ANSWER
Case Study: Improving EHR Instruction and Handling Patient Safety Concerns
First Question: How Can the Practice Domain That Mirrors the EHR Production Domain Be Fully Implemented?
The following techniques ought to be used in order to successfully simulate the EHR production domain:
Exact EHR System Replication:
In the simulation lab, make use of the same EHR software that is being used in the clinical setting. This promotes familiarity and lessens transition difficulties by guaranteeing that nurses are practicing on the exact same system they use on a daily basis.
Justification: Maintaining consistency between the practice and production settings reduces the learning curve and facilitates nurses’ immediate application of simulation-based knowledge to their everyday tasks (Nabovati et al., 2022).
Including Practical Clinical Scenarios:
Justification: By simulating real-world workflows, nurses can better apply their knowledge to practice and hone their critical thinking abilities when utilizing the EHR (Trout et al., 2022).
Including Multidisciplinary Workflow:
Make sure the simulation incorporates interdisciplinary interactions. For example, situations might include pharmacists, doctors, and nurses working together to solve pharmaceutical management concerns.
Justification:
Performance metrics and real-time feedback:
Put in place mechanisms in the simulation that give prompt feedback on mistakes or omissions, such incomplete medicine administration records or overlooked paperwork.
Justification: Prompt feedback improves documentation practices by encouraging error correction and reinforcing learning.
Question 3: Assessing Nurses’ Performance and Required Evaluation Instruments
It is advised to use the following techniques and resources in order to assess nurses’ performance during the EHR simulations:
Checklists for Structured Observations:
Provide thorough checklists that evaluators can use to gauge important skills including precise medication input, error detection, and workflow effectiveness.
Justification: According to Strudwick et al. (2021), structured checklists provide uniformity in assessment and enable an unbiased appraisal of nurses’ proficiency with electronic health records.
Metrics for Simulation Performance:
Utilize the analytics features included into the EHR system to monitor performance metrics, including task completion time, error frequency, and documentation procedure adherence.
Justification: These measures show areas that need improvement and offer quantitative information on nurses’ competencies.
Prior to and following training:
To assess learning results, give knowledge and skill tests both before and after the course. These tests may consist of case-based problem-solving, practical exercises, or multiple-choice questions.
Justification: Comparisons made before and after training aid in gauging the program’s efficacy and locating any knowledge or skill gaps that still exist (Ahmed et al., 2020).
Self-and Peer Assessment:
Promote nudity
Justification: While group feedback improves the learning process through shared insights, self-assessment encourages accountability.
Sessions of debriefing:
After every simulation, do organized debriefings to go over mistakes, difficulties, and best practices. Review and analyze simulation sessions that have been recorded.
Justification: Debriefing is a tried-and-true technique for targeting particular areas of clinical simulation improvement and strengthening learning.
Citations
Sevdalis, N., Tiew, S., Ahmed, M., Arora, S., & Vincent, C. (2020). Creating a foundation that is safer: the knowledge gained from implementing a junior physician training program based on simulation. 29(5), 379-385. BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2019-009635
Vakili-Arki, H., Taherzadeh, Z., Saberi, M., Nabovati, E., & Eslami, S. (2022). A comprehensive study of the effectiveness of training based on electronic health records in lowering documentation errors. Biomedical Informatics Journal, 132, 104154. 10.1016/j.jbi.2022.104154 https://doi.org
Bell, M., McLay, C., Warnock, C., Reisdorfer, E., and Strudwick, G. (2021). Improving competency with electronic health records: A pilot program to train nurse preceptors to be EHR superusers. 280-289 in Journal of Nursing Management, 29(2). Jonm.13164 https://doi.org/10.1111
Richmond, N. A., Gomez, D. A., and Trout, K. E. (2022). A review of simulation training for enhancing patient safety when using electronic health records. 1594 in Healthcare, 10(8). 10.3390/healthcare10081594 https://do.org
QUESTION
Case Discussion:
You are a nursing educator within a large academic medical center responsible for the annual competency evaluation of nurses within the hospital and clinics. The senior vice president for quality and safety, the chief information officer, and the chief nursing information officer requested a meeting to discuss identified issues related to the electronic health record (EHR) documentation and patient safety issues regarding medication orders, management of the orders within the EHR, and administration of the medications.
Events involving patient safety are increasing, and the senior executives believe that this is largely an issue related to competency in using the new EHR (implemented in the past 2 years). They have asked you to recommend a training and competency evaluation strategy that might affect these measures of patient safety and improve competencies related to the documentation errors they are seeing. They are taking responsibility for monitoring the progress on impact and are asking you to come back with recommendations for the education program.
After meeting with your chief nursing officer, education department staff, directors of nursing on the units, and the staff nurses, all parties agree that it would be helpful to have a training program for the EHR that simulates clinical workflow on some of the common issues concerning medication errors.
You and your department are responsible for the simulation center, and the following are questions for your team to consider as you design a plan for the implementation of the EHR in the simulation lab. Choose ONLY 2 of the questions below to answer in your discussion post:
1. What strategies will you use to fully implement the practice domain that replicates the EHR production domain with which nurses are currently working? Explain your answers with best practices and scholarly support.
2. How will you identify cases related to the patient safety events that are occurring and incorporate them into the EHR to simulate what is happening and allow nurses time to practice on workflow and documentation related to these events? Explain your answers with best practices and scholarly support.
3. How will you evaluate the nurses’ performance and what assessment tools will you need? Explain your answers with best practices and scholarly support.
4. How much time do you believe you need per nurse to run through the simulated case, and how will you manage these time constraints and the schedule in the simulation center? Explain your answers with best practices and scholarly support.
5. Will you manually load data into the EHR representing the clinical data, including data that are clinically representative of the cases in which medication and documentation errors are occurring? Explain your answers with best practices and scholarly support.
6. What other alternative could you consider in loading clinical data representative of the conditions related to medication and documentation errors? Explain your answers with best practices and scholarly support.
7. What challenges do you identify in the data-loading strategies? Explain your answers with best practices and scholarly support.
Please remember for discussion posts: the initial post must be uploaded by the WEDNESDAY of the week and two replies to your peers by Saturday at 2359.
Please note the grading rubric for the discussion board.
As a reminder, all discussion posts must be a minimum of 350 words initial and 250 words peer responses, references must be cited in APA format 7th Edition, and must include a minimum of 2 scholarly resources published within the past 5 years.