here did the myth about nurses not welcom- ing automation to their workflows begin? The benefits of electronic health records (EHR) systems are well known – more ef- ficient documentation of patient care and better treatment outcomes. But a common perception persists that getting nursing professionals to adopt EHRs is like coaxing a child to take a pill: trust me, just swallow it and you’ll feel better. Concerns about adopting new technology are often valid. Nursing staffs already operate at full steam and may have reservations about the time it takes to learn a new system. Bottom line: Using an EHR as part of the workflow changes established processes, and the nursing staff might not fully understand how it benefits patient care. Recent studies related to the implementation of EHRs conducted at two large urban hospitals and one rural community hospital provide mean- ingful insight into the real benefits of moving to automated systems. All three studies examine the impact of automated systems on nurses’ work- flows, as well as beneficial outcomes.
Denise Authier, RN, BSN, is professional practice coordinator, Presbyterian Intercommunity Hospital, Whittier, Cal. Pamela Bradshaw, MSN, MBA, is vice president of nursing and clinical services, department of nursing, United Regional Health Care System, Wichita Falls, Texas. Louise Hickman, RN, BSN, MHA, CLNC, is vice president of patient services/chief nursing officer, Jefferson Regional Medical Center, Pine Bluff, Ark. Steve Shaha, PhD, DBA, is professor, Center for Policy and Public Administration, University of Utah, and principal outcomes consultant, Allscripts, Chicago, Ill. For more on Allscripts: www. rsleads.com/210ht-204
While each hospital conducted its own cus- tomized study, they all produced similar, positive results. Instead of balking at implementing new sys-
tems, the studies found that EHRs enable nurses to: • Spend more time with patients; • Improve coordination of care; • Reduce time spent documenting patient care; and • Deliver safer care with fewer medication errors. Study #1 – Nursing Documentation and Barcode Medi-
cation Administration; Jefferson Regional Medical Center, Pine Bluff, Ark.
This three-year study uses work-sampling techniques to document the amount of time the nursing staff spent in direct-versus-indirect patient care, with the assumption that more direct care is better because:
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Figure 1 – Impact on how much time nurses spent in direct care before and after the implementation of the bedside barcoded medication delivery system. Direct care time rose nearly 50 percent two years after the system was in use.
HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com Authier Bradshaw Hickman Shaha By Denise Authier, Pamela Bradshaw, Louise Hickman and Steve Shaha
• Nurses are the best professionals to know and coordinate patient care. By spending more time with patients, nurses can more actively and intuitively assess patient needs;
• Patient outcomes are better when nurses are able to make sure needs are met; and
• Patient satisfaction with care rises with more direct con- tact with the nursing staff.
The study is conducted during the same month in each of the three years to normalize study results for patient load, clinical severity and seasonality. The three years of data represent: • The baseline, during which the EHR was already imple- mented, along with computer-based provider order entry (CPOE).
• Year 1, with the implementation of the nursing documen- tation capabilities within the EHR.
• Year 2, with the additional implementation of barcode medication administration integrated with the EHR. At the end of the three-year study, nurses were observed to spend 1½ hours more time for direct patient care per 12- hour shift, a nearly 30 percent increase (p<.01), see Figure 1. With this boost, direct care – care at the bedside in direct proximity of the patient – is approaching 50 percent of nurs- ing time (p<.001), see Figure 2.
In year 2, the impact of the barcode medication admin- istration is studied. With no change in how medical errors are reported or tracked, Jefferson Regional also tracked a more than 70 percent decrease in medication errors after implementing the Allscripts system.