Introduction

            Nursing informatics is a specialty that incorporates nursing knowledge and information technology to ensure that medical data and statistics are well-arranged to impact the outcomes of patient care in the hospital. As such Electronic Health Record (EHR) programs are used to run the process of collecting, assembling, and storing health-related information and statistics so that it can be applied in providing nursing care. For example, well-focused EHR programs can help nurses to avoid medical administration errors, and this helps avoid adverse effects related to the inappropriate administration of drugs.

In this discussion, a scenario whereby strange healthcare outcomes were noticed after a number of medication administration errors in a hospital will be assessed. The reported errors in medication administration are shown to have resulted due to the use of an unreliable EHR program by the nurses. Therefore, the major aim of this project is to come up with a taskforce that will carry out the assessment to identify a reliable EHR that can provide positive medical information to avoid encountering the same errors while caring for patients in the future. As such, this project will entail a detailed analysis of the selected scenario in relation to the EHR program, description of a reliable informatics theory that can be applied in initiating the needed change in the EHR program. Also, the role of informatics nurses in initiating the program.

The Scenario of Medication Administration Errors in relation to EHR Program

Medical administration errors have been reported to be among the major causes of unintended deaths in hospitals in the USA and other parts of the world (Senders, 2018). Such errors include the administration of wrong medications, dosage, and at an inappropriate time. Since medications have accompanying side effects and adverse effects, errors made during administration may result in such effects. In cases where nurses are vigilant during drug administration, the errors result due to wrong documentation in that they end up following wrong instruction. After realizing that human beings are prone to errors, researchers in the health sector discovered an electronic health record program which can be used to keep confidential information regarding patients’ in a secure mode. The program involves the use of computer skills to collect, edit, save and retrieve medical information when it is required. As such, the healthcare system introduced a specialty in nursing called nursing informatics. Apart from taking care of patients like other nurses, informatics deal with collection, arrangement, and analysis of medical information for each patient to make it easier for other health care personnel to identify them while providing care.

The major work of informatics is to ensure that the information saved in computer devices is correct. Such information includes the patients’ profile, history, medications, and planned interventions. However, sometimes informatics make mistakes while documenting data belonging to different patients. For example, they may allocate the wrong medication to a patient. Such an error will be transmitted to other health care practitioners, and so they will end up administering wrong medications. As a result, the patient may present with adverse symptoms which may result in chronic symptoms or death. Still, such errors can be avoided if confirmation is done before administering medications.

In the scenario, the cause of medication administration errors the use of an outdated EHR program. Such a program can initiate errors even when the informatics and other nurses in the hospital are vigilant. Since sentinel events had occurred due to the medication administration errors, an assessment of the best approaches to solve the issue was mandatory. In this case, the basis of the assessment is to determine an appropriate EHR program that can keep information about patients in a safe way without imposing unnecessary changes.  Basically, newly designed EHR programs are capable of keeping information safe. Thus, the assessment team should rely on new EHR programs such as AdvancedMD, CureMD, GE Healthcare, and Practice Fusion among others (Centers for Medicare & Medicaid Services (CMS), 2015).

Informatics Theory applicable in the Scenario

            There are several theories that can be used to determine a new EHR program that can be implemented in the hospital to mitigate medication administration errors. However, the favorable theory in this scenario is Lewin’s Change theory. The theory consists of three major steps which are applied in nursing informatics to initiate a change. The stages include unfreezing, change, and refreezing (Cummings, Bridgman, & Brown, 2016). Firstly, unfreezing is the first stage in the changes process whereby the organization realizes that there is a need to make a change. In the scenario, the need to change from the old EHR is apparent when sentinel events started happening due to medication administration errors. To avoid the continuation of such events, the hospital had to perform an assessment to come up with a new EHR program that can be reliable in storing patient information. As such, a taskforce to carry out the assessment had to be selected so as to begin the process of bringing change in the EHR program of the hospital. Again, the unfreezing process involves dissemination of the information regarding the intended change to other members in the organization to ensure that they are aware of any changes. Also, this helps the taskforce to get views concerning the intended change.

The second stage in the change process is the initiation of change itself. In this scenario, the change involves replacing the previous EHR program with the updated one which does not cause unnecessary errors in the recorded patient information. According to Lewin, the change process does not only change in the intended strategies but also in the thought, behaviors. The team involved in the change process has to convince other organizational members that the intended modifications will impact the organization’s functions. Also, this stage involves spending all the need resources to implement the change. In this scenario, the installation of the new EHR program will take place in this stage. Testing the program for reliability will also be necessary to ensure that it functions well thereafter. To initiate this change, organization have to incur all the costs which are used to purchase new machines, and also employ new personnel who have skills to operate them. Therefore, the healthcare organization should be ready to support the project financially so that this stage can be successful.

The last stage in Lewin’s change theory is refreezing. At this stage, the organization ensures that the implemented procedure becomes a standard operating procedure. Employees are encouraged to adhere to it such that those who do that are rewarded by the administration. Also, these stages include finishing up the pending projects about the implemented change. Lewin claims that without this process the change may backslide and employees may go back to the previous practices. Therefore, similar approaches should be followed while implementing the new EHR program in the hospital. In this case, the taskforce should encourage the healthcare administration to lead nurses in adhering to the new approach. At the end of this stage, the new program will have been frozen into a normal practice in the organization.

As explained in Lewin’s change theory above, the new EHR program should be established in stages to ensure that it becomes a standard operating procedure. Also, the whole health care team should take part in the change process since the program will benefit their functions in the hospital (Udod, & Wagner, 2018). Besides, teamwork will ensure that the initiated change does not backslide. As a result, the previous sentinel events that resulted from the unreliable EHR program will not be present again.

Role of the Informatics Nurse in the Scenario

As shown earlier, informatics nurses are specialized in the field of informatics whereby they deal with the recording of patient information in computers so that it can be secure for retrieval any time it is required. Such nurses have undergone special training apart from the usual training for nurses. Therefore, they have more roles to play in enhancing patient safety. Firstly of all, they make the required changes in the EHR program to enhance the safe storage of information. Since they have undergone training in managing information technology, they can comfortably manipulate computers to ensure that patient data is accessible at any time. By doing this, errors that present during patient treatment will be avoided. For example, medical administration errors will not be witnessed. Therefore, they enhance patient safety through keep clear records of patients.

Secondly, informatics nurses are involved in the analysis, designing, and implementation of the clinical systems. Clinical systems are applications that are used to analyze data about the progress in the hospital. After analyzing the hospital management makes decisions on what to do to make improvements in the healthcare system. Since informatics nurses possess knowledge in running computer devices, they are involved in analyzing such information. Another role of informatics nurses is to improve the quality of care in the hospital (McCormick, & Saba, 2015). As shown above, they collect information about the progress in the hospital, analyze it and present it to the management so that decisions to improve the quality of care can be made. Lastly, informatics nurses are involved in the nursing care of patients. They also undergo normal training for nurses. Therefore, they can as well carry out the usual duties of nurses such as administering medications and managing patients using the nursing care plan.

Conclusion

            In the discussion above, the approaches towards establishing a new EHR program have been explained so as to eliminate the sentinel events resulting from medication administration errors. To necessitate this, the taskforce should apply a reliable informatics theory such as Lewin’s change theory. Such a theory will guide them from the start of the assessment to implementation of the new EHR program. More so, nurses play a vital role in preventing medical administration errors. Therefore, they should be involved in the change process. Furthermore, the aim of this paper was to initiate the project of introducing a reliable EHR program that cannot cause medical errors. Thus, the healthcare organization should take up the mantle of implementing the new EHR program to improve patient safety.

Reference

Centers for Medicare & Medicaid Services (CMS), HHS. (2015). Medicare and Medicaid Programs; Electronic Health Record Incentive Program–Stage 3 and Modifications to Meaningful Use in 2015 Through 2017. Final rules with comment period. Federal Register, 80(200), 62761.

Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human relations, 69(1), 33-60.

McCormick, K., & Saba, V. (2015). Essentials of nursing informatics. McGraw-Hill Education.

Senders, J. W. (2018). Medical devices, medical errors, and medical accidents. In Human error in medicine (pp. 159-177). CRC Press.

Udod, S., & Wagner, J. (2018). Common Change Theories and Application to Different Nursing Situations. Leadership and Influencing Change in Nursing.