Assignment: Literature Review: The Use Of Clinical Systems To Improve Outcomes And Efficiencies

Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
Identify and select 4 peer-reviewed research articles from your research.
For information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies
The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
Include an introduction explaining the purpose of the paper.
Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
Use APA format and include a title page.
Use the Safe Assign Drafts to check your match percentage before submitting your work.

Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

Transforming Nursing and Healthcare Through Technology NURS 5051/NURS 6051 0125/2021

Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies Comment by Christina Lundberg [2]:

The healthcare industry is one of the beneficiaries of technological advancement. The body of knowledge associating health information technology (IT) with an improvement of clinical outcomes is expanding as nurse informaticists utilize new and existing technologies to develop clinical systems that positively impact results. [🡨You want to name or reference the author’s name once. You do not need to provide the year of publication because all of the information is in the reference entry just above.] Healthcare leaders and nurse informaticists consult existing research to make informed decisions on the applications that should be adopted to improve healthcare delivery. Existing and new technologies are increasing the number of clinical systems that nurse informaticists can choose from. [Their]🡨Noun/pronoun agreement: As your reader, I do not know who the pronoun “their” is referring to. I know this is an area that you are working on from our last review. Be encouraged. The more you are aware of noun/pronoun agreement, the easier and easier it gets to correct it and watch for it in your writing. I encourage you to use the noun here. Who is the pronoun “their” referring to? The answer is what you want to replace the word “their” with.] decision would be based on the clinical systems that show higher benefits to nursing care. In this paper, I [This paper]🡨Anthropomorphism: I know this is an area you are working on from our last review. Be encouraged. APA specifies to avoid anthropomorphism, giving huma traits to non-human things. You can use “I,” or you can use “researcher.”] Suggest omitting. [R]review[s] peer-reviewed literature on using a [🡨Proofreading: There is a missing article here.] computerized provider order entry (CPOE) system to improve efficiencies and outcomes in nursing care.

Article One

Franco, K. A., & O’Mara, K. (2016). Impact of computerized provider order entry on total parenteral nutrition in the neonatal intensive care unit. The Journal of Pediatric Pharmacology and Therapeutics, 21(4), 339-345. https://doi.org/10.5863/1551-6776-21.4.339 Comment by Christina Lundberg [5]:

Franco and O’Mara (2016) [🡨There are often not citations within an annotative bibliography, for it is assumed that the information you have provided is from the reference that is referenced above it.] conducted a study to identify the impact of CPOE on the time taken for preterm neonates to reach the desired parental macronutrient goals. The researchers conducted a retrospective review of preterm neonates receiving parental nutrition (PN) in a pre-and-post-CPOE implementation. The secondary outcomes were the time taken to attain PN goals, the incidences of electrolyte abnormalities, and physicians’ frequency of adjustments on PN orders. Franco and O’Mara (2016) revealed that CPOE parental nutrition led to an increase in the number of neonates who attained their overall macronutrient goals. CPOE allowed more preterm neonates to achieve their protein goals, while the lipids’ goals were completed within a shorter period. Comment by Christina Lundberg [6]:

CPOE also led to a decrease in the frequency of incidences of verifying parental nutritional (PN) orders and positively impacted the reduction of the incidences of disturbances from serum electrolytes. CPOE implementation improves clinical outcomes by helping preterm neonates reach their PN goals with minimal pharmacists’ interventions. The lessons learned are that (a) when a larger number of neonates attain their macronutrient goals, it indicates that the intervention may have a clinically significant positive effect on the neurodevelopment and growth of the infants; and (b) CPOE can improve workflow with the decrease in the pharmacists’ interventions required to verify PN orders, and the intervention can be used in other institutions to enhance the welfare of infants and enhance their development.[🡨You have an excellent summary here that looks like it meets the specifications within the assignment. To complete a full annotative bibliography, I encourage you to add the analysis section and the application sections.

Analysis: What you make of the content you summarized and what your take is on the content and why.

Application: How is the content useful or not useful to your work? Explain…

Article Two

Khammarnia, M., Sharifian, R., Zand, F., Barati, O., Keshtkaran, A., Sabetian, G., … & Setoodezadeh, F. (2017). The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran. Medical journal of the Islamic Republic of Iran, 31, 69. https://doi.org/10.14196/mjiri.31.69 Comment by Christina Lundberg [3]:

The primary objective was to determine the impact of CPOE on reducing medication errors by comparing prescription orders made to two groups of patients admitted in intensive care unit wards (ICU) where CPOE software was implemented on the intervention group. Khammarnia et al. (2017) conducted a pre-and post-prospective study in two ICU wards in an Iranian public hospital between 2014 and 2016. The ICU physician and clinical pharmacist validated prescription orders, and error rates were compared before and after CPOE implementation. [The researchers who shared information on the study, conveyed….] study of significantly reduced findings]🡨Anthropomorphism: The study cannot indicate, but the researchers can. I modeled an example to help you with your revisions.] indicated that the intervention significantly reduced various types of errors, including illegible orders and no drug form. There was also a reduction in other types of mistakes, but the decrease was not statistically significant.

The findings indicated that the use of CPOE might significantly reduce prescription errors. However, Khammarnia et al. (2017) recommended that clinicians should be more cautious because the system is not safe. The recommendation was valid because no clinical system is secure, and mistakes can lead to more catastrophic results. For example, if a physician enters the wrong data into a system, the outcomes will be wrong. The CPOE is recommendable for use in clinical settings to improve the quality of care. Reduction of prescription errors improves patient safety since medication errors are a safety concern. However, entrepreneurs need to make improvements in the CPOE system to eliminate the weaknesses. Some of the system’s shortcomings include an increase in prescription errors such as the wrong dosage and wrong drug form. The lesson learned from the study is that the effectiveness of CPOE on reducing medication errors will be significantly affected by the user’s skills.

Analysis: What you make of the content you summarized and what your take is on the content and why.

Application: How is the content useful or not useful to your work? Explain…

Article Three

Lyons, A. M., Sward, K. A., Deshmukh, V. G., Pett, M. A., Donaldson, G. W., & Turnbull, J. (2017). Impact of computerized provider order entry (CPOE) on length of stay and mortality. Journal of the American Medical Informatics Association, 24(2), 303-309. https://doi.org/10.1093/jamia/ocw091 Comment by Christina Lundberg [8]:

The researcher’s [study’s] purpose in this study [🡨Anthropomorphism: I encourage you to revise this area.] was to examine the impact of CPOE on two variables of patient outcomes: mortality and length of stay (LOS). Lyons et al. (2017) conducted a pre-and post-retrospective study at an academic medical center, with a 450-bed surgical and medical hospital, a 90-bed psychiatric hospital, and a 50-bed cancer center. 104,153 admissions were reviewed, and 66,186 patients were evaluated. Lyons et al. (2017) established that the implementation of CPOE led to a significant reduction in mortality and LOS. The findings were positive in the surgical and medical units, and there were adverse outcomes in intensive care units. Mortality and LOS are national benchmarks of patient outcomes; thus, improving these outcomes makes the intervention suitable for implementation in other health institutions.

Lyons et al. (2017) reported some differences in the patients’ LOS due to structure variables such as private rooms, patient care unit, and facility. However, the decrease in all the units was associated with CPOE. Lyons et al. (2017) noted an increase in mortality rate in the ICUs, which was associated with the increased complexity of patient care. They also highlighted a rise in mortality three months to implementing the intervention and a decline of mortality after implementation. The lessons learned are that (b) institutional changes may harm nursing care due to the uncertainty on the impact of the changes on nursing roles, and (b) mortality may be sensitive to disruptions in nursing care. Large-scale intervention implementation involves the training of nurses, which may disrupt normal operations.

Analysis: What you make of the content you summarized and what your take is on the content and why.

Application: How is the content useful or not useful to your work? Explain…

Article Four Comment by Christina Lundberg [9]:

Pontefract, S. K., Hodson, J., Slee, A., Shah, S., Girling, A. J., Williams, R., … & Coleman, J. J. (2018). Impact of a commercial order entry system on prescribing errors amenable to computerised decision support in the hospital setting: a prospective pre-post study. BMJ Quality & Safety, 27(9), 725-736. http://dx.doi.org/10.1136/bmjqs-2017-007135 Comment by Christina Lundberg [10]:

The researchers sought to determine the impact of CPOE and clinical decision support (CDS) on the rate of prescription errors. They tested 78 high-risk errors that arise from prescriptions. The quality of errors was conducted through pre-and post-intervention tests in three acute hospitals in England, where the researchers reviewed 4000 medications before and after CPOE implementation. Pontefract et al. (2018) audited prescriptions given to 1244 and 1178 patients before and after CPOE implementation. The total number of prescriptions was 28,526, and there were 21,138 opportunities for physicians to make an error. Pontefract et al. (2018) found that the rate of prescription errors reduced significantly after CPOE implementation.

Pontefract et al. (2018) concluded that CPOE implementation with CDS might significantly reduce the error rate of high-risk prescriptions. The researchers reported an association of reducing prescription errors with the CDS restriction, which varies with different CPOE configurations. The lessons learned are that (a) CPOE with CDS should be implemented with caution to ensure the CDS restriction level would produce the desired outcomes, and (b) CPOE can be implemented with other clinical systems to improve patient outcomes.

Analysis: What you make of the content you summarized and what your take is on the content and why.

Application: How is the content useful or not useful to your work? Explain…

Conclusion

A review of Franco, and O’Mara (2016), Khammarnia et al. (2017), Lyons et al. (2017), and Pontefract et al. (2017) indicate[s]ed [🡨APA tense: specifies to use the past tense when referring to research.] that CPOE has a significant impact on outcomes. Franco and O’Mara (2016) associated CPOE with an increase in the number of neonates who attained their overall macronutrient goals. The system allowed more preterm neonates to achieve their protein goals, while the lipids’ goals were conducted within a shorter period. Khammarnia et al. (2017) found that CPOE significantly reduced various types of errors, including illegible orders, no drug form, and no route. Lyons et al. (2017) found that implementation of CPOE led to a significant reduction in mortality and LOS. Pontefract et al. (2017) established a positive relationship between CPOE implementation with CDS and reducing the error rate of high-risk prescriptions. The [literature review]🡨Assignment correction: The assignment was to do an annotative bibliography. I encourage you to adjust this wording here to avoid potential reader confusion.] [identifies] Here is a possible revision for you to help inspire your own revision: In the annotative bibliography I conducted, I identified that ] CPOE as a suitable clinical system for institution-wide implementation to improve patients’ quality of care. However, given the weaknesses identified, such as adverse outcomes in some cases, there is a need for adequate training to ensure clinicians can use the system appropriately. The implementation should also be done with care to ensure there are minimal disruptions to prevent anxiety associated with change on nurses and other health care providers, which may cause negative outcomes.

It is a joy to continue to work with you. I encourage you to continue working on noun/pronoun agreement and eliminating anthropomorphism in your writing. Be encouraged. You can do it. Additionally, I recommend that you look to the webinar resource I provided for you. It is so helpful. Aim to add in your analysis and application sections for each of your sources. Last, I encourage you to incorporate italics into your reference entries for your journal titles and vol. numbers. I wish you the best on your revision.

Be well,

Christina

[🡨Image of sunflowers in a field. Taken from Pixabay]

I wish you a happy and rejuvenating day.

I hope what I found today is helpful to you. The best of luck to you as you revise.

I invite you to take this brief survey. Your feedback is valuable to me. My gratitude and appreciation to you in advance.

Thank you for the opportunity to review your work. I hope to see you again!

References Comment by Christina Lundberg [4]:

Franco, K. A., & O’Mara, K. (2016). Impact of computerized provider order entry on total parenteral nutrition in the neonatal intensive care unit. The Journal of Pediatric Pharmacology and Therapeutics, 21(4), 339-345. https://doi.org/10.5863/1551-6776-21.4.339

Khammarnia, M., Sharifian, R., Zand, F., Barati, O., Keshtkaran, A., Sabetian, G., … & Setoodezadeh, F. (2017). The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran. Medical journal of the Islamic Republic of Iran, 31, 69. https://doi.org/10.14196/mjiri.31.69

Lyons, A. M., Sward, K. A., Deshmukh, V. G., Pett, M. A., Donaldson, G. W., & Turnbull, J. (2017). Impact of computerized provider order entry (CPOE) on length of stay and mortality. Journal of the American Medical Informatics Association, 24(2), 303-309. https://doi.org/10.1093/jamia/ocw091

Pontefract, S. K., Hodson, J., Slee, A., Shah, S., Girling, A. J., Williams, R., … & Coleman, J. J. (2018). Impact of a commercial order entry system on prescribing errors amenable to computerised decision support in the hospital setting: a prospective pre-post study. BMJ Quality & Safety, 27(9), 725-736. http://dx.doi.org/10.1136/bmjqs-2017-007135

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