The New Millennium Brings Nursing Informatics into the OR - 1

AORN Journal, Dec, 2000 by Joel L. Parker, Patricia A. Abbott

In using information technology in nursing practice, the nursing profession historically has depended on direction and guidance from technology systems vendors, consultants, and information systems professionals to plan for integration and system use. Frequently, this approach resulted in a major investment of capital for technology that did not meet the needs of end users, particularly in the perioperative area. During the past decade, in concert with downsizing, cost containment, and an increasing reliance on computers in health care, a shift has occurred. Health care organizations no longer can afford to spend large sums of money on systems that do not meet the needs of clinicians, administrators, or payers. The need to improve the process by which clinical information technology is defined, procured, implemented, and maintained has given rise to one of nursing's newest specialty areas--nursing informatics. One of the more promising, active areas of the nursing informatics practice lies within the perioperative setting. This article demonstrates how perioperative informatics nurses can contribute to the paradigm shift needed to propel the perioperative arena into the new millennium via information and informatics.

According to one author, the patient information system of the future is being developed now.(1) Immediate involvement of perioperative personnel, therefore, is of paramount importance as clinical systems are developed, purchased, and continue to evolve. The absence of the perioperative "voice" may result in systems being developed or purchased by unenlightened personnel based on perceptions of the perioperative role and work flow. Perioperative nurses must reevaluate current modes of information management to be in a position to influence the framework of the final integrated system.(2) It often is said that the best way to predict the future is to create it. The opportunity for the perioperative environment to benefit by such creation lies waiting to be claimed.

NURSING INFORMATICS

The American Nurses Association (ANA) formalized the practice of nursing informatics in 1994. Judy Graves, RN, PhD, and Sheila Corcoran, RN, PhD, in their seminal definition of nursing informatics, state

   Nursing informatics is a combination of computer science, information
   science, and nursing science designed to assist in the management and
   processing of nursing data, information, and knowledge to support the
   practice of nursing and the delivery of nursing care.(3)

   As with any formalized nursing specialty, standards of practice were
   formulated. The Scope of Practice for Nursing Informatics outlines the
   application of the informatics nurse within specialty domains (eg,
   perioperative).

   The services of informatics nurses are required if integrated systems are
   to serve patients and health professionals successfully by assuring that
   the nursing perspective is available in such systems. To achieve
   high-quality performance, integrated systems must be designed so the needs
   of each category of user are considered at all phases of information
   systems development and implementation.(4)

These statements further support earlier statements regarding representation of the nursing perspective in choosing information technology systems. For integrated systems to truly serve, the services and skills of prepared informatics nurses are required. Providing these services is a great challenge for informatics nurses in the perioperative domain.

Informatics nurses understand current work flow patterns of providers, how change affects that flow, and ways to implement change. As a result, informatics nurses can evaluate and help design information systems beneficial to perioperative nursing.(5) The use of information handling technologies to define the practice and science of nursing, evaluate patient care functions performed by nurses, and support improvements in the quality of nursing care has led to the growth of the informatics nurse role.(6)

Informatics nurses educate, implement, and help integrate information systems throughout health care organizations.(7) The nature of the perioperative area, where a multitude of users, systems, patients, high technology, and providers converge, provides a unique challenge. Managing such complexity by understanding and representing underlying processes and flow of information is one of the greatest opportunities for the informatics nurse in the perioperative arena.

OVERVIEW OF THE PERIOPERATIVE ARENA

In the perioperative environment, nurses deliver care to the patient during a surgical experience. Historically, the phrase OR nursing described the care of patients in the immediate preoperative, intraoperative, and postoperative periods.(8) In keeping with this definition, OR nurses generally practiced within the confines of the surgical suite.

The trend toward managed care has broadened the geographic areas of the perioperative environment and increased the need to share health care information. The perioperative milieu encompasses areas outside of the surgical suite (eg, postanesthesia care unit [PACU], surgical clinic, ambulatory care center, physician's office). These areas collect and manage a multitude of data. Data integration and flow are critically important: