Monday, February 28, 2011

Module 3 - Information Retrieval

I did a search for information related to obesity and food deserts. In my search using the electronic index CINAHL, I was able to refine my search several times to achieve an adequate number of results without having information overload. I used the subject headings and initial search results to further guide my use of search terms, and ultimately had 196 articles.

When I used the guideline index, I had no "hits" using any of the search terms that I used in my database search. I think this is related to my topic - I was looking for background information that might further guide research, rather than a defined clinical problem with an intervention. In fact, the problem I am looking into is one of community resources as it relates to a disease, and there are likely no guidelines for that kind of problem.

When I searched google, using the final terms of my database search, I had 831,000 "hits" - this is pretty broad! In addition, many of these results were from questionable resources (ie, Google has a "google scholar" function that might be useful - for example, my research question might have relevant information in fields like sociology that may not be available in CINAHL or MEDLINE. And general Google searches might reveal information that would be helpful later (such as, what is the public perception of the problem, what are people doing to solve the problem - evidence based or otherwise, what resources are out there for this problem). I have used Google searches at work when database/guideline searches have not given me enough information. For example, a couple of weeks ago I was working with my supervisor to defend the use of a particular step in the central line dressing change, and was unable to successfully find enough information on MEDLINE or in the guidelines to justify our rationale for keeping that particular step, but a Google search led me to an FDA document highlighting the reasons behind the intervention.

So, I think that use of search strategies needs to be tempered by what the researcher needs - is it a purely nursing/allied health problem (some are), might other disciplines yield additional information regarding the problem, what are the standards in place right now surrounding the problem, what are the lay person's perceptions of the problem?

Thursday, February 3, 2011

Module 2 Healthcare Information and Devices

What is one way you could become involved in designing, selecting, evaluating, or implementing an information system in your workplace?

I have actually done this already. The department in which I work has an outpatient program where we monitor patients who are at home on either enteral or parenteral nutrition. We watch labs, provide phone calls, and sometimes have patients come in for a clinic visit. We often make changes to their regimen based on observed or reported data and information. 
Prior to when I started my job, the charting for these clients was done on paper. We had large bulky charts with hand written clinic notes, medications, notes from phone calls and tracking sheets for laboratory data. I am not a paper person, so I implemented the use of a pre-existing information system available at my facility to store free-text progress notes, assessments using templates and clinic visits using a SOAP form with areas to enter height, weight and other vital signs. The SOAP form also pulls in medications, problems and allergies entered by other providers, making med-rec a quick process, as well as flagging drug interactions when we prescribe new medications for our patients. The laboratory and radiology data have always been available in this computer system.
Unfortunately, while I have made a brave start, there are people in my department who won't "let go" of their paper - every clinic note and phone assessment now gets printed and put into the bulky patient chart, as well as being available in the computer. We are also still transcribing lab values and radiology information from the system into the paper chart.
In addition, we have demographic sheets in the charts with basic patient information, names and phone numbers for other providers, access device and current nutrition regimen. I have been trying to convert this to an electronic record for a year - the information on the paper gets crossed out, whited out, written over until it is often illegible, and we have no way of tracking history of nutrition regimen or access device. I tried making an excel worksheet but it still didn't fit my vision. I would rather use database software - but I need to get access to the software and help building a secure database. My preference would be to get a practice management system, but I haven't managed to sell that to my supervisor - the cost is a big factor there.
My vision is still a work in progress, andI am leaving my current position soon. I am not sure where the department will be in the future, but my hope is that I have planted the seed that there are better and more efficient ways of harboring patient information that bulky paper charts!