repositories that can be Internet-based or accessed from another source. Point-of-care decision support systems for medication administration are an example. These systems can support nurses in medication administration by providing information on drug actions, dosages, interactions, and side effects at the point of medication administration. When integrated with an automated medication administration record, they allow nurses to verify the five “rights” of medication administration—the right patient, medication, dose, route, and time (Ball et al., 2003).

An automated integrated clinical information system used by Our Lady of the Lake (OLOL) Regional Medical Center in Louisiana illustrates the potential of such advanced systems to provide decision support to nurses. This system provides online access to patient charts and the ability to capture vital signs at the point of care, as well as intake and output, weights, and alerts of medical orders. Rules for care are embedded in system components that capture nursing documentation, results of laboratory tests, and medication orders. The system is accessed through wireless laptop devices used by nurses for input of care documentation; it includes a clinical repository for access to the patient’s electronic medical record, and a pharmacy system with a reference database that enables checking for drug–drug interactions and adverse drug event rules. Additional rules built into the system identify patients at risk for falls, pressure ulcers, and other medical errors. When one of these rules is triggered, the system sends an alert from the clinical documentation that produces care protocols with simultaneous orders to all the departments involved in the response (e.g., nursing, physicians, dietary, supplies). During a 12-month study of the use of the system, falls decreased from 4.45. to 3.70 per 1000 inpatient days, and the risk of pressure sore development decreased from 9 to 1 percent. Two years after implementation, the medical center took advantage of planned system down time to measure the differences in documentation time with and without the system. This evaluation revealed time savings gained through use of the system; moreover, nurses complained about the loss of reminders for work organization when the system was available (Ball et al., 2003).

Given the career-long need for nursing staff to maintain competency through the acquisition of new knowledge and skills, and the essential role of HCOs in helping to meet this need, the committee makes the following recommendation:

Recommendation 5-5. HCOs should dedicate budgetary resources equal to a defined percentage of nursing payroll to support nursing staff in their ongoing acquisition and maintenance of knowledge and skills. These resources should be sufficient for and used to implement policies and practices that:

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