Evidence and Nursing Informatics to Improve Safety and Outcomes
Sandra Bodin, MA, RN, CNN, ANNA President-Elect

Every President of The American Nephrology Nurses’ Association (ANNA) is passionate about the practice of nephrology nursing and seeks to improve that practice through their work with the Association. Guided by ANNA’s Strategic Plan and driven by individual passion, each President identifies goals and outcomes they want to accomplish in their presidential year. These goals and outcomes are refined throughout their service as President-Elect, so that by the time a new President takes office, they are well defined and the passion has clear direction.

Nursing Informatics: An Evolving and Much-Needed Specialty
So what is my passion as President of ANNA? I believe the single most important thing that nephrology nurses can do to provide safety and improve outcomes for our patients is to embrace health information technology. In addition, I also believe that we must continue our efforts to support a health care environment where nursing practice is evidence based.

The American Nurses Association (ANA) defines nursing informatics as a “specialty that integrates nursing science, computer science and information science to manage and communicate data, information and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings” (ANA, 2001). Even though sophisticated technology is used in informatics, it is not the technology that provides quality patient care. Technology is merely the tool that allows transfer of the information that improves care.

In 2004, President G.W. Bush issued an executive order creating The Decade of Health Information Technology with a goal of establishing an electronic health record (EHR) for every American in the next 10 years. One of the reasons for this order was the release of findings from the Institute of Medicine (IOM) studies concluding that information technologies hold the promise to transform health care practice and facilitate patient safety in our nation (IOM, 2000, 2001). Barry Straube, Chief Medical Officer and Director of the Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services (CMS) discussed the agency’s quality initiatives during his keynote address at ANNA’s National Symposium in April 2006. One of CMS’ most important initiatives is to assist practitioners in making care more effective and less costly, particularly by promoting adoption of health information technology (Straube, 2006).

Nurses Must Embrace Informatics to Improve Healthcare
Informatics underlines all nursing practice and all nurses need informatics competencies (ANA, 2001). I find it discouraging, then, that many nurses have little or no training to help them find evidence on which to base their practice. Pravikoff’s study (2005) concluded that RNs in the United States are not ready for evidence-based practice because of the gaps in their information literacy and computer skills, their limited access to high-quality information resources, and the attitudes toward research. The outcome of this study spurred nursing and informatics leaders to unite and create the Technology Informatics Guiding Educational Reform (TIGER) Initiative. During their Summit in 2006, TIGER collaborated with colleagues from key federal agencies and healthcare organizations and articulated a vision for the future of nursing that enables nurses to use informatics in practice and education to provide safe, quality care.

Many acute care hospitals, medical centers, and ambulatory clinics are investing millions of dollars in health information technology to improve patient outcomes and make health care safer. The vision of a national health information system is not yet achievable because we lack the necessary infrastructure. Individual systems do not have the interoperability to allow linking with other systems in order to share data. In other words, these systems do not speak to each other, which makes it difficult to share patient information in a timely manner. In addition, we currently do not even have the required standards that would allow systems to share health information without difficulty.

Another disquieting issue is the fact that software vendors are not developing systems that include sub-acute and long-term care because they do not see it as a profitable investment. This is a serious concern for nephrology nurses because our patients frequently have health needs that result in the patient receiving care at several different facilities. A nephrology nurse in the peritoneal dialysis program may have good information available to care for his or her patients; but what occurs when one of those patients end up in the emergency department at a local hospital with chest pain during the night? How do the doctors and nurses provide safe, quality care when they have no access to the patient’s health records in the dialysis facility? A nephrology clinic may have up to date electronic health records for their patients with chronic kidney disease (CKD), but what happens when one of the patients is summoned to an out-of-town hospital for a kidney transplant? How can the transplant coordinator be expected to provide the best possible care when the most accurate health data for the patient is out of reach and across the state at another clinic? Consider what transpires when a patient on hemodialysis is sent from the dialysis facility to interventional radiology at a medical center for a vascular access procedure. Frequently the radiology staff have no other option than to treat the patient without complete knowledge of the patient’s current medications and problems.

Nurses: A Driving Force
Nephrology nurses need to be a driving force behind the adoption of health information technology in our practice so that our patients’ health records are available to health care providers whenever and wherever patients with CKD need care. Until this vision is reality, we are not, in fact, providing safe, quality care for our patients. Making that vision happen is my passion.