CRITICAL CARE APPLICATIONS Critical care nursing is the nursing specialty that deals with human responses to life

threatening problems. Critical care is the multidisciplinary healthcare specialty that cares for patients with acute, life-threatening illness or injury. As the use of technology expands, the available information expands as well, making it increasingly difficult to access and manage the volume of data. Resource shortages, both staff and time, increase the difficulty of data management. Information technology offers solutions to these difficulties through manipulation of large volumes of data and presenting them to the clinician in meaningful ways to guide quality and cost-effective decision making. The microprocessors that are embedded in many of the devices used with critical patients facilitate downloading of the data that resides in the device to an information management system. DEVELOPMENT Developers of automated approaches to information management in critical care settings have incorporated complex formulas into physiologic monitors, rapidly analyzed small sample of gas or fluids, maintained near-normal physiologic ranges with life-supporting equipment, and stored large volumes of data that would otherwise be disorganized, lost, inaccurate, or illegible. Information systems have been implemented to address alarms and clinical alerts that push significant patient data to the clinician at the point of care. INFORMATION TECHNOLOGY CAPABILITIES AND APPLICATION IN CRITICAL CARE SETTINGS Major capabilities: Process, store, and integrate physiologic and diagnostic information from various sources Present deviations from preset ranges by an alarm or an alert Accept and store patient care documentation in a lifetime clinical repository Trend data in a graphical presentation Provide clinical decision support through alerts, alarms, and protocols Provide access to vital patient information from any location, both inside and outside of the critical care setting. Comparatively evaluate patients for outcome analysis Present clinical data based on concept-oriented views There are several data-intense information systems that exist in the critical care environment from which data can be obtained and integrated in a meaningful way. Information technology applications and functions typical in the critical care environment that will be described in this chapter include the ff:

Physiologic monitors, including arrhythmia and hemodynamic monitors Mechanical ventilators CCISs DEVICE CONNECTIVITY INFRASTRUCTURE The term Medical Information Bus (MIB) is used to classify the backbone of information exchange, allowing the data to be moved from one point to another. This infrastructure is used to send the workload generated by the patient care devices in the modern critical care setting. Most medical devices have small communication ports available that have the capability to transmit digital data to clinical software applications. Examples of messaging standards that are used to intercede information workflows within the healthcare enterprise are Health Language Seven (HL7) standards and the Institute of Electrical and Electronics Engineers (IEEE) Medical Data Device Language (MDDL). Physiologic monitoring was developed to oversee vital signs. Most physiologic monitors consist of five basic parts: sensors, signal conditioners, file to rank and order, computer processor, and evaluation or controlling component. Hemodynamic monitors allow for calculation of hemodynamic indices and limited data storage. Hemodynamic monitoring can be invasive or noninvasive. It is usually used for critical management. Arrhythmia monitors is a computerized monitoring and analysis of cardiac rhythm have proved reliable and effective in detecting potentially lethal heart rhythms. System types: detection surveillance and diagnostic or interpretive. Interpretive systems search the ECG complex for five parameters: 1) location of QRS complex 2) time from the beginning to the end of the QRS 3) comparison of amplitude, duration, and rate of QRS complex with all limb leads 4) P and T waves 5) comparison of P and T waves with all limb leads. Critical Care Information System a system designed to collect, store, organize, retrieve and manipulate all data related to care of critically ill patient. It has the ability to integrate information from a variety of sources and to manipulate that information in meaningful ways. Integration of these data results in a more complete representation of the patients status and can promote safety, quality, and efficiency in patient care. It also allows free flow of data between the critical care unit and other departments. This provides a rich repository of patient information that can be integrated for use in outcomes management. CCISs offer many functions to facilitate the work of critical care nurses. The components of CCIS include: Patient management it provides a clear view of patient data to facilitate early diagnosis and timely decision. Vital sign monitoring

Diagnostic testing results Clinical documentation a patient assessment flowsheets may be the cornerstone of the record, since they detail assessment findings that are regularly collected. Decision support Medication management use of bar code scanning and an electronic medication administration record that is integrated into the CCIS can facilitate the medication administration process. Interdisciplinary plans of care Provider order entry plays a critical role improving quality and safety.

Coordination and Scheduling of Patient Care Activities The critical care flowsheet is predominantly display format for CCISs. The goal of CCIS is to have as much information integrated into the system as possible to obtain a comprehensive picture of the patient. CCISs are most often used as bedside system.

Future Development As clinical information system mature, their use in the patient care environment will become more pervasive. Adoption of a standard interface language will further promote the development of the clinical information systems. Development of clinical pathways and outcomes management are important in improving critical care performance. Outcomes are measurements made to determine the course of illness and the effects of treatments on this course. Three types of data are useful in supporting outcomes analysis: input variables, which stratify patients into comparable groups; interventions; and outcomes. CCISs have recently been discussed as tools to assist in diagnosis of patient conditions through use of neural network.