1. How does nursing decision making differ from that of physicians? How might
information technology solutions to assist nurses differ from IT solutions focused on
physicians?
Ans. Nurses are an important part of the care process which starts with the physicians
diagnosing the condition or the ailment that the patient is suffering. Then it falls into the
hands of the nurses who take the care process forward. Nurse decision making focuses on the
whole patient and not the disease that the patient has been admitted in for. As soon as the
patient is shifted into a particular nursing location that nurses have to perform an initial
assessment of the patient to develop a clinical assessment so a patient plan can be created that
would include the following patient’s physical, social, nutritional, functional, communication
and patient education. Once the clinical assessment has been done that helps the nurse on the
floor develop various nursing interventions that might apply to the patient. The nurse can
communicate the dietary needs to the patient in consultation with the dietician based on the
condition and previous ailments that a patient is suffering from. The nurses also implement
the physician orders and nursing plans. They also assess, monitor and communicate with
various multidisciplinary teams the condition of the patient. Based on the response of
patient’s therapy the nurse may also revise the nursing plans so that the optimum results can
be achieved.
Various Healthcare IT tools can be of help to the nurses. The nurses mostly need access to
the patient education materials, medication information and document related to the various
best practices so as to deal with the patient’s condition. Links can be provided from with the
EMR where when the nurse’s change the nursing plan the system will check it against other
best practices and present an optimum nursing plan so as to be most effective. The nurses are
not as concerned as the diagnosis as the physician does, but to act on the diagnosis that the
physician has determined.
2. How does pharmacist decision making differ from that of physicians? How might
information technology solutions to assist pharmacists differ from IT solutions
focused on physicians?
Ans. The pharmacist decision making differs greatly from the physician decision making
process. A pharmacist decision are based on whether if the medications prescribed by the
physicians are safe , will be effective for treating the current diagnosis taken in consideration
the various factors like the age, condition of the patient etc. A physician’s decision making
process revolves mostly around making the correct diagnosis so that the subsequent treatment
plans are successful. Role of pharmacists have expanded to assuring proper drug selection,
dosing, monitoring and management of the entire drug use process to assure quality and costconscious use patterns. A pharmacist based on the tools at his disposal makes a determination
if the medication that is being prescribed by the physician is appropriate for the patient and if
they feel that it is not correct they can call back the physician to discuss alternatives. With the
current CPOE whenever a medication is prescribed the EMR checks the interaction of the
medication with various other medications on the patient’s profile. The system will prompt
the physician with the corrected dosage in case it was done wrong. The physician can go
ahead with the system recommendations or can call up the pharmacist for their expert
opinion. Medication therapy’s have become complex in the recent years and pharmacist help
is necessary for the same. The physicians are more focused on the diseases whereas the
pharmacists are more focused on providing better medications so as to have better patient
outcomes.
Information technology can help the pharmacists in the following way:
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Pharmacist’s can keep themselves updated on the latest trends with respect to availability
of new drugs, recall of existing drugs from the market and making appropriate changes to
the prescriptions.
Help them looking for more information about the drugs in case they are not sure about
the same.
The current EMR systems have provisions from where the pharmacists can external sites to
find more information with respect to a particular drug.
3. What are some of the factors, as discussed on the slides and in class, that impair the
ability of pharmacists, nurses, and physicians to make consistently prompt and
evidence based decisions?
Ans. The following factors hinder making of prompt and evidence based decisions.
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Information mining is a time consuming process. There are EMR’s in the market that
allow for easy accessibility of the clinical data but most of the time they are not organized
categorically which results in incorrect search results. Even when the search results are
appropriate for the search context there is so much information that it is difficult to go
through all that information within a short duration of time.
Incomplete handoffs are often reason or wrong clinical decisions.
There is issue of understaffing which results in pressure to get things done in a short
duration of time generally impacts patient’s care.
Improper communication between the various interdisciplinary teams which would result
in breakdown of the process and hence affecting patient care.
References: Clinical Thinking: A Nursing and Pharmacist Perspective - Anne Bobb, RPh and
Katie Dejuras, RN MSN, Week 5, MMI 402.