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Nursing educator within a large academic medical center responsible for the annual competency

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.

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Sample Answer

 

 

 

Proposed EHR Simulation Training Program

1. Strategies for Implementing the EHR Production Domain

To fully replicate the EHR production domain, we will utilize the following strategies:

  • Realistic Clinical Scenarios: Develop a library of simulated clinical scenarios that mirror real-world patient cases, including common medication errors and documentation challenges.
  • Authentic EHR Environment: Create a simulated EHR environment that closely resembles the actual EHR used in the hospital, incorporating similar features, workflows, and interfaces.

Full Answer Section

 

 

 

 

  • Role-Playing: Assign roles to participants, such as patients, physicians, and other healthcare professionals, to create a realistic and immersive experience.
  • Scenario-Based Learning: Use scenario-based learning to challenge participants to apply their knowledge and skills in real-world situations.

2. Incorporating Patient Safety Events

To identify and incorporate relevant cases into the EHR simulation, we will:

  • Review Incident Reports: Analyze incident reports and quality improvement data to identify common medication errors and documentation issues.
  • Consult with Experts: Seek input from clinical experts, such as pharmacists and medication safety officers, to develop realistic scenarios.
  • Utilize Case Studies: Incorporate case studies from the literature or real-world examples into the simulations.

3. Evaluating Nurse Performance

We will use a combination of objective and subjective measures to evaluate nurses’ performance in the EHR simulation:

  • Objective Measures:
    • Time taken to complete tasks
    • Accuracy of documentation
    • Adherence to protocols
  • Subjective Measures:
    • Observations of clinical decision-making
    • Feedback from role-playing participants
    • Self-assessment by the nurse

4. Time Allocation and Scheduling

We estimate that each nurse will need approximately 2-3 hours to complete a simulated case. To manage time constraints and scheduling, we will:

  • Prioritize High-Risk Scenarios: Focus on simulating cases that are most likely to involve medication errors or documentation issues.
  • Flexible Scheduling: Offer multiple session times and allow nurses to schedule training at their convenience.
  • Online Training: Consider offering online or blended learning options to accommodate different schedules.

5. Data Loading Strategies

We will manually load clinical data into the EHR simulation environment to represent real-world scenarios. This data will include:

  • Patient demographics
  • Medical history
  • Vital signs
  • Medication orders
  • Laboratory results
  • Documentation templates

6. Challenges and Considerations

Some potential challenges in data loading include:

  • Data Privacy and Security: Ensuring that patient data is protected and confidential.
  • Complexity of EHR Systems: Replicating the full complexity of the EHR system may be challenging.
  • Resource Constraints: Limited resources may constrain the number and variety of scenarios that can be simulated.

To address these challenges, we will work closely with the IT department to ensure that the simulated EHR environment is secure and representative of the real system. We will also prioritize high-risk scenarios and focus on the most critical aspects of medication management and documentation.

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