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： 护士平均花费三分之一的患者护理时间与电子健康记录进行交互 （EHR），高护理工作量可能导致错过对患者安全和护理质量至关重要的护理护理 护理，并增加用药错误的几率，这可能是致命的。 关于护士 EHR 负担的研究，尽管超过 90% 对住院患者 EHR 使用、负担、 时间需求，并对 EHR 对患者护理质量和安全的影响表示怀疑。 需要全面检查 EHR 的可用性和实用性，并经过深思熟虑以提高有效性 然而，使用人为因素和系统工程方法的解决方案通常有限。 检查可用性/有用性的单个方面，很少将护士 EHR 与患者安全和质量联系起来 为了解决这些研究空白，我们提出了一个为期 5 年、前瞻性、多地点、混合方法的领域。 研究的目的如下： 1-了解并全面评估护士 EHR 的可用性和 使用微观和宏观层面的措施，包括护士 EHR 临床流程图 工作流程、EHR 数据分析（例如 EPIC 报告时间戳、任务/页面排序）、结构化访谈、 有针对性的观察和护士调查，同时考虑 EHR 结构（功能、互操作性）2-； 通过带时间戳的 EPIC 移动监控（通过眼动追踪眼镜）来测量实时可用性 报告，然后在监测后进行认知访谈，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（遗漏） 护理、用药错误），考虑护理工作量的各个方面（例如认知、 最后，我们将对 3 个关键因素进行主动风险分析。 该研究通过确定 AHRQ 优先事项来解决 EHR 支持的临床护理工作流程。 医疗安全与质量改进组织指出，潜在的“威胁患者安全的根本原因” 研究 (HSQR) 部分，通过研究的重点是减少护理 EHR 负担，感知遗漏 护理和用药错误。