Get it into your system

Upcoming conference will explore how to bring IT online for maximum benefits and support from staff. 

The changing landscape of healthcare and increasing demands on the system mean technology and informatics will need to play a much stronger part in how nurses deliver care in the future, one academic plans to tell an upcoming conference.

Associate professor Alison McMillan, chief nurse and midwifery officer at the Department of Health, Victoria, says, “We’re beginning to see some of that already, and when you add that to a forecasted significant shortfall in particularly the nursing workforce moving into the mid part of the century, we will need to think about how we can use informatics and technology in nursing much better than we have up until now.”

McMillan will speak at the Health Informatics Society of Australia’s Nursing Informatics Australia 2014, Australia’s Nursing Informatics Conference, in August. She plans to discuss some of the technologies that should receive more attention. For example, she says technology that involves nurses entering information and allowing for the generation of decision support around planning and prioritising care is something that hasn’t been done particularly well so far.

Even so, she hopes such applications will eventually improve outcomes and result in better care decisions surrounding patients at risk and appropriate interventions.

It will also help to have data about how nursing intervention can change patient outcomes, McMillan adds. “We’ve never been particularly good at being able to demonstrate how great nursing care can minimise harm,” she says.

McMillan will be looking to challenge nurses to embrace technology and not be frightened of it.

“There is a fear of technology, particularly perhaps in the more mature nurses,” she says. However, in her experience, new technologies can make work more rewarding and enjoyable and help generate better patient outcomes.

“My experience of the adoption of things like electronic medication management systems, for instance, is that nurses are quick and adept at adapting to the introduction of technology, particularly where they can see it makes their work easier at the bedside,” McMillan says. “They shouldn’t be frightened of it because the systems are designed today to make our jobs easier and often do.”

She says it’s important that nurses are engaged at the beginning of any implementation project so the ways they deliver care are adopted within the new system.

NIA 2014 chair and senior e-health project officer at Gold Coast Medicare Local, Lis Herbert, who has implemented a number of projects in hospitals, says fear of new technology amongst nurses is not something she has encountered. However, she says this may be dependent on the organisation and, like McMillan, adds that how things are integrated is important.

“If you’ve got a good change manager and a good project team and nurses are included right from the start the same as everybody else, there will be no problems,” she says. “Nurses make up the majority of your clinical workforce so you have to have them on board for everything, otherwise it’s not going to work.

Herbert says to approach technology with an open mind and with the realisation that new technology is not meant to be a burden but is there for a reason. “If you’re playing with a new pump device you learn how to use that because you need to use it in your everyday clinical life; an information system is no different,” she says. “You learn how to use it.”

She explains that nurses can support each other in this process. “I’ve found doing implementations that if you have some super-user type nurses, they’re always around to help others,” she says, adding this is already done in other aspects of clinical life. “Don’t feel silly asking. If you don’t know, ask someone; no one will think you’re stupid if you ask.”

Nursing informatics is a growing field, Herbert says. “There are so many information systems that nurses use in their everyday work. Nurses need to understand how technology can help them in their everyday life.”

Jane Lawless, director of Lawless Consulting, which provides advice, diagnostics and tools for healthcare organisations, will also be a keynote speaker at the NIA conference. She says exploration is needed to discover why many nurses are opposed to electronic decision support tools, and how that can be changed.

A large proportion of an organisation’s funding is spent on nursing, and Lawless says it makes no sense not to make the most of that critical investment. She says the nursing workforce is reporting being overworked and high levels of stress, and is leaving the profession at worrying levels. Data is also showing significant failures in patient safety associated with staff levels.

Lawless says reluctance to engage with technology results in nurses flying blind when making critical decisions about best resourcing design. This affects nurses and patients, as it means workers don’t have the tools in place to advocate for their patients and profession, Lawless says.

“The pharmaceutical industry has been accused of using research and research data selectively with the result that many patients do [worse] than they should, are harmed, or die,” she says. “Nursing's failure to generate and/or make use of data that links nursing service design and the impact on patients may be having similar consequences.

“The key point is, though, that although we have some evidence to support this proposition, the fact is that we just don’t know.”

She says the result is an inability to state with confidence that nurses are preventing avoidable harm and providing the ideal environment for patients.

“Nursing will have to drive the changes that are required and in particular will need to be prepared to make an ongoing commitment to producing the information that can remove the organisational blind spots that are getting in the way of our having a clear picture of what goes on behind the closed curtains of our wards and services,” Lawless says.

She adds the technology, data and systems already exist and what is now needed is the commitment to support large-scale change.

“This NIA conference [is the right one] to be delivering this content to because the delegates are in a small and precious group of people who understand both the world of nursing and the world of information management,” Lawless says. “The delegates are key change agents in the next steps.”

Megan Zigomanis, clinical application specialist at healthcare IT company Emerging Systems says nurses are also integral to medical management processes, and that the transition to electronic methods affects workflows.

At the conference, Zigomanis will discuss essential elements needed to safely implement electronic medication management (EMM), taking into consideration the benefits and lessons gained through prior implementations within Australia.

“Be heard and be part of the change process,” she says. “Improving access to information in real time at the point of care not only benefits those delivering the care but also the patients receiving it.

“It is crucial that EMM implementations are successful and that we get them right,” Zigomanis says. “Strong change management as well as learning from past challenges and lessons are imperative in delivering solutions that meet the needs of the Australian public and private healthcare systems.”

She says the EMM journey is well on its way. “It is essential that there is a shared vision, involvement in change management and equal adoption by all professional stakeholders,” she adds. “Solutions not only need to meet the needs of the Australian healthcare system but they also must adhere to national and local standards in order to achieve the ultimate in improved patient outcomes.