Contribuições dos registros eletrônicos para a segurança do paciente em terapia intensiva: uma revisão integrativa

Content Provider	Scilit
Author	Sousa, Paulino Artur Ferreira De Sasso, Grace Teresinha Marcon Dal Barra, Daniela Couto Carvalho
Copyright Year	2012
Abstract	Integrative review publications that analyzed the contributions of electronic health records for patient safety in intensive care units. The survey was conducted in the databases CINAHL, MEDLINE and SciELO, using the keywords: electronic health records, information systems, nursing informatics, medical informatics, intensive care units, patient safety and security management. A total 64 articles were included and analyzed in two empirical categories: "Information systems and information technology: the electronic record for the continuity of nursing care", "decision support systems: contributions to patient safety" and "indicators of quality of care and patient safety from the records electronics". The studies pointed to contributions to continuity of care, decision making based on decision support systems and the creation of quality indicators and patient safety from electronic records. Descriptors: Electronic health records. Information systems. Nursing informatics. Safety management. Intensive care units. RESUMEN Revisión integrativa que analizó en las publicaciones las contribuciones de los registros electrónicos de salud para la seguridad de los pacientes en unidades de cuidados intensivos. La investigación se realizó en las bases de datos CINAHL, MEDLINE y SciELO, utilizando las palabras clave: registros médicos electrónicos, sistemas de información, informática de enfermería, informática médica, unidades de cuidados intensivos, seguridad del paciente y gestión de la seguridad. Se incluyeron 64 artículos y se analizaron en dos categorías empíricas: "Los sistemas de información y tecnología de la información: el registro electrónico para la continuidad de los cuidados de enfermería", "sistemas de apoyo: las contribuciones a la seguridad del paciente" y "los indicadores de calidad de la atención y seguridad de los pacientes de los registros electrónica". Los estudios señalaron como contribuciones a la continuidad de la atención, la toma de decisiones basadas en los sistemas de soporte de decisiones y la creación de indicadores de calidad y seguridad de los pacientes de los registros electrónicos. Descriptores: Registros electrónicos de salud. Sistemas de información. Informática aplicada a la enfermería. Administración de la seguridad. Unidades de terapia intensiva. INTRODUCTION Healthcare information is often associated with a set of data within useful and meaningful contexts. When information is adequately furnished for a specific purpose, it provides orientation, instruction and knowledge to health care professionals, thus empowering them to develop a plan of care and/or make decisions within a specific context. 1 In present days, the complexity of existing health care scenarios, especially those seen in Intensive Care Units (ICU), show an enormous amount of heterogeneous, scattered, detailed and unstructured data and information. Information is a core issue in the health care process; that is, the access to information regarding health care practices provides nurses with clinical evidence that sustains the nursing contributions toward patient outcomes. Therefore, it is possible to affirm that there is an essential connection between the access to information in terms of the nursing process and patient outcomes and safety. 2-3 It should be highlighted that the clinical record must be objective, clear and thorough, in such a way that all healthcare team members who access such information can understand their context and meaning. In addition to guaranteeing the execution and sequence of adequate treatment, these records can provide the healthcare team with the ability to render knowledge-based care, considering both ethical and legal aspects. 4 Moreover, the nursing clinical records are able to improve and support the safety of the patient, as well as provide information regarding the care and the daily actions involved in the nursing practice. 5 Information and Communication Technologies (ICTs) have been widely used as a means of improving clinical records, in addition to supporting the development of a computerized nursing process because they allow for their integration into a logical data, information and knowledge structure and support the decision-making processes in nursing care. 2 The application of ICTs in the area of health care directly contributes toward the safety of the patient, as it has the potential to transform the work environment, the status and the quality of the care rendered, allowing procedures to be more accurate and efficient and promoting the reduction of human error risks. 6 The issues associated with patient safety stand out as a serious health problem all around the world, as the risk and the occurrence of adverse events/iatrogenesis has been escalating in all health care environments. This fact is mainly related to the ever-increasing number of therapeutic and diagnostic alternatives. It can be also observed that patients and relatives are at constant risk of becoming victims of preventable errors and/or adverse events, even in highly structured health institutions. 7-10 Among the various health care areas, ICUs stand out as an environment in which the focus on patient safety is of immense importance, as patients admitted to these units tend to be more vulnerable to the occurrence of errors and adverse events due to the severity and gravity of their conditions, a higher frequency of pharmacologic and therapeutic interventions, and the use of multiple technological devices. 10-12 The severity and continuous fluctuation in the patient's health status reinforce the relevance of the need for support structures that can provide objective decision-making processes toward safer care. In light of this scenario and the above-mentioned considerations, the following research question arose: "What are the contributions of electronic health records to the safety of Intensive Care Unit patients?" Besides motivating the search for specific knowledge regarding this issue in nursing publications, such an inquiry justifies the present study, as we understand that whenever visibility is given to the contributions of electronic health records, innovative and transforming aspects in nursing practices will be generated, especially in the area of patient safety. Hence, this study aims to identify the major contributions of electronic health records in the area of patient safety in Intensive Care Units by means of reviewing the publications found in national and international journals. METHODOLOGY This thematic integrative review is a scientific update of publications issued between 2005 and 2010. The chosen period is justified by the intention of this study to analyze the most recent contributions of electronic health records in the area of the patient safety in ICUs. Aiming to maintain scientific rigor, the phases of the proposed literature integrative review are grounded on a framework defined by a protocol previously elaborated by the researchers, namely: 1) selection of the research question; 2) definition of inclusion criteria and sample selection; 3) representation of selected studies in table format, taking into consideration all common characteristics; 4) critical analysis of the findings, identifying differences and conflicts; 5) interpretation of results; and 6) a clear report on the evidence discovered. 13 The applied search strategy used to identify and select appropriate studies was the bibliographic survey of publications indexed in the following databases: Medical Literature and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Scientific Electronic Library Online (SciELO). The MEDLINE and CINAHL databases were accessed through the links made available at the Porto Higher Nursing School portal, Portugal. The SciELO database was accessed through the portal of the Virtual Health Library (VHL). The criteria adopted for the selection of articles were: all article categories (original research, literature reviews, systematic reviews, reflections, updates, experience reports, editorials, etc); articles with abstracts and full texts freely available for analysis; articles available in the Portuguese, English or Spanish languages; articles published between 2005 and 2010; and articles whose titles and/or abstracts contained the following descriptors: electronic health records; information systems; nursing computing; medical computing; and intensive care units associated with the descriptors "safety" and "safety management", as well as their respective English and Spanish translations. The resource used in the research was the "exact term" option; the articles that were indexed in more than one database were considered only once. Based on these criteria, 64 articles were selected for the analysis. For the organization and tabulation of data, a detailed reading of each abstract/article was carried out; the process emphasized those articles that positively corresponded with the objective of the study. The researchers built a data collection instrument, which included: title, journal, country of study, year of publication, study category, study characteristic, adopted classification terminology/system, analysis method, thematic focus, and final considerations/conclusions. Subsequently, the major contributions addressed in each article and that drew the researchers' attention were extracted. These contributions were compared and clustered according to content similarity, thus generating three analysis categories, as follows: "health information and computing systems: the electronic record and the continuity of nursing care"; "decision-making support systems: contributions to the patient's safety"; and "care quality and patient's safety indicators based on electronic records". RESULTS AND DISCUSSION From the MEDLINE database, 34 articles were selected for analysis; from CINAHL, 21 studies were selected, while nine articles were sel
Related Links	http://www.scielo.br/pdf/tce/v21n4/en_30.pdf http://www.scielo.br/scielo.php?script=sci_pdf&pid=S0104-07072012000400030&lng=pt&nrm=iso&tlng=en
Ending Page	979
Page Count	9
Starting Page	971
ISSN	01040707
e-ISSN	01040707
DOI	10.1590/s0104-07072012000400030
Journal	Texto & Contexto - Enfermagem
Issue Number	4
Volume Number	21
Language	English
Publisher	FapUNIFESP (SciELO)
Publisher Date	2012-12-01
Access Restriction	Open
Subject Keyword	Enfermagem Decision Support Systems Electronic Health Records Adverse Events Patient's Experience Decision Making Information Technology
Content Type	Text
Resource Type	Article
Subject	Advanced and Specialized Nursing