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tion errors are significantly impacted. In fact, results were overwhelmingly favorable.

The mean composite rating computed across all items evaluating “improved” or “better” was 3.95. Means were significantly higher (p<.0001) for each item for pre-versus- post surveys.

Most significantly, all survey participants answered every medication safety question, producing a very high 4.15 com- posite rating finding that medication safety improved after the implementation of the EHR, see Figure 3.

Study #3 – Impact of Implementing Automation on

Figure 2 – Direct care nursing time is now approaching nearly 50 percent of every nursing shift, an almost 30 percent increase since year 1 of the study before the barcode system was implemented.

Study #2 – Staff Perception of Improved Patient Safety using Bedside Barcoding for Medication Delivery; United Regional Health Care System, Wichita Falls, Texas. Bedside barcoded medication delivery is a known best practice often measured by reductions in delivery errors. Medication errors are typically reported on a voluntary basis and are widely known to be under accounted. United Regional Healthcare System chose an innovative approach by studying the impact on nurses’ perceptions of the implementation of Allscripts. The hospital surmised that when staff is engaged in rolling out a new technology they will use on a regular basis, the associated new processes would be more efficient. A survey conducted prior to implementation of the new system determined a baseline of staff nurse perceptions of safety, ease of use and documentation when administering medications. A post-survey was conducted after fully imple- menting bedside barcoding in all inpatient nursing units. More than 400 nurses as participants evaluated the impact of the Knowledge-Based Medication Administration (KBMA) implementation by completing pre- and post-surveys leverag- ing Likert rating scales from 0-5. The data clearly shows that post implementation, staff perception and rate of medica-

Workflow, Staff Satisfaction and Outcomes; Presbyterian Intercommunity Hospital, Whittier, Cal. Presbyterian Intercommunity was building on a long history of EHR use when administrators decided to add knowledge-based charting. After reviewing survey instru- ments and methods, the hospital combined both end-user survey and work-sampling studies, along with a data review to answer three compelling questions: • What did the nursing and ancillary staff think of the move from paper to electronic documentation?

• Would there be a significant change in time spent in nurs- ing activities?

• Could the move from paper documentation to an elec- tronic system be made without adversely affecting out- comes?

Staff is surveyed before implementation of the new sys- tem, then again six months and one year post-implementation. A survey with a Likert scale from 1 (absolutely disagree) to 6 (absolutely agree) is used. A neutral choice option is not included. Answers are either favorable or non-favorable. A pre-implementation survey found the staff already had favorable early expectations of the benefits of the knowledge- based charting. Post-implementation results indicate that, as staff became more familiar with the system over time, the higher their perception of benefits, such as improved coor- dination of care, safety and outcomes, see Table 1.

Table 1. Perception of Effi cacy and Effi ciency for Key Questions 6 months

Has patient safety been enhanced? 12 months 70% favorable 78% favorable

Has clinical management improved? 61% favorable 71% favorable Has communication improved?

Has saved signifi cant time waiting for charts?

Has coordination of care improved?

74% favorable 81% favorable 82% favorable 86% favorable

73% favorable 83% favorable

Figure 3 – Composite rankings of questions regarding medication safety, ease of checking the Five Rights of Patient Medication, alerting and reduction/prevention of medication errors (mean=4.15, std. dev.=1.033, n=407).

Work-study samples were also conducted pre-implementa- tion, then again six months and one year post-implementation on four medical-surgical nursing units over three consecutive days. Every nurse on duty during the study period was ob- served at a random time within 30-minute intervals.


Continued on page 21 October 2012 11

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