Nutrition support nursing handoff: a computerized template

At a large Midwest private nutrition support practice, a manual reporting tool has been the communication practice used in daily handoff practices. For patients who require consultation from the Nutrition Support Consulting Service, accurate communication of the nutrition plan of care among members of the health care team is a critical element of patient care and safety. Because communication errors are a leading cause of sentinel events for patients, having a safe transfer of care from nurse to nurse each day is imperative. A nutrition support computerized handoff template not only creates continuity of care among team members, it also results in patient safety and improved standardization of patient nutritional information daily via a computerized template. Using the computer for nutrition support nursing handoff promotes trust among coworkers and optimizes patient interaction as less time is spent manually documenting patient data. \u27Watson\u27s Caring Theory and the concept of intentionality provide a framework for implementing the computerized handoff template. A conceptual metaphor of a relay runner with baton provides a visual for the goals of a computerized handoff template that integrates caring intentionality and relationships into practice. The use of a standardized reporting tool in the computerized handoff template for nutrition support nurses will be evaluated through colleagues\u27 feedback and a confidential interview with a nursing administrator. Nurses who implement the computerized handoff template into their practice will produce a more efficient method of recording patient data while demonstrating greater commitment to the caring acts that encompass nursing practice

The Effectiveness of an Anesthesia Handoff Tool: An Electronic Health Record Application to Enhance Patient Safety

Perioperative patient care handoffs are complex and multidimensional and require accurate attention to detail. Communication failures among healthcare providers increase the risk of morbidity and mortality. Utilizing a standardized handoff tool located within the electronic anesthesia record formalizes the handoff process and improves patient safety. Prior to the introduction of the Electronic Anesthesia Handoff Tool, 82 patient care transfer observations were conducted; subsequent to the launch of the tool, 75 patient care transfer observations were conducted, and then before and after comparisons were made. Descriptive statistics, a two-tailed t-test, and Spearman’s correlations were conducted. Alpha level was set at p \u3c 0.05. There were significantly (p\u3c .05) fewer errors made in all categories of patient information following the introduction of the Electronic Anesthesia Handoff Tool. Though there were trends towards more omissions occurring after 3:00 p.m., the difference in most patient information categories was not significant (p\u3c .05). In addition, there were no differences in omissions related to the severity of patient co-morbidities based on patients’ American Society of Anesthesiologists physical status classification. This study provided information regarding the incidence of patient information inaccuracies and omissions during patient care transfer before and after implementation of an electronic patient care transfer tool

Program Evaluation of a Bundled Educational Intervention to Enhance Implementation of Professional Exchange Report

Communication handover is a source of potential error and risk to patient safety. Electronic-based tools may reduce errors and mitigate risks to patient safety. Electronic tools have been successfully implemented using multiple methods of education and training. Electronic tools vary in functionality and integration with the electronic health record (EHR). A large West Michigan Regional Health System (RHS) implemented a new EHR containing an embedded tool for communication handover called Professional Exchange Report (PER). There was inconsistency in the practice of bedside report by nurses. The RHS planned to use a bundled approach of educational interventions to implement the new tool and report structure including communications, video demonstration, in-seat training and at the elbow support during the go-live. This project systematically evaluated the interventions to implement PER using evidence based methodology. Evaluation was based on collection of data and evidence through interviews, pre- and post-implementation surveys, observations of the report process, and review of documents related to planning, implementing and evaluating the program. Organizational leaders engaged in robust planning. Educational interventions were evidence-based. Implementation was carried out effectively. The organization did not have a detailed, specific plan for evaluation of educational interventions or PER outcomes. Change in length of report could not be attributed to the process change, and nurse perceptions of the process and consistency of practice at bedside did not change. Observed opening of the EHR during report increased by 68%. There were statistically significant increases in yes responses to awareness of, understanding why, knowledge of specific, and ability to make practice changes

Comparison of the effectiveness of traditional nursing medication administration with the Color Coding Kids system in a sample of undergraduate nursing students

The problem of medication errors in hospitals and the vulnerability of pediatric patients to adverse drug events (ADE) was investigated and well substantiated. The estimated additional cost of inpatient care for ADE’s in the hospital setting alone was conservatively estimated at an annual rate per incident of 400,000 preventable events each incurring an extra cost of approximately $5,857. The purpose of the researcher was to compare the effectiveness of traditional nursing medication administration with the Color Coding Kids (CCK) system (developed by Broselow and Luten for standardizing dosages) to reduce pediatric medication errors. A simulated pediatric rapid response scenario was used in a randomized clinical study to measure the effects of the CCK system to the traditional method of treatment using last semester nursing students. Safe medication administration, workflow turnaround time and hand-off communication were variables studied. A multivariate analysis of variance was used to reveal a significant difference between the groups on safe medication administration. No significant difference between the groups on time and communication was found. The researcher provides substantial evidence that the CCK system of medication administration is a promising technological breakthrough in the prevention of pediatric medication errors

IMPROVING PCS 5.67 MEDITECH’S USER INTERFACE BY ADDING A “ONE-CLICK-ONE-SCREEN” ELECTRONIC PAGE

Medical organizations and physicians have been encouraged to implement different EHR systems. Initially these systems aimed to record, and store clinical data and improve its access and legibility. However, as these systems have become almost indispensable, users are demanding from these applications more complex tasks. Small practices and/or rural medical organizations often cannot afford to continuously upgrade their EHR systems or acquire modern systems. Research has shown that one way to solve this problem is to customize and add features that can facilitate user navigation. The purpose of this QI project was to investigate if integrating a “one-click-one-screen” electronic window displaying a snapshot of the most relevant and up-to-date patient information into PCS 5.67 Meditech was able to facilitate and improve data accessibility, information exchange, user satisfaction, patient care, and communication among the users. A pre-survey, given to 30 frequent users of PCS 5.67 Meditech, gathered their perception of the system’s UI. A “one-click one-screen” feature was designed however it was difficult to integrate it into the system’s UI because customization of this EHR system was complex beyond the local IT expertice. Nonetheless, the pre-survey data indicated that a significant number of PCS 5.67 Meditech users were dissatisfied with the performance of this EHR system. Additionally, the pre-survey data showed that the EHR system UI did not display clinical data in an efficient and user-friendly manner

An Exploratory Study on how to Improve Bedside Change-of-Shift Process: Evidence from One Hospital Using Technology to Support Verbal Reporting

Change-of-shift report, often referred to as patient handoff in the inpatient setting involves exchange of accurate and critical information between providers to ensure continuity of patient care. Inefficient communication significantly contributes to medical errors, affecting patient safety, and care quality. The current exploratory study was conducted to understand the issues associated with change-of-shift reporting that occurs throughout one hospital in its various nursing units. Nurses participating in the study were assigned a simulated patient case to develop a shift report to transfer to the incoming nurse. After completing the report, each nurse was interviewed using open-ended questions. Based on qualitative analysis of data obtained from sixteen one-on-one nurse interviews, ten themes were identified. The themes highlighted issues that posed coordination challenges for nurses, impeded nurse workflow, and underscored deficiencies in the bedside reporting process followed at the hospital. Recommendations are discussed on how to overcome these challenges

Patient Handoffs: A Review of Current Status in the USA

The goal of this paper is to highlight the status of patient handoffs in the United States. A summary of what patient handoffs are, and the current processes through which handoffs are carried out will be described, as well as the benefits and limitations of each approach. In addition, this project will describe some major flaws in the handoff system, and suggestions to how they may be remedied. This paper will conclude by mentioning a new system which has reduced handoff errors, and propose an extension to this research in order to instigate further developments

A Team-Based Approach to Studying Complex Healthcare Processes

Communication is a critical aspect of clinical work. In 2010, the Joint Commission (JC) found that gaps in communication were among leading factors contributing to medical errors. Healthcare processes, such as patient discharge, depend on interdisciplinary communication to be successful. Electronic health records (EHRs) have the potential to facilitate communication and information sharing between interdisciplinary care team members; however, challenges remain in designing tools for team-based care and questions remain in understanding how EHRs impact interdisciplinary team communication. This dissertation focuses on understanding how EHRs can be designed to support communication and information sharing within interdisciplinary patient care teams. The first aim of the dissertation investigated how EHRs impact interdisciplinary clinical teams’ communication, shared mental models, and information sharing activities. The results showed that implementing new EHR tools appeared to have little impact on communication and shared mental models, but new information sharing activities mediated by EHR developed. These changes and lack thereof suggest that new EHR tools will be specifically needed to facilitate interdisciplinary team information sharing activities. The second aim of the dissertation investigates the information sharing activities and information needs of interdisciplinary team members during patient discharge. The results showed that the information clinicians sought out during discharge depended on the roles that person played as well as the progress of the discharge process. Future EHR tools should be aware of how patient care teams are progressing through the patient discharge process in order to provide information contextualized to their current tasks. In conclusion, interdisciplinary team communication and information sharing remain poorly supported by current EHRs and new tools designed specifically for interdisciplinary teams should provide information based on the completion of team activities

Effective Handoff Communication

The patient handoff—the transfer of patient related health information from one caregiver to another—has come under increased scrutiny in recent years. This is due to many factors including high-profile and well documented incidents of medical errors, a subsequent magnified focus on patient safety by the general public, and changes in resident work hours which have had the unintentional consequence of increasing the number of necessary handoffs during a given patient hospitalization. As medical care becomes more specialized and increasingly fragmented, handoffs are necessary in order to maintain consistency of information and plans of care. However, despite this increased focus, errors in transferring medical information are still common. In order to meet standards, many training organizations and medical institutions mandate lengthy handoffs at all levels. While initial studies demonstrated a decrease in medical errors after implementation of a standardized handoff bundle, more recent evidence calls into question those results. Certainly many components are necessary, can improve handoff communications, and reduce errors during a patient sign-out. However, more is not always better, and caregivers should not blindly attempt to transfer information unless there is medical necessity. Achieving a balance between “safe” and “effective” communication is the goal that we are still trying to achieve

Identifying Physicians’ User Experience (UX) Pain Points in Using Electronic Health Record (EHR) Systems

Healthcare institutions have migrated to online electronic documentation through the means of Electronic Health Record (EHR) systems. Physicians rely on these systems to support their various clinical work processes, such as entering clinical orders, reviewing essential clinical data, and making important medical decisions using reporting analytics. Although EHR systems appear to be useful and have known advantages over paper records, studies suggest there are persistent user interface design problems that may hinder physician productivity. The study focused on the research problem that EHR system designs create productivity problems for physician users who frequently report that system workflows are inefficient and do not map to their clinical process needs. Although researchers have examined EHR system adaptation and user interface design with various stakeholders, research is limited on the lived experiences of physicians who use the system. A few studies have focused on quantifying the factors that describe the phenomena of “meaningful use” of EHR systems. A qualitative approach to studying the phenomenon of physicians\u27 use of EHR systems is understudied and is relevant to investigate given EHR systems have become commonplace tools in clinical settings. An interpretive phenomenological analysis (IPA) study was conducted with the goal to discover what emergency room physicians describe as the pain points of their user experiences with EHR systems, which may include many different experiences to be uncovered, and their perspectives about how they manage the difficulty of system tasks and demands. Eight participants who represented a purposeful sample were recruited from one hospital in the Southeast region of the United States and participated in semi-structured interviews with open-ended questions. The data derived from the personal lived experiences of the participants were reviewed and analyzed through a step-by-step analytical process to develop five super-ordinate themes: Historical Chart Review, Inadequate Note Documentation, Difficult Order Entry, Patient Throughput Barriers, and Poor System Performance. The findings reveal consistencies with previous research that suggests physicians experience mental burden and burnout using EHR systems due to task complexity, task demand, and inefficiencies of system design. The findings have multiple implications for information technology (IT) system designers, healthcare administrators, and physician end users. This study provides future research opportunities to investigate the experiences of individuals who work in a different specialized area of the hospital, such as the intensive care unit (ICU)