6.1 CLINICAL KNOWLEDGE AND DECISION MAKING.pptx

CLINICAL KNOWLEDGE
AND
DECISION MAKING
DISHA PATEL

DISHA
PATEL
INTRODUCTION
• India has a large population, where majority of the population has access to
one or the other healthcare facility.
• Consequently, vast knowledge and expertise are required to treat every
individual patient's unique symptoms.
• Not only clinical knowledge, but knowledge about the process and
procedures, treatment information, patient information, etc. is also required
to treat patients effectively.
• Healthcare industry is knowledge driven industry. A knowledge management
system is required to ensure that sufficient and required amount of
information can flow between the healthcare providers, staff and the patient.

DISHA
PATEL
ROLE OF KNOWLEDGE MANAGEMENT IN
IMPROVING DECISION-MAKING IN CLINICAL
AND POLICY CONTEXT
• Medical field is based on scientific knowledge, where knowledge is defined as facts
that can be empirically verified by bio-medical methods.
• Knowledge management is the practice of harnessing and building upon a core set of
knowledge to enable an individual or a group of individuals to do their best work. It
has become crucial in the healthcare industry to improve effectiveness and
productivity, as well as encourage organizational learning.
• Healthcare knowledge management is particularly important as healthcare
professionals are faced with constant information overload, yet actually finding the
updated health, patient, and processes information takes time. The patient's life
depends on this and hence knowledge management is important.

DISHA
PATEL
Role of Knowledge Management in
Healthcare Industry
• A healthcare knowledge management system creates more efficient flow of information
between healthcare providers and staff. The application of knowledge management
system encourages the culture of continuous cooperation and innovation are as follow.
• Boost Operational Efficiency
• An up-to-date, reliable and readily available information would improve operational efficiency in
providing patient care by cutting the wait time.
• An efficient knowledge management system would support healthcare providers in a facility to
provide better services, maintain compliance and procedures in the organization as well as reduce
overall operating costs.
• Empowered Decision Making
• Knowledge Management system would allow healthcare providers to access relevant required
information quickly and would help overcome the struggle of finding relevant information from the
data dump.
• A knowledge management system is required for doctors to immediately search and identify
symptoms, procedures and other valuable information that could benefit patients.

DISHA
PATEL
• Lesser Mistakes
• A mistake in the healthcare industry can have severe consequences for both
the patient and healthcare provider. Thus, healthcare knowledge
management system can help avoid mistakes by allowing hospitals to
standardize procedures as well as provide accessible training for them.
• Training of medical staff for procedures would benefit patients, even as new
staff comes in, as they would understand the procedures and the best
practices.
• Secure Collaboration
• A knowledge management system is required to collaborate among
healthcare providers by sharing critical information, while simultaneously
withholding patient-doctor confidentiality and patient anonymity.
• A knowledge management system would standardize all processes and
make the information more accessible.

DISHA
PATEL
• Builds Learning Organization
• A knowledge management system is required to create a conducive
learning environment.
• A data- driven, continuous learning environment helps the healthcare
providers to expand their capacity to produce desirable results.
• Learning from experience can also help them to build knowledge that
would enhance patient care.
• Stimulate Cultural Change and Innovations
• A knowledge management system can be used to help patients from
distinct cultures, or suffering from rare diseases by enabling medical
professionals over the world to collaborate, since knowledge management
system contains standardized procedures and best practices.

DISHA
PATEL
BENEFITS OF KNOWLEDGE
MANAGEMENT IN HEALTHCARE
• Educated and Empowered Decision-Making from Information Overload
• The healthcare providers still largely based their decisions on personal knowledge and
experiences, and limited patient information that is available.
• Although they have access to constantly incoming new knowledge, yet actionable
information required is often unavailable. With doctors seeing a large number of
patients daily, there is rarely time to consult other doctors for individual appointments.
• A knowledge management system would allow the nurses to make an empowered
decision making by checking which fellow healthcare provider treated a patient with
similar set of symptoms that they themselves are not very familiar to.
• This eliminates doctors writing a prescription based on assumptions, and rather guide
them to make accurate diagnosis thereby providing quality healthcare for the patients.

DISHA
PATEL
• Avoiding Medical Malpractice
• The chance of mistakes increases as the medical staff leaves or are laid off since their
knowledge of procedures and current best practices leave with them.
• Healthcare knowledge management solutions allow hospitals to completely
standardize all procedures and provide easily accessible training on these procedures.
• This allows other healthcare providers access to information, even if someone with
specialized knowledge leaves the organization. This consequently cuts down fatal
misdiagnoses and reduces the potential for mistakes.
• Encourages Collaboration between Medical Professionals while Protecting
Patient Confidentiality
• With the adoption of EMR (Electronic Medical Records), the doctors can easily access,
update and transfer patient information.
• This, however, also raises concerns for security and confidentiality. Knowledge
Management System helps the healthcare providers to collaborate and share
knowledge without violating doctor-patient confidentiality.
• It allows doctors and specialists to document and share symptoms, treatments, and
other helpful information while upholding patient anonymity. This way, potentially life-
saving knowledge is not off-limits, and patient privacy remains protected.

DISHA
PATEL
• Encourages Learning Environment in the Healthcare Organization
• The science of medicine is continuously evolving with new studies, research and drug
developments every day.
• The healthcare providers must learn to understand providing up-to-date and effective
patient care. A knowledge management system can help the healthcare providers to
share key take-away from new research and industry development, as well as from
continuing education courses.
• This fosters a learning environment in the organization by prioritizing knowledge
sharing, making a learning routine and making up-to-date industry information
accessible to all.
• Drives Digital Transformation in Healthcare
• Healthcare organizations adopt digital systems with the goals of enhancing patient
care, improving efficiency and productivity, and minimizing the risk of errors.
• However digital transformation can be slow due to resistance by staff to change from
conventional methods. Knowledge Management Systems have robust search function,
customized feeds of information, and integration with many other existing apps, such
that it can be easily incorporated into healthcare providers' existing workflows.
• This helps to streamline the transition to digital tools and consequently the healthcare
facility as a whole is able to provide quality patient care via effective and efficient
collaboration.

DISHA
PATEL
• Encourages Innovation
• In the healthcare industry, new knowledge is a constant. The
application of knowledge management systems in healthcare
organizations creates a culture of ongoing collaboration and
innovation, by putting emphasis on a culture of knowledge
sharing to encourage engagement in continuous
learning and education.

DISHA
PATEL
Barriers to adoption of knowledge
management system
• Infrastructure/Technological constraints in healthcare facilities
• Huge initial investment
• Limited access to modern technologies
• System unreliability
• Poor interface usability and problem with accessing health IT
• Lack of support from management or failure to see the importance of
KM systems
• applications
• Lack of motivation among employees to share knowledge

DISHA
PATEL
• Reluctance to use ICT tools daily due to time constraint
• Lack of attention to the results Limited documents and use of
good practices
• Inadequate awareness about KM systems
• Poor quality of data/lack of incentives for proper documentation
• Lack of centralized knowledge base system .
• Lack of communication between researchers and policy makers

DISHA
PATEL
ICD-10-CM
• The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical
Modification) is a system used by physicians and other healthcare providers to classify
and code all diagnoses, symptoms and procedures recorded in conjunction with hospital
care.
• ICD-10-CM is based on the International Classification of Diseases, which is published by
the World Health Organization (WHO). It uses unique alpha-numeric codes to identify
known diseases and other health problems.
• According to WHO, physicians, coders, health information managers, nurses and other
healthcare professionals also use ICD-10-CM to assist them in the storage and retrieval
of diagnostic information. ICD records are also used in the compilation of national
mortality and morbidity statistics in the US.
• Code Structure
• The structure of ICD-10-CM codes is as follow
• The first character is alpha character, excluding
• The second and third characters are numeric.'u’
• The fourth to seventh characters can be a mix of alpha and numeric characters.

DISHA
PATEL
• The characters signify as follow
• The first three characters categorize the injury.
• The fourth through sixth characters describe in greater detail the cause,
anatomical location and severity of an injury or illness.
• The seventh character is an extension digit. It is used to classify an initial,
subsequent or sequela(late effect) treatment encounter.
• Example:
• F53.0 Postpartum depression
• T43.641A Poisoning by ecstasy, accidental (unintentional), initial
encounter
• T43.641D Poisoning by ecstasy, accidental (unintentional),
subsequent encounter
• T43.641S Poisoning by ecstasy, accidental (unintentional), sequela

DISHA
PATEL
STANDARD NURSING TERMINOLOGIES
• Use of a Standardized Nursing Language (SNL) for documentation of nursing care is vital both to the
nursing profession and to the bedside/direct care nurse. It is impossible for medicine; nursing, or any
health care-related discipline to implement the use of electronic documentation and EHR without
having a standardized language or vocabulary to describe key components of the care process.
• SNL is commonly-understood set of terms used to describe the clinical judgements involved in nursing
diagnoses, along with the interventions, and outcomes related to the documentation of nursing care.
Nurses lacked a standardized language to communicate their practice until a task force that later
became the North American Nursing Diagnosis Association (NANDA) was formed in 1973. After this,
the Nursing Minimum Data Set (NMDS) was developed in 1988 followed by the Nursing Management
Minimum Data Set (NMMDS) in 1989. The Clinical Care Classification (CCC) was developed in 1991 for
use in hospitals, ambulatory care clinics, and other settings. The standardized language developed for
home, public health, and school health is the Omaha System. The Nursing Intervention Classification
(NIC) was published first in 1992.
• Currently, the American Nurses Association has approved thirteen standardized languages that
support nursing practice, only ten of which are considered languages specific to nursing care. These
benefits of standardizing nursing languages in the clinical setting are better communication among
nurses and other health care providers, increased visibility of nursing interventions, improved patient
care, enhanced data collection to evaluate nursing care outcomes, greater adherence to standards of
care, and facilitated assessment of nursing competency.

DISHA
PATEL
NANDA International
• NANDA International (formerly, NANDA North American Nursing
Diagnoses Association) is a - professional organization of nurses
interested in standardized nursing terminology. It develops,
researches, disseminates and refines the nomenclature, criterion
and taxonomy of nursing diagnoses. The current structure of
NANDA-I's nursing diagnoses in referred to as Taxonomy II and
has three levels: Domains (13), Classes (47) and Diagnoses

DISHA
PATEL
Nursing Interventions Classification (NIC)
• The Nursing Interventions Classification (NIC) is the first comprehensive
classification of treatments performed by nurses. It is a standardized language
of both nurse-initiated and physician-initiated nursing treatments.
• An intervention is defined as any treatment, based upon clinical judgment and
knowledge, which a nurse performs to enhance patient/client outcomes. NIC
interventions include:
• (1)The physiological (e.g., Acid-Base Management, Airway Suctioning,
Pressure Ulcer Care)
• (2)The psychosocial (e.g., Anxiety Reduction, Preparatory Sensory
Information, Home Maintenance Assistance) Illness treatment (e.g.,
Hyperglycemia Management, Ostomy Care, Shock Management)Illness
prevention (e.g., Fall Prevention, Infection Protection,
Immunization Administration)

DISHA
PATEL
• (3)Health promotion (e.g., Exercise Promotion, Nutrition
Management, Smoking Cessation Assistance); and those used for
individuals and those for families (e.g., Family Integrity Promotion,
Family Support) and for use with entire communities (e.g.,
Environment Management: Community) Most recently, indirect
care interventions (e.g., Emergency Cart Checking, Supply
Management) have been developed. Each intervention as it
appears in the classification is listed with a label name, a
definition, a set of activities to carry out the intervention, and
background readings.
• The 565 interventions in NIC (seventh edition) are grouped into
thirty classes and seven domainsfor ease of use.
• The 7 domains are: Physiological: Basic, Physiological: Complex,
Behavioural, Safety,Family, Health System, and Community.

DISHA
PATEL
• NIC is useful for clinical documentation, communication of care
across settings, integration of data across systems and settings,
effectiveness research, productivity measurement, competency
evaluation, reimbursement, and curricular design.
• NIC provides nursing with the treatment language that is essential
for the computerized EHR for documentation and reimbursement.
The domains and classes provide a description of the essence of
nursing. NIC is helpful in representing nursing to the public and in
socializing students to the profession. The language is
comprehensive and can be used by nurses in all settings and in
all specialties.

DISHA
PATEL
Benefits of Standardized Languages
• Better communication among healthcare providers:
• SNL helps improve communication between nurses, healthcare professionals and administrators,
both nationally and internationally.
• It is important as it will alert nurses to helpful interventions that may not be used at that moment
in their respective areas.
• Increased visibility of nursing interventions:
• Nursing practice, in addition to the interventions, treatments, and procedures, includes the use of
observation skills and experience to make nursing judgments about patient care.
• Interventions that should be undertaken in supporting and demonstrating the depth of nursing
judgments are built into SNL.
• Increased sensitivity to the nursing care activities provided by these computerized documentation
systems, located close to the patient, will help highlight the contribution of nurses to patient
outcomes, making nursing more visible.

DISHA
PATEL
• Improved patient care:
• The use of a standardized nursing language can help diagnose patients better and
understand their complaints, thereby improving patient care.
• Enhanced data collection to evaluate nursing care outcomes:
• The nursing care data stored in a standardized nursing language in an EMR can help
constructing data repositories that will facilitate benchmarking with other hospitals and
settings that provide nursing care.
• This can provide consistency necessary to compare quality of the outcomes for various
nursing interventions across settings.
• Greater adherence to standards of care:
• The level of adherence to the standards of care for a given patient population is directly
related to the quality of care.
• The NIC and NOC standardized nursing language systems are based on both the input of
expert nurses and the standards of care from various professional organizations.
• Assessing nursing competency:
• The nursing interventions delineated in standardized nursing languages can be used as a
standard by which to assess nurse competency in the performance of these interventions.

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