Module I, The Beginning of Discovery

My name is Melissa Hinton, MSN to DNP, FNP. I have been a nurse for 20 years (this year) and have been able to savor a sampling of many areas of nursing during that time. My first 5-10 years of nursing included experience in Med/Surg, Oncology, L&D, Peds, Psych, Ortho, Home Health, and I was an IV specialist for PICC placement/IV education (often with 2-3 jobs at a time). I have worked my last 15 years primarily in Intensive/Critical Care and Emergency/Trauma with several years of LifeFlight as an Invasive Nurse. In addition, I have also been a charge nurse, Clinical Educator, AHA instructor, adjunct faculty at Dixie State College and am currently the Emergency Department Manager at DRMC in St. George, Utah.

As graduate level nurses, we need to be familiar with, if not proficient in, information management as our current health care systems are turning to technology and computer interfacing to better manage information and data. As our population ages and is living for longer periods of time, patients are accumulating massive amounts of health information with multiple providers and specialists. We are constantly seeking out these pieces of information that have traditionally been housed somewhere in a provider's office and have not been accessible, piecing together a medical history that we know has been documented "somewhere." In addition, data-driven care based on best outcomes has become an integral part of our practice as nurses and helps us identify elements that must be addressed in practice. If we are to use "Best Practice" standards for the care that we deliver, a working knowledge of information management would serve each of us best - as the very role of the DNP involves the collaborative effort, research, and education that is being demanded by the patients we serve.

Information Technology development and implementation is fast becoming a necessity (and reality) in Emergency Departments across the nation. Though nurses and staff initially repel the very thought of process change, especially in EDs where time constraints and employee longevity/older workforce create natural resistance to change, there is much to be said for it's use. It is understood that there is a learning curve to every new program. Past the first several weeks of implementation, there is instant access to a patient's history, making assessment and treatment more timely and efficient. Our department doesn't use computer charting yet, but all the ED records are scanned and available through our "Help2" program, making all hospital information exchange easier and ultimately, saving time. In addition, most of our analytical reports are created off of the Help2 system and are used in tandem with our PTS (Patient Tracking System). While the use of two systems is not as efficient as a central repository, the programs are acceptable. Intermountain has spent millions of dollars trying to improve and streamline these programs for better interface and efficiency. I've also been able to work with the VA system. Though many of their programs are not as user friendly, there is a huge benefit in their complete conversion to information systems which creates a continuity of care that many systems are unable to provide. Of both systems, I must say that there is a huge deficit in that the information is not available to providers outside of the system by computer, leaving manual transmission of information and data the primary means of communication.

Dixie Regional Medical Center, part of Intermountain Healthcare (IH), has both computer and paper charting, both of which have pros and cons and both of which create difficulties (illegible writing, medical errors in interpretation, incorrect orders being manually entered into computer systems, repetition of procedures/meds/etc. from lack of documentation, coding left to interpretation, billing errors, and so on . . .). Our ED CC, admit times, census, etc. are on the PTS, but all patient care documentation is on a traditional paper form. As for coding, our ED coders and billers use outpatient ICD-9 coding which is quickly phasing over to ICD-10. Terminology includes NM(M)DS, NANDA and NIC. As an acute outpatient treatment area, our reimbursement corresponds to RVUs and DRGs which are monitored by Revenue Integrity/Accounting and ultimately drives our staffing FTEs.

As a floor nurse, I was wholly unaware what coding involved and how my charting related to both reimbursement and data that I didn't really care much about. I'm seeing a relationship now-a-days. Structured and coded clinical data promotes quality patient care because it can help give definition to procedures, skills and what the nurse writes in the chart if they become familiar with what is being expected. I firmly believe that we do a dis-service to our nurses by not teaching them basic coding to help them understand documentation standards, who is auditing the charts, what they are looking for and why. What they DON'T write ultimately means a dollar loss. Most nurses don't care about this until they realize that the benefit of documentation is that they are employed . . . their care quantifies their job! In addition, accurate documentation reflects more accurate data. Numbers are a reflection of the care we give, but if it is not documented, those numbers skew the data from the very beginning. There are also legal ramifications to data elements, collection and outcomes that nurses often dismiss as naught. If, however, data shows a certain negative trend that providers choose not to address, either because of complacency or ignorance to the meaning of the data, there is not much legal council can do for them. Naivety does not give us recourse. The data is the evidence. Likewise, positive outcomes and trends indicate "Evidence-Based" practice. Hence, best practice.

In all, I feel myself fortunate to be able to glimpse the [oftimes] overwhelming current of technology and information systems that is blowing through the front door of health care. I only recently began my role as the ED Department Manager at DRMC and it has afforded me trials, experience, and an awareness of the inner workings of politics that I have never been exposed to. In fact, I have actually been jealous of dear Heide because of her previous experience in management. I felt that I was missing out on some piece of elusive infromation that I really needed. And guess what?!? I did! I am not planning on staying in this role, but I can say that I have learned, and continue to learn another side of nursing that I had turned a deaf ear to because, as they say, "It's somebody else's job."

Bottom line . . . we can't look the other way anymore. It's coming like a tidal wave!

Introducing...Miss Hinton

Until today, I've been busy journaling my adventurous life on paper, in a hardbound book, scribed with ink and cluttered with bits of remembrances of yesteryear. Can my life be summed up in paragraphs, squished between 12 point Trebuchet Font on an inanimate object that does not endear like a comfortable and favorite old book on a shelf, just waiting to be picked up? Hardly. In fact, one can't even see the slant of my writing or the flourish of my letters...telling, if one looks closely.Without all these tiny glimpses into my life, you might wonder..."who, really, is Miss Hinton?"

Today, I begin a personal journey that I will share with those who have come in and out of my life. Here, on this non-paper page, an archive of experience will be added, click by click, as my continuing journey evolves. Welcome to Miss Hinton's Blog. Stay, share, laugh, cry, and spend a moment with me while we visit from miles apart and compare experience for greater understanding of life, love, and lesson at Melissa's Hinton Haven (or havoc, depending on the moment and circumstance).

Soon,
Miss H.