Errors Associated With Electronic Health Records Case Study

In regards to technology and how its influences healthcare today we see the use of EHRs, which allows for a high capacity healthcare environment by condensing patient information into an easily accessible form for all healthcare professionals. “EHRs allow us to collect meaningful data to determine the efficacy in which our units are functioning” (Biddle & Milstead 2016, p.12). This technology can help manage the high capacity hospital environment while not compromising quality. This

End of shift reports between nurses has been an important process in clinical nursing practice. Allowing nurses to exchange vital patient information to ensure continuity of care and patient safety. Therefore, the chance of potential communication gaps causing an error is high. According to the Joint Commission, communication is the primary cause of medical errors, with handoffs accounting for 80% of these errors [ (Zhani, 2012) ]. The most commonly practiced model of report takes place in the staff room, at the nurses’ station, or other locations away

Traditionally, nursing shift-to-shift reports were organized methods of communication between only the oncoming and leaving nurse, designated to a location such as the central nursing station or nook of a hallway. Shift reports can be considered the foundation of how the day is going to plan out because it introduces the patient, diagnoses, complications, medications, consults, upcoming test and the entire plan of care. These reports are full of complicated and vital information and while set in certain locations that are vulnerable to interruptions, such as the nursing station, medical errors and miscommunication are more likely to be made. The Joint Commission’s 2009 and 2010 National Patient Safety Goals (Joint Commission, 2015) included two patient safety standards, first to encourage patients to be involved in their health care plan and second, to implement a standardized communication process for handoff reports between providers. Soon after in 2013, The Agency for Healthcare Research and Quality under the United States Department of Health and Human Services introduced a set of strategies to improve patient engagement along with safety and quality in patient care. Within these strategies the new method of nurse bedside shift report was developed, which suggests nurses to conduct shift-to-shift reports at bedside in the room of each patient, rather than out of the room. The benefits of this new method were

Effective communication during a patient handoff is critical in ensuring patient-care quality and safety and bedside shift reports have been found to increase patient involvement and satisfaction (Wakefield, Ragan, Brandt, and Tregnago, 2012). Bedside shift report is viewed as an opportunity to reduce errors and ensure improved communication between nurses (Gregory, Tan, Tilrico, Edwardson, and Gamm, 2014). Improved communication between nurses can be beneficial for all involved. In response to the Joint Commission’s National Patient Safety Goals, bedside report has been supported as improving patient safety, patient-centered care, and nurse communication as well as reducing medical errors (Gregory, et al., 2014). Ofori-Atta, Biniend, and Chalupka’s (2015) article examines statistics regarding hospital care and shows that according to the Inspector General Office, Health and Human Services

The Role of Electronic Health Records and Health Information Exchange in the Delivery of Quality Healthcare

The concept of EHRs is much more complex than what it may appear to be on the surface. EHRs and what they do incorporates a wide range from delivery of care to nurse-patient interaction to the research revolving around EHRs. On-going research of EHRs allow nurses to understand the vision of future with advancing technology (Barey, McGonigle, & Mastrian, 2018). Implementation of EHRs is a nationwide priority at this time (Kutney-Lee & Kelly, 2011).

The Inner City Clinic is experiencing problems with medication prescribing errors and seeks a resolution to this problem through use of electronic medical records and registration medication reconciliation. The Institute of Medicine reports in the work entitled "Preventing Medication Errors" that the "average hospitalized patient is subject to at least one medication per day. This is reported to confirm previous research findings that medication errors represent the "most common patient safety error." (Barnsteiner, nd, p.1) Medication reconciliation is described as follows:

In the modern world technology is everywhere and it affects everyone’s daily life. People are constantly attached to cell phones, laptops, and other electronics, which all have affected how people live their lives. Technology is also a large part of the healthcare system today. There are many electronics and technologies that are used in health care, such as electronic health record, medication bar code scanning, electronic documentation, telenursing, and there are many more forms of technology that impact nursing. One technology that stands out is the electronic health record. The electronic health record, also referred to as EHR, is an electronic version of a patient’s chart, and it contains is a list of the patient’s current medications, allergies, laboratory results, diagnoses, immunization dates, images, treatments, and medical history (“Learn EHR Basics,” 2014). The purpose of the electronic health record is to have a patient’s health care record available to health care providers nationwide, but the patient can decide who has access to their record (Edwards, Chiweda, Oyinka, McKay, & Wiles, 2011). The electronic health record is a very important technology in health care and it impacts nurses, nursing care, and has a significant impact on patient outcomes.

Unfortunately, physician's perceptions are not objective outcome measures (Schenarts and Schenarts, 2012). It’s very dangerous the fact that providers rely on the electronic system to catch our errors. Furthermore, some of the most notable benefits of EHR include providers’ ability to access patients’ medical history almost anywhere, at any time. Nonetheless, the heavy reliance on health information technology is a major concern. It has the potential to cause harm to patients instead of the intended purpose of patient safety. Some examples of this include latent errors that do not manifest until they have already caused harm to the patient, or system failures which can cause a delay in time for healthcare professionals to review records thus, causing a delay in patient care. In addition, patient orders can be lost or miscommunicated. Healthcare providers rely on with confidence that the computer system will seamlessly promote the quality care of patients. According to Fiercehealthcare.com (2017), because of deficiencies in the eclinicalworks software, patients could not rely on the accuracy of their medical records. In addition, one patient was

Patient satisfaction is a driving force in today’s health care system. Incorporating the patient in their care will help with the patients healing process as well as encouraging the patient to be more compliant with their prescribed care. Bedside reporting is a practice that some organizations have incorporated in their standards of care. The patients care does not stop when the nurse’s shift ends. Therefore, it is important for the patient’s information to be conveyed accurately to the oncoming nurse. Conducting shift reports at the bedside allows the oncoming nurse to both visualize and interact with the patient much sooner than if the nurse had received report in another manner. Furthermore, bedside reporting allows the patient to interact with both nurses; and allows them to see that their care is being properly managed. This type of reporting also allows the oncoming nurse to ask questions, as other methods of shift reporting limits the oncoming nurse from interacting and asking questions of the off going nurse. Patient satisfaction as well as accurate transfer of information and patient safety is a crucial part in providing quality patient care.

EHRs has been known to be a problem for some physicians or healthcare providers despite of the advantages. Because of this system physicians are forced to perform some time-consuming tasks that could be assigned to someone with lesser qualification, which creates more work for the physicians. Physicians described poor Electronic Health Record (EHR) usability that did not match clinical workflows, time-consuming data entry, interference with face-to-face patient care, and overwhelming numbers of electronic messages and alerts (Friedberg, Crosson, & Tutty). Another issue that was reported is that there are a lot of electronic alerts and people also could potentially misuse the template-based notes which is pre-formatted and computer generated.

The aim of this project is to educate nursing staff regarding the evidence-based practice of bedside shift reporting. A greater awareness of proper handoffs can result in improved patient outcomes and nursing satisfaction within the health care setting.

With the increasing advances with technology in this day in age, there is no surprise that electronic health records will soon be a major component in all hospitals of the Canadian health care system. Assessment of Electronic Health Record Usability with Undergraduate Nursing Students is an informative article, written by Jones & Donelle, about the increased use of electronic health records within our system and discusses its benefits, as well as difficulties nursing students experience with this new type of technology. It is a new method of technology that will soon replace paper charting and will allow access to patients to communicate with their health care providers, manage their health information, schedule appointments, and have access

Change of shift is a busy time at the hospital. Nurses and techs who have cared for patients on the outgoing shift meet with those who will care for the patients for the next shift and give updates. This communication is often done as a meeting in a room or area that is away from the patients. Much thought has been given to implementing bedside nursing shift reports as a way to improve nursing satisfaction, reduce patient falls, and reduce medication errors. Although this method has been researched and reported in previous papers, those papers seemed lacking in data on sample sizes and rarely calculated statistical significance of the study results. The article used as a basis for this paper addressed these deficits seen in previous papers

Gone are the days of taped change of shift reports or written communications between nurses for hand off. The Centers for Medicare and Medicaid (CMM) have recently linked quality of care to payments. The hospital value-based purchasing program now adjusts the reimbursement hospitals receive on several key concepts including the patient experience. Patient satisfaction accounts for 30% of the total performance scores (Centers for Medicare & Medicaid Services [CMM], 2015). General medicine consistently receives low scores on communication with patients. The purpose of this paper is to find solutions to the patient perceived lack of communication by reviewing the current process of bedside reporting during shift changes and find the appropriate change theory to reverse the current findings.