Do EHRs Rob Nurses of Voice and Oversimplify Description of Patient Care?

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology. Editor’s note: this post has been slightly revised for clarity since its initial publication a day ago.

Heroines of Nursing, mixed media collage by julianna paradisi, 2013. Text by Florence Nightingale
Heroines of Nursing, mixed media collage by julianna paradisi, 2013. Text by Florence Nightingale

Previously I’ve written that I have a new employer. Part of this transition is relearning how to use the electronic health record (EHR). Fortunately, this new employer uses the same program as my last. However, that version was EHR-lite compared to the one we use now.

For instance, the new system contains an abundance of “smart phrases” that are used to lessen time spent writing nursing notes. If you are unfamiliar with smart phrases, an uncomplicated explanation is that they are preconstructed phrases chosen from those commonly found in charting, such as “The patient arrived ambulatory for IV infusion.” Instead of typing in this phrase, nurses can click on it from a computer screen menu, and voilà! The entire phrase is electronically inserted into the notes.

Smart phrases, like charting by […]

2016-11-21T13:06:30-05:00September 23rd, 2013|digital health, nursing perspective|7 Comments
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My Supporting Role

In nursing as in acting, connecting is key.

The Actor, by Picasso/Wikimedia Commons

When I graduated from nursing school, I was given a pen, stethoscope, tape, and scissors. In my current practice as a pediatric nurse in acute care, I’ve found that it’s all too easy to let technology with all its conveniences and safety measures take center stage. I have a bedside computer, cell phone, and cardiac monitor, among many other technical tools.

Yet the importance of creating a therapeutic milieu for patients and families has remained unchanged. Now the challenge I have is how best to use technology as a prop and a backdrop and not as the main event, how to prevent data collection from creating a barrier between me and my patient.

Of course technology has many advantages. In the past, I had to spend long stretches of time away from the bedside, creating written medications sheets and care plans. I remember spending hours looking up each medication dose and side effects in reference books. Transcribing written doctor’s orders and medication information was an art form. Now we obtain the most current doctor’s order and medication information in seconds with a click of a button.

Making technology an asset, not an obstacle.

While these conveniences have given me more time […]

2020-02-07T11:15:00-05:00September 16th, 2013|digital health, nursing perspective, patient engagement, Patients|3 Comments
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Health Technology Hazards: ECRI’s Top 10 for 2013

hazard/jasleen kaur, via Flickr hazard/jasleen kaur, via Flickr

It’s a new year and with it comes new health care technology hazards to keep in mind, as listed in the most recent ECRI Institute report, 2013 Top 10 Heath Technology Hazards. While some risks from last year’s list made a repeat appearance, a few new topics made the cut for 2013.

Alarm hazards still posed the greatest risk, topping the list at number one. Other repeat hazards included medication administration errors while using smart pumps, unnecessary radiation exposure, and surgical fires. For an overview on these, see our post from last year.

Several new opportunities for harm seemed to involve new information technology (IT) that is making its way into health care facilities, such as smartphones and mobile devices. Here’s a snapshot of several of these, and some suggestions the report gives on how to prevent them.

Patient/data mismatches in electronic health records (EHRs) and other health IT systems

The risk: One patient’s records ending up in another patient’s file may not be a new phenomenon—it happened in traditional paper-based systems as well. But newer, more powerful health IT systems have the capability to transmit mistaken data to a variety of devices and systems, multiplying the adverse effects that could result from these errors.

Some suggestions: The report suggests that when purchasing health IT systems, facilities should consider how all the connected technologies facilitate placing the right patient data into the right record. […]

2016-11-21T13:08:37-05:00January 4th, 2013|digital health, Nursing|1 Comment
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ECRI Conference Notes: Creating and Replicating ‘Systemness’ within Health Care Delivery

By Joyce Pulcini, PhD, RN, FAAN, Policy and Politics contributing editor, AJN

The ECRI Institute’s 19th annual conference (November 28–29) looked at system-level innovation and quality in the health care system. It brought together experts from many fields, including medicine, nursing, hospital or health system administration, informatics, health care quality, policy makers, journalists, and academics. ECRI Institute is an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care. The goals of the conference were to address the following:

  1. What is “systemness”?
  2. Which elements within mature health care systems result in the best clinical outcomes?
  3. Are approaches taken by long-established systems transferable to smaller, newer, or less integrated systems?
  4. Are financial incentives enough to drive change?
  5. How can electronic health records (EHRs) help improve “systemness”?
  6. Do transformation units within health care systems produce results?

The conference essentially tried to attack in a creative way the issues around the creation of systems that function optimally. Truly changing culture and providing optimal care delivery should always result in putting the patient at the center of care. The conversation was open and the conference succeeded in fostering important dialogue among the speakers and the audience.  A major focus was on creating systems, looking at technological or financial solutions, and measuring outcomes.

The session on team care (“Creating teams to improve inter- and intra-health care systems: Does evidence show a benefit?”)  highlighted the vexing issues around how to truly foster optimal teams. Lisa Schilling, RN, MPH, VP National HC Performance Improvement, Director, Center for […]

2016-11-21T13:08:48-05:00December 5th, 2012|digital health, health care policy, nursing perspective|0 Comments
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Health information Technology, EHRs, Meaningful Use, and Nursing

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

If you’re like most nurses working in a health care organization, you’ve been involved in a migration to electronic health records, computerized physician order entry (CPOE), or bar code medication administration.

If you’re lucky, nursing input was considered during the planning stages of all this health information technology (HIT). We’ve heard from many nurses (and have had a few submissions from nurses about their experiences—see for example the Reflections essay “Paper Chart Nurse”) who have had “issues” with the systems or who wonder, why the big push?

In the August issue of AJN, which is available online and on the iPad (download the app here), Susan McBride and colleagues John Delaney and Mari Tietze debut their three-part series on HIT. The first article, “Health Information Technology and Nursing,” examines the federal policies behind efforts to expand the use of this technology, the importance of meaningful use, and the implications for nurses. Subsequent articles upcoming in the fall will take a closer look at the use of HIT to improve patient safety and quality of care, and the important role nurses are playing—and could play—in this system-wide initiative.

It’s crucial for nurses to understand HIT. As the authors note,

“If HIT systems are going to truly improve care, nurses need a voice in their planning and development to ensure patient safety and system usability. The success of this technology depends on nurses informing the […]

2016-11-21T13:09:28-05:00August 15th, 2012|digital health, nursing perspective|3 Comments
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