Utilizing Technology to Transform Your Workflow

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NURSING SCIENCE

Leveraging digital technology in nursing

Cooperation Not Competition: Why Nurse-Technology Partnerships Are Necessary for the Future of Patient Care

Houston Methodist Special Edition of the Journal of Nursing Education and Practice

EDUCATION

Houston Methodist Willowbrook: Transforming Nursing Education Through Innovative Methods

WatchNursing Houston Methodist

Upcoming Courses

PRACTICE

Transforming Patient Satisfaction Scores with Nurse-Physician Bedside Rounding

PROFESSIONAL DEVELOPMENT

Transitional Residency to Acute Care (TRAC) Program

FROM OUR TEAMS

The Role of the Patient Care Assistant in Transforming Nursing at the Bedside

Utilizing Technology to Transform Your Workflow

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

pH

7.26

(7.35-7.45)

PaO₂

83

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

pH

7.32

(7.35-7.45)

PaCO₂

40

(35-45)

HCO₃

20

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

pH

7.49

(7.35-7.45)

PaO₂

94

(80-100)

PaCO₂

52

(35-45)

HCO₃

25

(22 – 26)

BE

+2

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

pH

7.51

(7.35-7.45)

PaO₂

95

(80-100)

PaCO₂

42

(35-45)

HCO₃

30

(22 – 26)

BE

+3

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

Utilizing Technology to Transform Your Workflow

By Christine Ouko, MSN, RN-BC

The Unit Administrative Assistant (UAA) is vital in delivering care using technology by transforming information to impact the outcomes of patients across the healthcare system. The UAAs are the first point of contact with patients through telephones, iPads, call lights, and other technologies to ensure the safety of our patients and the delivery of quality care. They facilitate and coordinate the care of our patients through admissions, transfers, and discharges as they promptly relate appropriate information to the proper care provider to meet the patient's demands and yield the best outcomes.

During the admission process, the UAA puts the patient into the appropriate unit and room and ensures the patient's identification information is correct. This reduces errors for other healthcare providers, such as nurses, when administering medications and completing other treatments. As the patient is transferred within the same healthcare institution or to another institution, the UAAs ensure appropriate information is transmitted. They coordinate and keep the communication loop by faxing and sharing accurate data across the systems. At discharge, the UAAs facilitate the patient's transition from an acute care setting to a home or outpatient facility. They engage with different healthcare providers, such as physicians, RNs, case managers, and social workers, to meet patients' needs. Technology has simplified this process by reducing redundancy and manual labor, resulting in improved practice efficiency and better outcomes.

Technology has helped improve the communication process for UAAs. Previously, many healthcare providers could only be reached through handheld phones that were easily misplaced. This led to many delays in care while trying to contact providers. But the Vocera has made the process easier as it is lightweight, hands-free, voice-controlled, wireless, and wearable, enabling most RNs to promptly respond to patients' needs. Having Vocera as a device has helped streamline the workflow. It has reduced the need for paging staff overhead, reducing background noise for patients within the unit. The Vocera even has the option to locate team members, which reduces time away from the desk for the UAA.

How have you seen technology improve your workflow as a UAA?