Dispatches from the hi-blogs.info krew

Opening keynote 06.29.09 morning session – Dr. David Bates June 29, 2009

Keynotes today are shifted due to severe health problems of the original speaker. So, David Bates, scheduled for later today, is the opening speaker. Dr. Charles Friedman will be the opening afternoon speaker.

David Bates’ talk is about IT & patient safety (“Improving safety & quality using HIT: Keys for nursing”). Talk will range from background to using HIT for safety, in various settings, then crossing issues and final thoughts / issues. He cites the IOM report “To Err is Human” as a primary compelling force behind current interest in patient safety & HIT. Provides a list of 10 top priorities for patient safety research in developing countries (see very recent BMJ article). Nurses impact adverse events from pressure ulcers to adverse drug events, too. He describes the US efforts and considers US to be near ‘tipping point’. LL Weed cited as to use of external aids to promote change in health care; patients could participate in decision-making (their own). Ways IT to improve safet include error prevention / adverse events to more rapid resonse after adverse event to tracking & feedback of adverse events.

Bates then outlines 7 main strategies for preventing errors & adverse events, via HIT, including improving communication to accessible knowledge to providing key information, calculation assistance, real-time ‘checks’ to monitoring assistance and finally decision support. He then cites specific examples such as CPOE to smart pumps / monitoring and so forth. A specific example / research project is titled ‘NEPHROS’, which looked at renal insufficiency patients (Chertow et al, JAMA 2001). Another specific area of patient safety is medication administration, in particular, several US major adverse events surrounding use of heparin. Some ‘easy’ solutions are BMA (bar code administration) as well smart pumps (Rothschild et al, Crit Care med 2005). Most of Bates’ discussion centered on inpatient / acute care environment. He also, though, did discuss outpatient environment, which may be termed ‘medical home’. Nice use of a Dilber cartoon to state where he believes health care is today. Future areas for NI include personal health records as well as decision support (e.g.: computer ‘think along’ with provider), interoperability, and so forth. Quality from IT and its transforming ability from ehr (poc decision support, registry tools & ‘team’ care) and measure performance; safety need to increase processes reliability (e.g. check lists, new CPOE approaches). IS helps with communication, cost holding, quality accessible, and such.

Keys for NI include tools to track risk, digital documentation (vital signs), computerized handovers / report, nursing decision support, multidisciplinary communcation, and key roles in medical home patients / outpatient settings. Sytems future possibilities range from ‘better provider cockpit’ to communcation to quality measurement and NI needs higher profile in most organizations, all leading to safer care with use of IT. Ended with Yogi Berra quote “I don’t want to make the wrong mistake.” Nice ending and nice talk. Time for Q&A at this point. One question justly asked had to do with public health disease / pandemic condition tracking and monitoring (infections, H1N1, and so forth).

Personal thought – not sure if talk content is anything startlingly new but may instead be a reminder of what NI persons can or should do regarding patient safety. Scott Erdley