EHR usability and usefulness, perceived missed nursing care and medication errors in critical care

EHR 可用性和实用性、感知的错过护理和重症监护中的用药错误

• 批准号: 10670851
• 负责人: AYSE PINAR GURSES
• 金额: $ 40万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670851
• 关键词: EHR; usability; usefulness; perceived; missed

PROJECT ABSTRACT: Nurses spend an average of one-third of their patient care time interacting with the electronic health record (EHR), and high nursing workloads can lead to missed nursing care essential for patient safety and quality of care, and increase the odds of medication errors, which can be deadly. However, there has been a lack of studies of EHR burden on nurses, even though over 90% were dissatisfied with inpatient EHR use, burden, time demands, and had doubts about EHR impact on patient care quality and safety. This indicates a critical need to comprehensively examine EHR usability and usefulness and to develop effective, well thought out solutions using a human factors and systems engineering approach. However, the limited studies typically examine a single aspect of usability/usefulness, and very few link nurse EHR to patient safety and quality outcomes. To address these research gaps, we propose a 5-year, prospective, multi-site, mixed-method field study with the following aims: 1-to understand and comprehensively evaluate nurse EHR usability and usefulness, using micro- and macro-level measures, that include process mapping of nurse EHR clinical workflow, EHR data analytics (e.g., EPIC reports-time stamps, task/page sequencing), structured interviews, targeted observations and nurse surveys, with consideration of EHR structure (functionality, interoperability); 2- to measure real-time usability with mobile monitoring (via eye-tracking glasses) with time-stamped EPIC reports, followed by cognitive interviews post-monitoring to obtain details on EHR challenges and flow decisions; 3- to examine the impact of EHR usability and usefulness on nurse-perceived patient safety (missed nursing care, medication errors), accounting for various dimensions of nursing workload (e.g., cognitive, physical, temporal), and clinical nursing workflow. Finally, we will conduct a proactive risk analysis of 3 key EHR-supported clinical nursing workflow processes. The study addresses AHRQ priorities by identifying potential “root causes of threats to patient safety,” noted by the Healthcare Safety & Quality Improvement Research (HSQR) section, through the study’s focus on reducing nursing EHR burden, perceived missed nursing care and medication errors.

项目摘要： 护士平均花费其患者护理时间的三分之一与电子健康记录互动 （EHR），高护士工作量可能会导致对患者安全和质量至关重要的遗漏护理护理 护理并增加药物错误的几率，这可能是致命的。但是，缺乏 尽管超过90％对住院EHR的使用不满意，但对护士的EHR燃烧的研究，燃烧， 时间需求，并对EHR对患者护理质量和安全产生影响有疑问。这表明一个关键 需要全面检查EHR的可用性和实用性，并发展有效，经过深思熟虑 使用人为因素和系统工程方法的解决方案。但是，有限的研究通常 检查可用性/实用性的一个方面，很少有将护士EHR与患者的安全和质量联系起来 结果。为了解决这些研究差距，我们提出了一个5年，预期的，多站点的混合方法领域 以以下目的进行研究：1了解并全面评估护士EHR可用性和 使用微观和宏观措施，包括护士EHR临床映射的实用性 工作流程，EHR数据分析（例如，Epic Reports时间邮票，任务/页面测序），结构化访谈， 有针对性的观察和护士调查，并考虑EHR结构（功能，互操作性）； 2- 通过移动监控（通过眼镜玻璃）测量实时可用性 报告，随后进行监测后的认知访谈，以获取有关EHR挑战和流程的详细信息 决定； 3-检查EHR可用性和实用性对护士感知的患者安全的影响（错过 护士护理，用药错误），考虑护士工作量的各个方面（例如，认知， 身体，临时）和临床护士工作流程。最后，我们将对3个关键进行主动风险分析 EHR支持的临床护士工作流程过程。该研究通过识别来解决AHRQ的优先事项 潜在的“对患者安全威胁的根本原因”，由医疗保健安全和质量改进指出 研究（HSQR）部分，通过研究的重点减少护士EHR Burnen，认为错过了 护理和用药错误。