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

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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.