INSTITUTE OF MEDICINE

1. INSTITUTE OF MEDICINE By: Lori Chantland, Cassandra Kotlarczyk, Scott Kowalewsky, Maria Kurlenda, & Michelle Metzger

2. Table of Contents • Background & History of IOM • IOM & Organ Donation • Facts about Organ Donation • Impact on Practice • IOM & Informatics • Facts about Informatics • Impact on Practice • IOM and the Future of Nursing • IOM and Medication Errors • IOM and Chronic Illness

3. History of the IOM • Established in 1970 • Originated from the National Academy of Sciences under President Lincoln in 1863 • Helps the government and the private sector make informed health decisions • Annually, thousands of members and nonmembers volunteer their knowledge and expertise to the IOM (IOM, 2012a)

4. About the IOM • Independent, nonprofit organization • Asks and answers the nation’s most pressing questions about health and health care. • Works outside of the government to provide unbiased and authoritative advice to decision makers and the public. (IOM, 2012a)

5. IOMs Work • Congress mandates studies, federal agencies and independent organizations request studies. • Works alone once the statement is established to avoid any outside influences. • The IOM has local, national and global influences. (IOM, 2012a)

6. Reports of IOM • Consensus Reports- Results based on scientific evidence following group deliberation. • Letter Reports- Same as consensus reports however, takes the form of a letter to a third party. • Workshop Reports- Collaboration of the opinions of those at the workshop. • Workshop Summary- Summary of opinions of those at the workshop. (IOM, 2009)

7. Examples of IOM topics • Quality of medical care • Medical research • Environmental research • Disease treatments • Vaccines (IOM, 2010)

8. IOM and Organ Donation In my current practice area of Cardiothoracic and vascular progressive care, The IOM practice standards influence my nursing practice by their recommendations on who can donate organs. My unit currently has heart transplant patients and beginning in January of next year we will take care of lung transplant patients as well. The IOM in this case has an influence on a number of people: • Nurses taking care of patients who die and organ donation is possible • Organ donors • Organ recipients • Organ donor families • Organ recipient families • Physicians • and many more...

9. IOM and Organ Donation A committee was put together by the IOM to possibly use "uncontrolled" donation after a circulatory determination of death (uDCD) such as sudden cardiac arrest deaths and death by excessive blood loss following traumatic injury. As of right now this type of death is not considered for organ donation in the United States. (DuBois, 2008)

10. Facts About Organ Donation • Current organ donors are mainly declared dead by brain death not circulatory death, "...roughly 10,500 to 16,800 who are declared dead each year using neurological criteria (currently approximately 94% of all deceased donors)" • "Most deceased donors are declared dead using neurological criteria (“brain death” criteria) while circulation and respiration are artificially maintained. In controlled DCD, which is increasingly common in the U.S., circulation and respiration are artificially maintained until shortly before death is determined." • "It estimated that of the roughly 335,000 deaths by cardiac arrest each year, at least 22,000 individuals would meet the criteria for uDCD." • "...the Committee observed that outcomes with uDCD kidneys appeared to be nearly identical to those from standard deceased donors. Thus, the Committee argued that the potential positive impact of uDCD on kidney donation is significant enough to warrant demonstration projects." (DuBois, 2008)

11. IOM Has a Great Impact on My Practice In my area of work with heart and lung transplants, of course we would not get a heart that had a sudden cardiac arrest, but possibly we could get the lungs of this donor. We also have patients that pass away from sudden cardiac arrest so I may be on the donor side of this issue as well in my practice.

12. IOM & Informatics • Informatics combines nursing science with information management science and computer science to manage information nurses need and to make the information accessible. • This is used to communicate, manage knowledge, mitigate error, and support decision making. • It can help nurses deliver more effective care in a number of ways which include computerizing a nursing document or system; writing a program to support nursing care of patients; developing an interactive video disk system for educational purposes; helping nurse managers develop systems to use nursing resources effectively; and/or designing systems to collect and aggregate clinical data. (Chitty & Black, 2011, p. 20)

13. IOM & Informatics • Informatics is very important to the IOM • It is considered one of the five core competencies identified in the Institute of Medicine's 2003 report, Health Professions Education: A Bridge to Quality. • The report reads, “Clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and desires, changing health system expectations, evolving practice requirements and staffing arrangements, new information, a focus on improving quality or new technologies”. (Chitty & Black, 2011, p. 20) (Preparing, 2008, n.p.)

14. IOM, Informatics & Practice • I currently work in the Emergency Department at the largest hospital in my area. • In my current practice I am going to a standardized charting system hospital wide. • This includes the main hospital and satellite hospitals, lab, outpatient services, radiology, specialty services, primary care physician offices that are affiliated, and everything in between. • By doing this, everyone who is affiliate with my hospital, will be on the same system. -Cassie

15. IOM, Informatics & Practice • When a patient walks into her Emergency Department, she will be able to see: • what the patient's Primary Care Physician (PCP) has ordered • labs • radiology studies and results • admission charts and orders • discharge instructions • medication lists • consults while in the hospital • any specialists the patient has seen within the healthcare system she works in • and a number of other things • This is going to help streamline care, make it so all healthcare providers are on the same page, improve communication between healthcare associates, and most importantly, improve safety and quality care for each patient.

16. IOM Standards on Future Nursing • Nurses should practice to their highest education and training • Nurses should seek out higher education and training through enhanced education systems • Nurse should work hand in hand with doctors and other healthcare officials to help redesign healthcare in the USA (American Nurses Association, 2011)

17. IOM Recommendations for the Future in Nursing • Remove barriers to nurse’s scope-of-practice • Expand nurses opportunity to lead collaborative improvements • Implement nurse residency programs • 80% of nurses have their BSN and double number of nurses with doctorates by 2020 • Nurses = lifelong learner • Allow/ prepare nurses to lead change in advanced health • Collect and analyze interprofessional healthcare data (American Nurses Association, 2011)

18. How practice standards influence/relate to my practice In my practice in the surgical intensive care unit, my practice is influenced by the IOM in that I strive towards the future and seek higher education. The IOM has identified the importance of nurses collaborating and working towards the future of healthcare. Beyond caring for patients, attending conferences with surgeons for our open heart surgical patients to find new methods or more effective ways to care for patients is a way I try to reach my highest training. Furthermore, seeking my BSN outside of work mirrors the IOMs standards of seeking higher education. Lastly, I collect lab work (data) at certain points and times on our open heart patients for national studies that our group is participating in. Scott

19. IOM, Medication Errors • Almost everyone takes a medication at one time or another. • When taken correctly or for the right ailment, they are usually beneficial, but occasionally when given incorrectly or not monitored for side effects, they can cause harm. • These errors are called, "adverse drug events" or ADEs. (IOM,2006)

20. Medication Errors According to IOM, errors in the medication process each year cause an estimated 380,000 to 450,000 ADEs to occur in the hospital setting and 800,000 ADEs to occur in long-term care facilities. This doesn't even take into account errors of omission. (IOM, 2006)

21. Suggestions to Reduce Errors • IOM suggests creating a partnership between provider and patient where the patient takes greater responsibility in what medications they take and reporting any and all effects they experience from the medication. (IOM, 2006)

22. What We Can Do As Providers Explain to the patient: • What medication we are giving. • What the medication is for. • What side effects to watch for. • What the contraindications are in taking the medication. (IOM, 2006)

23. What I do to Avoid Med Errors I use the 5 rights of medication administration: • The Right patient. • The Right reason for giving a medication. • The Right method of giving the medication. • The Right dosage prescribed. • The Right time the medication is prescribed. and a 6th • The Right medication for THIS patient. -Lori

24. What I do to Avoid Med Errors con't As a maternity nurse, I must use my own judgement on medications ordered for a laboring patient. • Are they contracting too much-stop the pitocin or give Terbutaline • BP too high? No Procardia • BP too low? Give Ephedrine • Bleeding too much? Give Pitocin, Hemabate, and or Methergine. -Lori C.

25. Chronic Illness As a Rehabilitation Nurse, not only do I treat patients immediate, admitting diagnosis, but also any chronic illnesses they may have as well. Examples of chronic illness are: • COPD • Arthritis • Cancer • Chronic pain • Type 2 Diabetes • Dementia • Vision and hearing loss

26. Chronic Illness Cont. After the IOM's services being requested by the CDC and the nonprofit Arthritis Foundation to reduce disability and improve functionality of those with chronic illness, the IOM emphasizes to care for the patient in a holistic manner. (IOM, 2012b)

27. Treating Chronic Illness Considering the mind, body and social aspect of a patient is something we do on our unit daily. When we plan a discharge for a patient, we don't just want to get them out of the hospital, we want them living in the most optimal environment to enhance their independence, considering prevention of future hospitalizations. For example: • Does their medication management need altering? • Do they need to be physically stronger to manage their steps at home before they can be discharged? • Does the patient need to go to an assisted living environment instead of returning home?

28. IOM Influence on Chronic Illness The IOM committee aims to create and implement community services, add new legislation, and allow for increased testing to help improve the lives of those with chronic illnesses. (IOM, 2012b)

29. References American Nurses Association. (2011). Ana, cma and oa activities reflected in the iom recommendations. Retrieved from http://www.nursingworld.org/ANA-Activities-IOM-Report Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders DuBois, J., & Volpe, R. (2008). Introduction: organ donation and death from unexpected circulatory arrest: engaging the recommendations of the Institute of Medicine. Journal Of Law, Medicine & Ethics, 36(4), 731-734. Institute of Medicine. (2006, July). Preventing Medication Errors. Retrieved from http://www.iom.edu/Reports/2006/Preventing-Medication-Errors-Quality.aspx Institute of Medicine. (2009, Oct.). Reports. Retrieved from http://www.iom.edu/About-IOM/Study-Process/Reports.aspx Institute of Medicine. (2010, March). Making a difference. Retrieved from http://www.iom.edu/About-IOM/Making-a-difference.aspx Institute of Medicine. (2012a, Jan.).About the iom. Retrieved from http://www.iom.edu/About-IOM.aspx

30. References Institute of Medicine. (2012b, Jan.). Living well with chronic illness: A call for public health action. Retrieved from http://www.iom.edu/Reports/2012/Living-Well-with-Chronic-Illness.aspx National League for Nursing. (2008). Preparing the next generation of nurses to practice in a technology-rich environment: An Informatics Agenda. Retrieved December 1, 2012, from National League of Nursing website: http://www.nln.org/aboutnln/positionstatements/informatics_052808.pdf