Introduction
The nursing setting is a significant aspect of quality care. Moreover, research suggests that the parts of the environment influence healthcare design, particularly in terms of minimizing the occurrence of hospital-acquired illnesses. Several impacts are ensuing from hospital settings, which include patient safety, other clinical outcomes, and staff consequences. The findings support the importance of enhancing outcomes for various design features, such as private rooms rather than multibed spaces, effective ventilators, good acoustic surroundings, and other interventions. However, one of the most significant issues concerns electronic system vulnerability in the workplace, which has similar consequences for healthcare. In this presentation, the specific problem of work rounds affecting electronic systems is discussed.
Identifying electronic vulnerabilities
The electronic medical record has gained popularity due to its undeniable advantages over a paper-based approach. As electronic medical records grow more prevalent, various security vulnerabilities to the systems arise. Weak authorization, cross-site programming, and code injection are among the common security flaws discovered in electronic medical record systems. However, to manage these vulnerabilities, it is necessary to establish the frequent causes that affect electronic systems. As such, work rounds often result in poor management of electronic systems. Staff is required to conduct activities such as noting allergies, ordering testing, and prescribing prescriptions during the ward round, lengthening the time needed to serve the patient.
Work rounds issue within the context of electronic systems
The work rounds’ effect on electronic systems is connected primarily to communication problems. Poor communication between nurses and doctors contributes significantly to adverse occurrences in the management of the systems. First, the complex structure of nurses’ and physicians’ relationships may hamper communication and lead to substandard treatment. Second, environmental variables such as variances in workflow habits may obstruct communication chances. Finally, the level of stress encountered by nurses and doctors while working has been recognized as a factor influencing some activities, such as physician-to-nurse handoffs and nursing processes. As a result, communication issues, healthcare settings hierarchy, differences in the workflow, and stress during the work rounds affect the use of electronic systems.
Work rounds issue impact on employee safety
The presence of work rounds-related problems described earlier results in several interconnected implications for patient care. As such, the possibility for the electronic systems to lengthen ward rounds causes discharges to be delayed, increasing A&E wait times. In turn, the delay of care poses hazards to patient safety, namely, preventing rapid intervention for acute cases. Moreover, ward rounds shift from experts reporting clinical choices to junior doctors participating more actively in care planning. Junior physicians complete most of the paperwork, which raises concerns that they would remain clerks for their consultants, resulting in missed learning opportunities. Hence, the junior clerks who missed the significant part of learning during their practice might provide poor patient care in the future.
Alternatives to the current state
The research suggests several alternatives to the traditional work rounds to improve the efficiency of their integration with electronic systems. For example, physicians advocated replacing computers with two-way mobile communications systems. This practice reorganizes electronic health records management to enable access to essential information and increase electronic system training. Other researchers devised a model for change with multiple interventions, which demonstrated effectiveness in reducing care delays and improving communication. The interventions tried were reasoning sharing, PFCR (Participation in Family Centered Rounds) checklist adjustment, electronic transfer SmartForms, data verification and feedback, and discharge criteria uniformity. Thus, these alternatives can ameliorate the weakness in the electronic system.
An educational plan for the roll-out of the improved system
To implement the change, several steps are required to incorporate the described practices. The first step in developing an effective roll-out strategy is determining whom the change may affect. Next, the implementation team, which comprises quality improvement experts, healthcare administrators, and hospital staff, is involved. The necessary actions for education and implementation include training in working with reasoning sharing, checklist adjustment, SmartForms, data verification, and feedback. The training milestones should be connected to the practical exercises completed by the staff, which are arranged according to a timetable. Finally, the milestones should be the ground for the checkpoint to evaluate the pre-implementation results.
Strategy for obtaining buy-in
The proponents of the change should understand that the new model expands verbal conversations of discharge conditions during PFCR using quality improvement techniques without increasing round length, which signifies the ease of implementation. The process of introducing and funding the change requires, first of all, identifying its stakeholders. Patients, physicians, managers, administrators, clinical assistants, and payers are all familiar stakeholders in transforming healthcare. The findings of the stakeholder analysis serve as the foundation for the project communication strategy. The implementation would require quality improvement practitioners who engage stakeholders to assess unpredictable consequences or patient treatment experiences. The stakeholders’ participation advantages include improved adherence to ethical norms to ensure that all valid interests are represented, more valuable and relevant assessment information, and improved political buy-in to increase the effect.
Conclusion
To conclude, one of the most significant issues affecting the electronic systems in healthcare is work rounds and the consequences of the related problems. The work rounds often cause inefficiency in the management of electronic medical records due to poor communication, hierarchies, complicated structure, varieties in workflow, and employee stress. As a result, the work rounds affect patient safety in terms of electronic systems by delaying care and reducing learning opportunities for junior doctors. However, these issues could be eliminated or their influence reduced by implementing strategies for enhanced communication. This alternative comprises practices such as mobile devices, regular checklist filling, reasoning sharing, and transfer of data inputs to all the involved staff. To implement the change, the proponents should encourage stakeholders by hiring quality improvement professionals to guarantee buy-in of the program.
References
Adamu, J., Hamzah, R., & Rosli, M. (2020). Security issues and framework of electronic medical record: A review. Bulletin of Electrical Engineering and Informatics, 9(2).
Bayramzadeh, S., Portillo, M., & Carmel-Gilfilen, C. (2019). Understanding design vulnerabilities in the physical environment relating to patient fall patterns in a psychiatric hospital: Seven years of sentinel events. Journal of the American Psychiatric Nurses Association, 25(2).
Christianson, K., Kalinowski, A., Bauer, S., Liu, Y., Titus, L., Havas, M., Lynch, K., & Rogers, A. (2022, January 6). Using quality improvement methodology to increase communication of discharge criteria on rounds. Hospital Pediatrics, 12(2), 156–164.