The University of Iowa Hospitals and Clinics is
a nationally recognized center for nursing informatics. First implemented
in 1988, the University of Iowa Hospitals and Clinics Information Network
for Online Retrieval and Medical Management (INFORMM) System Nursing Information
System (NIS) has been developed entirely in-house by a multidisciplinary
team of nurses and Information Systems staff. The design supports the use
of nursing process and the database incorporates standardized nursing languages.
Applications
Database
Features
Timeline of INFORMM NIS Development
Applications
Patient Critical Data
-
Demographic data
-
Dominant Language
-
Health History
Patient Care Groups and Orders
-
Assessments and interventions carried out by direct
caregivers
-
Generated by RN or MD or other authorized clinician
Patient Problems / Nursing Diagnoses
-
Health problems identified by an RN or other authorized
clinician
Patient Discharge Referral
-
Patient critical data
-
Patient care orders
-
Patient problems / nursing diagnoses
-
Related patient data
Patient Care Documentation
-
Data charted for patient care orders
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Database
The INFORMM NIS database, developed and maintained by Nursing Informatics,
contains the standardized nursing languages. Components of the database include:
Patient care orders - assessments or treatments
carried out by direct caregivers
-
Order name
-
Order details (specifics for performing the order)
-
Charting parameters (specifics for documenting the
order)
-
Frequency, modification, and duration (specifics
for when to perform the order)
Example: Dressing Change
Patient care order groups - lists of related
patient care orders to carry out interventions
-
Group name
-
Patient care orders (specified and defaulted)
-
Signs and symptoms
-
Etiologies/related factors
-
Outcomes (goal statements)
Example: Wound Care
Patient problems/nursing diagnoses - health
problems identified by an RN or other authorized clinician
-
Problem/nursing diagnosis name
-
Patient care order groups
-
Signs and symptoms
-
Etiologies/related factors
-
Outcomes (goal statements)
Example: Skin Integrity Impairment
Patient populations - medical conditions, surgical or other invasive
procedures, major symptoms, etiologies, or age-specific factors that identify
groups of patients
-
Patient population name
-
Patient care order groups
-
Patient problems/nursing diagnoses
Example: Diabetes Mellitus: Adult
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Features
Central data repository and data archive
-
Data are entered, updated and available to all authorized
users
-
Transfer of data among applications and functions
is facilitated
-
All data elements are archived for clinical, quality
improvement, administrative, and research endeavors
Improved communication and continuity of care
-
Interdepartmental communication is automated, e.g.,
computer-generated message to Social Services or interpreter
-
Interagency communication is facilitated, e.g., public
health nurse, nursing facility
-
Patient care planning data are automatically defaulted
from the previous visit
-
Standardized terminology and content facilitate communication
Improved compliance with standards
-
Menu screens, functions and content are customized
by position classification to reflect scope of practice
-
Each patient care order is assigned a charting authorization
level so users chart only on orders commensurate to their classification
-
Patient order groups contain orders with defaulted
frequencies and selected charting parameters that reflect institutional
and national standards
-
An automated worklist of patient care orders with
scheduled due times cues timely performance of care
Decision support
-
System prompts and edits, color-coded items, and
a reminders list promote documentation compliance and completeness
-
Defaulted orders and standardized lists of patient
responses prompts consistent documentation
-
Linkages among signs/symptoms, etiologies/related
factors, patient populations, patient problems/nursing diagnoses, and patient
order groups provide support for clinical decision making
-
Each unit maintains its own unit-specific screen
to facilitate selecting problems/nursing diagnoses and patient care order
groups for its patient populations
-
Data can be displayed in both tabular and graphical
displays
User Support
-
User education is available using simulations, demonstrations,
"hands-on" training, and practice sessions
-
Nursing Informatics staff provide on-unit assistance
with implementation
-
Expert nursing staff provide on-the-job assistance
-
"HELP" screens are provided for every NIS screen
-
Multiple pathways are available to select patient
problems/nursing diagnoses, patient order groups and patient care orders
Increased efficiency
-
Data are retrieved by authorized users from multiple
computer sites, including remote access
-
When charting, previous responses are defaulted to
facilitate repetitive charting, eliminate redundant charting, and alert
users to changes in patient condition
-
Quantitative data entered for specific orders and
assessment tools are automatically computed
-
Printouts and patient chart forms can be printed
on demand on local printers
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Timeline of INFORMM NIS Development
| Date |
Event |
| 1984 |
Development of manual standard care plans for
nursing diagnoses |
| 1985 |
Revision of manual care plan forms and worksheets |
| 1986 |
Implementation of online patient acuity |
| 1988 |
Implementation of online patient care orders
and patient problems/nursing diagnoses |
| 1989 |
Implementation of manual flowsheet
documentation |
| 1991 |
Implementation of online patient
problem/nursing diagnosis chart form |
| 1991 |
Implementation of online discharge
referral form |
| 1993 |
Implementation of electronic signature
for nursing documentation |
| 1993 |
Initiation of database reorganization |
| 1994 |
Pilot of online documentation |
| 1995 |
Pilot of standardized patient care order groups |
| 1997 |
Implementation of PC INFORMM display
of patient profiles and narrative notes |
| 1998 |
Pilot of interdisciplinary online
documentation |
| 1998 |
Implementation of online documentation
on all general inpatient units completed |
| 1998 |
Evaluation of online documentation
completed |
| 1998 |
Implementation of standardized patient care order groups completed |
| 1999 |
Enhancement of Patient Care Groups and Orders application to update
and expand selection pathways and facilitate linkages |
| 2000 |
Revision of patient problems/nursing
diagnoses to reflect Nursing Diagnosis Extension
and Classification (NDEC) research findings |
| 2001 |
Enhancement of Patient Discharge Referral application to integrate
patient care groups |
| 2001 |
Field site research for Nursing
Outcomes Classification (NOC) |
| 2001 |
Enhancement of Problem/Nursing Diagnosis application to facilitate
linkages with interventions |
| 2002 |
Auto-Add feature for critical admission assessments |
| 2003 |
Bar Code Scanning for Bedside Blood Glucose Monitoring |
| 2004 |
Automated Adult Admission Assessment |
| 2004 |
Automated Patient Transfer Summary |
| 2004 |
Automated Discharge Assessment Record |
| 2004 |
Online Home Care Instructions |
| 2004 |
Automated Pain Reassessment |
ΚΚΚΚΚΚΚ
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