The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

Investigation Interoperability Problems in Pharmacy Automation: A Case Study in Saudi Arabia

The aim of this case study is to investigate the nature of interoperability problems in hospital systems automation. One of the advanced healthcare providers in Saudi Arabia is the host of the study. The interaction between the pharmacy system and automated medication dispensing cabinets is the focus of the case system. The research method is a detailed case study where multiple data collection methods are used. The modelling of the processes of inpatient pharmacy systems is presented using Business Process Model Notation. The data collected is analysed to study the different interoperability problems. This paper presents a framework that classifies health informatics interoperability implementation problems into technical, semantic, organisational levels. The detailed study of the interoperability problems in this case illustrates the challenges to the adoption of health information system automation which could help other healthcare organisations in their system automation projects

Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice

Background Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods A mixed-methods case study design was used. The case was a surgical unit in a pediatric academic-affiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study

Implementing a Checklist & Hourly Huddles to Increase Situational Awareness During the Second Stage of Labor-A Perinatal Quality Improvement Project

Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth outcomes. AIM Statement: The global aim of this project was to reduce variability in practice during the second stage of labor to improve neonatal birth outcomes. The specific aim was to implement a second stage situational awareness checklist with a completion percentage of 80% by July 2015. Method: The theoretical framework guiding this project was Endsley’s theory of Situation Awareness. Pre-implementation chart reviews were conducted to determine what information was currently being documented during the second stage. A 9-item checklist was developed based on hospital preference for use during hourly huddles once second stage was reached. Staff were educated on checklist use pre-implementation. Post-implementation chart reviews were conducted to determine checklist completion percentage. Results: Chart reviews demonstrated an average checklist completion percentage of 43% over the two-week implementation period with a range of 22-89%. Huddles were conducted and documented in 33% of the reviewed delivery charts. Conclusions: Continued follow up and work re-design is needed to consistently incorporate the checklist and huddles into practice. Implications for the CNL: Implications for the CNL include continuing staff education to increase awareness and acceptance of the practice change, and examining project effects on perinatal outcomes including delivery mode and neonatal Apgar scoring

Improving the rates of smoking history documentation in the electronic medical record.

Lung cancer is the leading cause of cancer related deaths in the United States, and Kentucky leads the nation in lung cancer deaths. Lung cancer care also contributes billions of dollars a year to the cost of health care in this country. The U.S. Preventive Services Task Force (USPSTF) recommends low-dose computed tomography (LDCT) for lung cancer screening with a grade B recommendation, which is a covered service under the Centers for Medicare and Medicaid Services (CMS) guidelines. In order to qualify, patients must have an appropriately documented smoking history. A primary care office was identified within a major healthcare system in Northern Kentucky that has an existing lung cancer screening program. It was found that patient smoking history information was not being properly documented in the electronic medical record (EMR). A quality improvement program was implemented. The program included a lunchtime educational presentation regarding lung cancer screening requirements and appropriate smoking history documentation in the EMR. Analysis revealed that staff members had a high rate of satisfaction with the program overall but were not as satisfied with implementing the educational program during their lunch break. The impact on smoking history documentation rates was unable to be interpreted due to an unforeseen change in the process for entering referrals into the EMR, which occurred 14 days after implementation of this educational intervention

Development of a complex intervention to support the initiation of advance care planning by general practitioners in patients at risk of deteriorating or dying: a phase 0-1 study

Background: Most patients with life-limiting illnesses are treated and cared for over a long period of time in primary care and guidelines suggest that ACP discussions should be initiated in primary care. However, a practical model to implement ACP in general practice is lacking. Therefore, the objective of this study is to develop an intervention to support the initiation of ACP in general practice. Methods: We conducted a Phase 0-I study according to the Medical Research Council (MRC) Framework. Phase 0 consisted of a systematic literature review about the barriers and facilitators for GPs to engage in ACP, focus groups with GPs were held about their experiences, attitudes and concerns regarding initiating ACP in general practice and a review of ACP interventions to identify potential components for the development of our intervention. In Phase 1, we developed a complex intervention to support the initiation of ACP in general practice in patients at risk of deteriorating or dying, based on the results of Phase 0. The complex intervention and its components were reviewed and refined by two expert panels. Results: Phase 0 resulted in the identification of the factors inhibiting or enabling GPs' initiation of ACP and important components underpinning existing ACP interventions. Based on these findings, an intervention was developed in Phase 1 consisting of: (1) a training for GPs in initiating and conducting ACP discussions, (2) a register of patients eligible for ACP discussions, (3) an educational booklet on ACP for patients to prepare the ACP discussions that includes general information on ACP, a section on the role of GPs in the process of ACP and a prompt list, (4) a conversation guide to support GPs in the ACP discussions and (5) a structured documentation template to record the outcomes of discussions. Conclusion: Taking into account the barriers and facilitators for GPs to initiate ACP as well as the key factors underpinning successful ACP intervention in other health care settings, a complex intervention for general practice was developed, after gaining feedback from two expert panels. The feasibility and acceptability of the intervention will subsequently be tested in a Phase II study

Examining Faith Community Nurses’ Perception and Utilization of Electronic Health Records

Abstract The purpose of this study is to identify current faith community nurse documentation practices, explore factors impacting intention to adopt electronic health records, and identify perceived barriers and benefits to electronic health record use among faith community nurses practicing in the Midwest. The technology acceptance model is used to examine impact of perceived usefulness and perceived ease of use of electronic health records on intention to adopt. This study is a quantitative exploratory research study utilizing a cross-sectional researcher-developed 39-item questionnaire. Surveys were distributed by mail and e-mail to faith community nurses practicing in South-Central Indiana and Western Kentucky. Survey data was collected from 114 faith community nurses whose nursing educational levels ranged from diploma to PhD for a response rate of 46%. Descriptive statistics and Pearson’s correlations were used to report study results. Positive correlations were found between both perceived usefulness and perceived ease of use and intention to adopt with a stronger correlation associated with perceived usefulness. Participants reported financial challenges as most significant barriers to electronic health record adoption while the highest rated benefits were associated with record access, enhanced care coordination, and improved ability to identify and communicate FCN practice to decision makers. This study adds new knowledge on documentation practices and perceptions of faith community nurses related to electronic health records. Understanding the impact of perceived usefulness, ease of use, barriers, and benefits on electronic health record adoption will inform future initiatives seeking to increase faith community nurse electronic health record adoption. Keywords: faith community nurses, electronic health record, adoption, barriers, facilitator

What You Need to Know about Bar-Code Medication Administration

Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and sustainability. The themes that emerged from the literature were poor BCMA design and implementation that resulted in workarounds.The three evidence based strategies proposed to address this gap are, evidence based standardization in planning and implementation, the identification and elimination of workarounds and hard wiring. An evidence based checklist evaluates compliance with standard procedures. The LEAN model of Jodoka is used to assure adaptation of the machine to human workflow. Direct observation provides valuable workflow assessment. An effective BCMA implementation involves careful system design, identification of workflow issues which cause workarounds, and adapting the machine to nursing needs

Evaluating Nursing Pain Assessment Documentation with the Pediatric Client

Pain is often seen as a primary complaint in the pediatric emergency department (ED). Assessment and documentation of pain are integral to effective pain management, and nurses are responsible for documenting pain assessment. Nursing documentation is essential for ensuring continuous, safe, high-quality care. Evidence shows nurses are inadequately documenting pain assessment and reassessment and not always using appropriate pain scales in a busy, cosmopolitan children\u27s hospital ED. The practice-focused question that guided this project was: How does an educational module and change in electronic health record pain assessment flowsheet increase the nurses\u27 compliance with initial documentation of pain? An educational module and minor change in the electronic health record was developed and implemented. Chart audits showed an improvement in pain documentation in triage from 16% to 84% with a chi-square value of 11.4, p = .001. Prior to the DNP project there were 24 of 71 charts (33.8%) with all 3 required elements properly documented; after the educational module, this improved to 51 of 80 charts, 63.7%. The results of the chi square 13.4, p = \u3c .001 demonstrate a statistically significant improvement. In the qualitative survey data collected before and after nurses completed the educational module, they cited short-staffing, electronic health records, lack of education, nursing experience, and time management as explanatory of documentation failures. Attention to accurate and timely pain assessment and documentation using the correct tools improves the care of the pediatric patient and contributes significantly to positive social change

Nurses’ Attitudes and Preferences towards usage of Electronic Medical Records

Electronic Medical records document the treatment plan and patient care. This study intends to identify trained nurses' reception toward using EMR in the wards. A non-experimental cross-sectional survey covered the multi-discipline area. A stratified random sampling method in which the population in this research consisted of n= 138 trained nurses. Results found that the trained nurses tended to document the data at the nurse's station compared to the bedside entry. It's also shown that the demographics variable significantly correlated with attitude domains. Hence with the research results, it is envisaged to benefit the nurses and organization and hopefully can become the catalyst for the Ministry of Health in further improving and elevating the system throughout all hospitals in Malaysia. Keywords: Attitude, Electronic medical record, Nurses, Preferences eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open-access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under the responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians), and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v7i21.357