervention, therefore, I must make critical decisions to care for my patients and know when to involve the physicians for further intervention. Clinical decision making cannot be taken lightly because the life of a patient is on the line. Especially in my area of critical care, one decision can change the status of a patient very quickly. It is important to know how to make appropriate clinical decisions and if answers aren't known, it is critical to know where to find the answers, whether it be from resources such as a clinical decision support system, or another source. I realize that the more experience I have as a RN, the more my clinical decision making skills will improve because I will be exposed to more situations with time, but I must also be aware of the possible heuristics and biases as are discussed below. I also realize that as I transition from the role of RN to ACNP, clinical decision making will be even more critical, as with more hierarchy comes more responsibility.

I believe that nursing experience is a tool that in invaluable and cannot be replaced. I have always learned best and been able to remember details better when I have experienced a situation or patient case and treatment personally. With that said, one has to be cautious to not let previous experience narrow the way of thinking or decision making. Sometimes, if a healthcare provider feels too comfortable and experienced in certain areas, there can be misdiagnoses because the clinician simply assumes a certain diagnosis due to a few obvious signs and symptoms without exploring fully the full set of signs and symptoms with which the patient presents. Tversky and Kahneman (1974) mention this idea, representativeness, as one of three hueristics which can possibly lead to biases in decision making. This idea could also be described as overconfidence, as described by Thompson (2003). As mentioned, nursing experience is critical in clinical decision making. It is obvious the difference in ability in clinical decision making between a new graduate RN and one that has working in the ICU for 20 years, or even 1 year, however, the biases need to be kept in mind and avoided when possible. Also, it is crucial to always be implementing evidence based practice in clinical decisions. Sometimes, when clinicians have been in the business for awhile, they make decisions based on past experience because that is the way they have always done it, however, it is necessary to stay informed on current evidence based practice and implement new findings into decision making in order to better treat the patients. For some, this might require using other resources, such as a CDSS, or studying recent research literature, or possibly a little humility in order to be willing to deviate a little from they way things have always been done in the past.