Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Institute for Medicine and Public Health, and the Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Patient Care Services, Vanderbilt University Medical Center, Nashville, USA.
J Gen Intern Med. 2023 Oct;38(Suppl 4):982-990. doi: 10.1007/s11606-023-08278-1. Epub 2023 Oct 5.
Electronic health record (EHR) system transitions are challenging for healthcare organizations. High-volume, safety-critical tasks like barcode medication administration (BCMA) should be evaluated, yet standards for ensuring safety during transition have not been established.
Identify risks in common and problem-prone medication tasks to inform safe transition between BCMA systems and establish benchmarks for future system changes.
Staff nurses completed simulation-based usability testing in the legacy system (R1) and new system pre- (R2) and post-go-live (R3). Tasks included (1) Hold/Administer, (2) IV Fluids, (3) PRN Pain, (4) Insulin, (5) Downtime/PRN, and (6) Messaging. Audiovisual recordings of task performance were systematically analyzed for time, navigation, and errors. The System Usability Scale measured perceived usability and satisfaction. Post-simulation interviews captured nurses' qualitative comments and perceptions of the systems.
Fifteen staff nurses completed 2-3-h simulation sessions. Eleven completed both R1 and R2, and seven completed all three rounds. Clinical experience ranged from novice (< 1 year) to experienced (> 10 years). Practice settings included adult and pediatric patient populations in ICU, stepdown, and acute care departments.
Task completion rates/times, safety and non-safety-related use errors (interaction difficulties), and user satisfaction.
Overall success rates remained relatively stable in all tasks except two: IV Fluids task success increased substantially (R1: 17%, R2: 54%, R3: 100%) and Downtime/PRN task success decreased (R1: 92%, R2: 64%, R3: 22%). Among the seven nurses who completed all rounds, overall safety-related errors decreased 53% from R1 to R3 and 50% from R2 to R3, and average task times for successfully completed tasks decreased 22% from R1 to R3 and 38% from R2 to R3.
Usability testing is a reasonable approach to compare different BCMA tasks to anticipate transition problems and establish benchmarks with which to monitor and evaluate system changes going forward.
电子健康记录 (EHR) 系统的转换对于医疗保健组织来说具有挑战性。像条形码药物管理 (BCMA) 这样的高容量、关键安全任务应该进行评估，但在转换过程中确保安全的标准尚未建立。
确定常见且容易出现问题的药物任务中的风险，以便为 BCMA 系统之间的安全过渡提供信息，并为未来的系统变更建立基准。
在遗留系统 (R1) 和新系统预 (R2) 和上线后 (R3)，护理人员完成了基于模拟的可用性测试。任务包括 (1) 持有/管理，(2) 静脉输液，(3) 按需疼痛，(4) 胰岛素，(5) 停机/按需，和 (6) 消息传递。任务执行的视听记录被系统地分析了时间、导航和错误。系统可用性量表测量了感知可用性和满意度。模拟后访谈捕捉了护士对系统的定性意见和看法。
十五名护理人员完成了 2-3 小时的模拟会议。十一人完成了 R1 和 R2，七人完成了所有三轮。临床经验从新手 (<1 年) 到经验丰富 (>10 年) 不等。实践环境包括 ICU、降阶梯和急性护理部门的成人和儿科患者群体。
任务完成率/时间、安全和非安全相关的使用错误（交互困难）以及用户满意度。
除了两项任务外，所有任务的总体成功率保持相对稳定：静脉输液任务的成功率大幅提高（R1：17%，R2：54%，R3：100%），停机/按需任务的成功率下降（R1：92%，R2：64%，R3：22%）。在完成所有三轮的七名护士中，总体安全相关错误从 R1 到 R3 减少了 53%，从 R2 到 R3 减少了 50%，成功完成任务的平均任务时间从 R1 到 R3 减少了 22%，从 R2 到 R3 减少了 38%。
可用性测试是一种合理的方法，可以比较不同的 BCMA 任务，以预测过渡问题，并建立基准，以便在未来监测和评估系统变更。
