Week 4: WORKFLOW SOLUTIONS: EHR MOBILITY

Workflows and Nursing Care Delivery

Challenges are faced when nurses have to alter effective workflows in order to accommodate technology not only impacting patient care but staff morale and particularly in relation to electronic health record. We know that the EHR is here to stay and that the need is to focus on improving workflows in the nursing care delivery environment...

A workflow is the sequence of processes through which a piece of work passes from initiation to completion. It is the set of tasks—grouped chronologically into processes—and the set of people or resources needed for those tasks, that are necessary to accomplish a given goal (NCBI). This can take shape in any number of ways in the healthcare setting. Nurses are faced with difficult scenarios in having to prioritize patient care, establish relationships and maintain high standards while technology platforms have faltered in keeping up with the demands of nursing workflow.

THE WORKFLOW PROBLEM

Not having proper access to EHR documentation platforms can be cause for serious safety concerns. When nurses cannot access health records in real-time, nurses report a litany of problems and barriers to timely documentation of interventions, care plans, and overall workflow (NCBI).

Many opportunities for development of HER documentation platforms have emerged in recent years. The initial concept of an ideal workflow in which the nurse had access to a stationary computer was quickly recognized in being insufficient (Heslop et al. 2011). The importance of having ready access to mobile devices has become a significant challenge in the ICU where I work.

The nurses have to log into multiple devices and loose information if pulled away. The ideal workflow is that the nurse has the time to carefully document each series of events and assessments. But the workflow for the day demands that the nurse has to pass all medications and assess patients early rather than late. By the time testing, transfers, admissions, discharges, and all manner of challenges present, the nurses cannot document in a timely manner. This is cause for concern. When information is not entered in a timely manner, important detail can be lost, increasing the risk of documenting on the wrong patient, and any number of other errors.

 

MORE ACCESS: BETTER CARE

 A BETTER WAY

Evidence reveals that nurses having to log into multiple devices is problematic and interrupts workflows. The solution is a personalized, wireless access device that can go anywhere with capability to access records, scan medications, and document patient care in the EHR. (Parker & Baldwin. 2008). The access to real-time electronic chart information and access decision-support mechanisms. Failure to comply with medication bar coding can be a major safety concern with work-arounds impeding safe processes. The introduction of a wireless device would allow the ICU nurses to seamlessly access EHRs and document care delivered. The Infographic below provides a description of the workflow.

THE NEW WORKFLOW: PLANNING AND PROCESS

ehr-infographic

References

Parker, C., & Baldwin, K. (2008). Mobile device improves documentation workflow and nurse satisfaction. CARING Newsletter, 23(2), 14-18 5p.

Heslop et al. (2011). Enhancing Clinical Nurse Workflow through Redesign of Networked Wireless Laptop Computers. Electronic Journal of Health Informatics, 6(3).

Patient Safety and Quality: An Evidence-Based Handbook for Nurses Organizational Workflow and Its Impact on Work Qualityhttp://www.ncbi.nlm.nih.gov/books/NBK2638/