Evidenced-Based Evidenced-Based Practice Using Your Practice Using Your Palm Pilot and Other Palm Pilot and Other Technology Technology November 20, 2001 Suzanne Bakken, RN, DNSc, FAAN School of Nursing & Department of Medical Informatics Columbia University
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Evidenced-Based Practice Using Your Palm Pilot and Other Technology November 20, 2001 Suzanne Bakken, RN, DNSc, FAAN School of Nursing & Department of.
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Evidenced-Based Practice Evidenced-Based Practice Using Your Palm Pilot and Using Your Palm Pilot and
Other TechnologyOther Technology
Evidenced-Based Practice Evidenced-Based Practice Using Your Palm Pilot and Using Your Palm Pilot and
Other TechnologyOther Technology
November 20, 2001
Suzanne Bakken, RN, DNSc, FAANSchool of Nursing & Department of Medical
InformaticsColumbia University
PurposePurpose
• Overview of informatics framework for evidence-based practice
• PDA products and resources• PDA projects at Columbia University
– Entry to Practice Program– Nursing Informatics Subspecialty– PalmCIS
What’s the Problem in What’s the Problem in Practice?Practice?
• Avoidable errors• Under-utilization of services• Overuse of services• Gap between “best” practice and
actual practice
What is Evidence-Based What is Evidence-Based Practice?Practice?
What is Evidence-Based What is Evidence-Based Practice?Practice?
• Traditional conceptualizations– Research utilization– Clinical trials-based– Clinical practice guidelines
• Application of domain knowledge to patient care– Evidence as a continuum
• Evidence-based medicine is the practice of making medical decisions through the judicious identification, evaluation, and application of the most relevant information (Friedland, 1998)
What Data Do We Need for What Data Do We Need for Evidence-Based Practice?Evidence-Based Practice?
• Information about the patient• Information about the context of care• Domain information and knowledge
(“the evidence”) from systematic inquiry and other sources
•Future – PDA interface to WebCIS through PalmCIS project
Building and Examining Knowledge from Building and Examining Knowledge from Practice:Practice:
ETP Clinical Encounter Documentation and ETP Clinical Encounter Documentation and AnalysisAnalysis• How
– Documentation of individual encounters• Pick list of subset of nursing diagnoses and interventions• Look-up database of other diagnoses, interventions, and
definitions
– Based on standardized terminology (Home Health Care Classification)
– Upload to central database for aggregation and analysis
• Why– Examine individual practice– Aggregate comparisons– Tie to required clinical competencies
Documenting Encounters with Documenting Encounters with HHCCHHCC
Diagnosis: Chronic pain (Q45.2)Interventions
� Pain control – Assess (Q47.0.1)� Pain control – Perform (Q47.0.2)� Pain control – Teach (Q47.0.3)� Medication Administration – Perform
(H24.0.2)
Competency (observed, supervised, independent)
Informatics CompetenciesInformatics Competencies
•Just-in-time for PDA-specific computer literacy competencies
•Informatics for Evidence-based Practice (3 units)