23-06-2012, 03:42 PM
Patient Care and Monitoring Systems
Patient Care and Monitoring Systems.ppt (Size: 876.5 KB / Downloads: 267)
After having heard this lecture, you should know the answers to
these questions:
· What are the four major information-management issues in
patient care?
· How have patient-care systems evolved during the last three
decades?
· How have patient-care systems influenced the process and
outcomes of patient care?
· Why are patient-care systems essential to the computer-based
patient record? How can they be differentiated from the
computer-based patient record itself?
· What is patient monitoring and why is it done?
· What are the primary applications of patient monitoring systems
in the intensive-care unit?
· How do computer-based patient monitors aid health
professionals in collecting, analyzing, and displaying data?
· What are the advantages of using microcomputers in bedside
monitors?
· What are the important issues for collecting high-quality data
either automatically or manually in the intensive-care unit?
· Why is integration of data from many sources in the hospital
necessary if a computer is to assist in most critical-care–
management decisions?
Patient care
Patient care is the focus of many clinical disciplines—
medicine, nursing, pharmacy, nutrition, therapies such as
respiratory, physical, and occupational, and others. Although
the work of the various disciplines sometimes overlaps, each has
its own primary focus, emphasis, and methods of care delivery.
Each discipline’s work is complex in itself, and collaboration
among disciplines adds another level of complexity. In all
disciplines, the quality of clinical decisions depends in part
on the quality of information available to the decision-maker.
The process of care begins with collecting data and assessing
the patient’s current status in comparison to criteria or
expectations of normality. Through cognitive processes specific
to the discipline, diagnostic labels are applied, therapeutic goals
are identified with timelines for evaluation, and therapeutic
interventions are selected and implemented. At specified
intervals, the patient is reassessed, the effectiveness of care is
evaluated, and therapeutic goals and interventions are continued
or adjusted as needed. If the reassessment shows that the patient
no longer needs care, services are terminated.
Discipline in patient care:
Patient care is a multidisciplinary process centered
on the care recipient in the context of the family,
significant others, and community.
1. Physician: diagnose diseases, prescribe appropriate
medications, authorize other care services.
2. Nurse: assess patient’s understanding of his/her condition
and treatment and his/her self-care abilities and practices;
teach and counsel as needed; help patient to perform exercises
at home; report findings to physician and other caregivers.
3. Nutritionist: assess patient’s nutritional status and eating
patterns; prescribe and teach appropriate diet to control blood
pressure and build physical strength.
4. Physical therapist: prescribe and teach appropriate exercises
to improve strength and flexibility and to enhance
cardiovascular health, within limitations of arthritis.
5. Occupational therapist: assess abilities and limitations for
performing activities of daily living; prescribe exercises to
improve strength and flexibility of hands and arms; teach
adaptive techniques and provide assistive devices as needed.
Information to Support Patient Care
As complex as patient care is, the essential information for direct
patient care is defined in the answers to the following questions:
· Who is involved in the care of the patient?
· What information does each professional require to make
decisions?
· From where, when, and in what form does the information
come?
· What information does each professional generate? Where,
when, and in what form is it needed?
History
The genesis of patient care systems occurred in the mid-1960’s.
One of the first and most successful systems was the Technicon Medical
Information System (TMIS), begun in 1965 as a collaborative project between
Lockheed and El Camino Hospital in Mountain View, California.
Designed to simplify documentation through the use of standard order sets and
care plans, TMIS defined the state of the art when it was developed.
More than three decades later, versions of TMIS are still widely used,
but the technology has moved on. The hierarchical, menu-driven arrangement of
information in TMIS required users to page through many screens to enter or
retrieve data and precluded aggregation of data across patients for statistical
analysis.
Today’s users have a different view of what can be done with data,
and they demand systems that support those uses.
Part of what changed users’ expectations for patient care systems was the
development and evolution of the HELP system at LDS Hospital in Salt Lake City,
Utah. (The HELP system by Pryor TA, Gardner RM, Clayton PD, Warner HR
in J Med Syst 1983 Apr;7(2):87-102.)
Initially providing decision support to physicians during the process of care
(in addition to managing and storing data), HELP has subsequently become
able to support nursing care decisions and to aggregate data for research leading
to improved patient care. Today, both vendors of information systems and
researchers in health care enterprises are working to incorporate decision support
and data aggregation features in systems that use the latest technologies for
navigating and linking information.