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

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交互 (EHR)，高护理工作量可能导致错过对患者安全和质量至关重要的护理 护理，并增加用药错误的几率，这可能是致命的。然而，一直以来，缺乏 关于护士电子病历负担的研究，尽管超过90%的人对住院病人电子病历的使用、负担、 时间要求，并对电子病历对患者护理质量和安全的影响表示怀疑。这表明一个危急的 需要全面检查电子病历的可用性和有用性，并开发有效的、经过深思熟虑的 使用人的因素和系统工程方法的解决方案。然而，有限的研究通常 检查可用性/有用性的一个方面，很少将护士电子病历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，我们提出了一个为期5年的、前瞻性的、多地点的、混合方法的领域 研究的目的如下：1-了解和全面评估护士电子病历的可用性和 有用性，使用微观和宏观水平的措施，包括护士电子健康记录临床的过程图 工作流程、电子病历数据分析(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，同时考虑到电子病历结构(功能、互操作性)；2- 使用带有时间戳的EPIC通过移动监控(通过眼睛跟踪眼镜)衡量实时可用性 报告，随后在监测后进行认知访谈，以获得有关电子病历挑战和流程的详细信息 决定；3-检查电子病历的可用性和有用性对护士感知的患者安全的影响(遗漏 护理、用药差错)，说明护理工作量的各个维度(例如，认知， 物理、时间)和临床护理工作流程。最后，我们将对3个关键因素进行积极的风险分析 EHR支持的临床护理工作流程。这项研究通过确定AHRQ的优先事项 医疗安全和质量改进指出，潜在的“威胁患者安全的根本原因” 研究(HSQR)部分，通过研究的重点减少护理EHR负担，感知错过 护理和用药差错。

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.