Discussion Topic
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Refer to Chapter 24 for this week’s Discussion Question
Case Discussion:
You are a nursing educator within a large academic medical center responsible for the annual competency evaluation of nurses within the hospital and clinics. The senior vice president for quality and safety, the chief information officer, and the chief nursing information officer requested a meeting to discuss identified issues related to the electronic health record (EHR) documentation and patient safety issues regarding medication orders, management of the orders within the EHR, and administration of the medications.
Events involving patient safety are increasing, and the senior executives believe that this is largely an issue related to competency in using the new EHR (implemented in the past 2 years). They have asked you to recommend a training and competency evaluation strategy that might affect these measures of patient safety and improve competencies related to the documentation errors they are seeing. They are taking responsibility for monitoring the progress on impact and are asking you to come back with recommendations for the education program.
After meeting with your chief nursing officer, education department staff, directors of nursing on the units, and the staff nurses, all parties agree that it would be helpful to have a training program for the EHR that simulates clinical workflow on some of the common issues concerning medication errors.
You and your department are responsible for the simulation center, and the following are questions for your team to consider as you design a plan for the implementation of the EHR in the simulation lab. Choose ONLY 2 of the questions below to answer in your discussion post:
1. What strategies will you use to fully implement the practice domain that replicates the EHR production domain with which nurses are currently working? Explain your answers with best practices and scholarly support.
2. How will you identify cases related to the patient safety events that are occurring and incorporate them into the EHR to simulate what is happening and allow nurses time to practice on workflow and documentation related to these events? Explain your answers with best practices and scholarly support.
3. How will you evaluate the nurses’ performance and what assessment tools will you need? Explain your answers with best practices and scholarly support.
4. How much time do you believe you need per nurse to run through the simulated case, and how will you manage these time constraints and the schedule in the simulation center? Explain your answers with best practices and scholarly support.
5. Will you manually load data into the EHR representing the clinical data, including data that are clinically representative of the cases in which medication and documentation errors are occurring? Explain your answers with best practices and scholarly support.
6. What other alternative could you consider in loading clinical data representative of the conditions related to medication and documentation errors? Explain your answers with best practices and scholarly support.
7. What challenges do you identify in the data-loading strategies? Explain your answers with best practices and scholarly support.
CHAPTER 24
Developing Competencies in Nursing for an Electronic Age of Healthcare
BACKGROUND
There is no agreed-upon definition of competency among educators, employers, and regulators.
Competencies establish a standard against which students can be measured.
No standards exist to identify when competency assessment should focus on general professional competency versus specialty competency.
Multiple national agencies have published position statements and accreditation requirements related to the integration of informatics technology.
Technology Informatics Guiding Education Reform (TIGER) Initiative has identified five core competencies including clinical nursing, nursing management, quality management, IT management in nursing, and coordinated interprofessional care.
TIGER and European Union collaborated to develop the International Recommendation Framework of Core Competencies in Health Informatics 2.0.
American Association of Colleges of Nursing (AACN) has released the DRAFT The Essentials: Core Competencies for Professional Nursing with Domain 8 dealing with Informatics and Healthcare Technologies.
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SIMULATION FOR EDUCATING HEALTHCARE PROFESSIONALS
Simulation is an educational technique.
It replicates substantial aspects of the real world in a fully interactive manner.
It can be conducted in a simulation center, a flipped classroom setting, or in situ.
Integration of simulation-based experiences into a program of study is based on published evidence-based standards.
Simulation based electronic health record (EHR) training has shown increased awareness of patient safety issues and promoted competency and confidence related to EHR use.
Transferability of knowledge from the classroom setting into a practice setting is inefficient.
The performance can vary due to a lack of standards for EHR skills.
Important factors related to students’ perception of educational EHRs:
Attitude of both students and faculty, perceived usefulness of the application, and ease of use.
Faculty superusers are essential for the acceptance and integration of academic EHRs.
Design, implementation, and assessment of simulation-based activities should be based on national/international standards.
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SIMULATION FOR EDUCATING HEALTHCARE PROFESSIONALS (Cont.)
Challenges in adopting and implementing EHRs for informatics competency development:
Implementing an EHR within a simulation center that replicates the clinical environment.
Live or propriety EHR domain can be very costly.
Simulation and educational facilities do not receive funding provided by meaningful use incentives.
Plethora of EHR systems available in the market.
Lack of variability that clinicians experience in a clinical setting.
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TELEHEALTH AND TELEMEDICINE IN SIMULATION
Telemedicine refers to the care provided by healthcare providers.
Usually physicians, using telecommunication technologies.
Telehealth includes a wider range of services provided by nurses, home health practitioners, physical therapists, and pharmacists.
This brings education and care management to patients in areas where services are not locally available.
Telehealth integration into the curriculum and simulation is inconsistent across nursing schools.
Barriers to the integration of telehealth into simulation include:
Lack of faculty experience
No room in the current curriculum for additional content
Cost of technology and equipment
Complexity in using the technology
Competencies with telehealth can be developed using simulation during Objective Structured Clinical Examinations (OSCE).
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EVALUATING INFORMATICS COMPETENCIES
Evaluation methods to examine EHR competencies in the clinical environment include:
Levels 1 through level 4 of nursing informatics competencies
Valid and reliable methods to evaluate informatics competencies are not yet available.
Evaluation of informatics competencies relies primarily on self-report through survey instrumentation methods.
Competency Assessment in Simulation of Electronic Health Records (CASE) is an objective tool to evaluate EHR documentation competencies in simulation settings.
It can be used by nursing faculty.
A five-point Likert scale provides faculty a method to score the students documentation.
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IMIA ON HEALTH INFORMATICS
International Medical Informatics (IMIA) has provided a three-dimensional model for education in biomedical and health informatics.
Professionals in healthcare, including physicians, nurses, and biomedical health informatics professionals (BMHI)
Specialization in BMHI, including health information technology (HIT) users and specialists
Stage of career progression ranging from bachelor’s to doctoral degrees
IMIA has developed the HEALTH model.
It emphasizes levels competencies needed to fully realize the benefits of HIT.
Health Information Technology Competencies (HITCOMP) is a collaboration of the European Union and the United States that developed a searchable database of healthcare informatics competencies.
Quality and Safety Education for Nurses (QSEN) initiative outlines knowledge, skills, and attitudes required for the six competencies.
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IMIA ON HEALTH INFORMATICS (Cont.)
The application of evidence-based guidelines to the care provided during the scenario reinforces learning.
It provides a safe environment to practice clinical reasoning skills.
Informatics is one of the six competencies identified by the QSEN initiative.
Teaching approaches for informatics can include:
Classroom skills
Simulation lab activities
Clinical practicum
To incorporate components of QSEN strategies, interprofessional education collaborative competencies can be overlaid.
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SUMMARY
TIGER initiative provides guidance for faculty to assess students’ informatics competencies.
National League for Nursing (NLN), AACN, IMIA, HITCOMP, and QSEN ensure nurses have the necessary informatics competencies.
EHRs in simulation can help students and healthcare providers practice in a safe environment.
They can:
Learn to manage and retrieve critical information.
Develop skills in clinical judgment.
Be prepared to document before entering the clinical setting.
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