The Ohio State University Wexner Medical Center, The Ohio State University College of Nursing, Columbus, OH, USA.
Translational Implementation Science Core, Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare, Columbus, OH, USA.
Worldviews Evid Based Nurs. 2020 Apr;17(2):136-143. doi: 10.1111/wvn.12435. Epub 2020 Mar 31.
Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence-based practice (EBP) initiatives into the electronic health record (EHR).
The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence-based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation.
A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes.
Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays.
Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.
全国各地的传闻都强调了这样一个事实，即护士在将新的基于证据的实践（EBP）举措纳入电子健康记录（EHR）时面临着重大挑战。
本研究的目的是：（a）了解将 EBP 嵌入 EHR 的当前流程，（b）揭示与将新的基于证据的护理实践快速纳入 EHR 相关的促进因素和障碍，以及（c）确定在全国范围内的医疗保健组织中成功实施的策略和流程。
采用定性研究设计。采用目的性抽样从全国各地招募护士（N=29）。进行了九次焦点小组会议。制定了半结构化访谈问题。通过视频和音频会议进行焦点小组讨论。使用归纳方法，阅读每个转录本并生成初始代码，从而产生主要主题和子主题。
确定了五个主要主题：（a）由于 EHR 导致 EBP 推进的障碍，（b）EHR 的组织结构和管理流程，（c）EHR 变更优先级的当前流程，（d）对临床医生实施 EBP 的能力的影响，以及（e）等待时间和延迟。
将新的 EBP 实践变更延迟纳入 EHR 是重大的。这些延迟是挫败感和工作不满的来源。我们的结果强调了为预期变更进行事先规划并将预期延迟纳入 EBP 项目时间表的重要性。此外，护理主管必须倡导在信息学技术治理结构中增加护理代表人数，并增加资源来聘请护理信息学家。
