2.50
Hdl Handle:
http://hdl.handle.net/10755/157464
Type:
Presentation
Title:
FAILURE TO RESCUE AND LINKS TO NURSE TO NURSE COMMUNICATION
Abstract:
FAILURE TO RESCUE AND LINKS TO NURSE TO NURSE COMMUNICATION
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Carrington, Jane M., RN
P.I. Institution Name:University of Colorado Denver
Title:Assistant Professor
Contact Address:13120 E 19th Ave, Room 4227 Mail stop C288-19, Aurora, CO, 80045, USA
PURPOSE: The purpose of this research was to explore nurses' perceptions of the strengths and limitations of the electronic health record (EHR) to effectively communicate patient status associated with a clinical event. A clinical event was defined as an unexpected event experienced by a patient on medical, surgical, or telemetry nursing units that did not require a patient transfer.
BACKGROUND: The link between nurse to nurse communication and failure to rescue or patient death associated with hospital complications, is not well understood.1 Failure to rescue has been associated with organizational and unit level systems issues. However, few have studied nurse to nurse communication as an antecedent to failure to rescue. Nurse to nurse communication was defined for this study as nursing documentation using the EHR. Few studies have explored the effectiveness of the EHR as a communication system. These studies were limited in that nurses did not focus their perceptions on a specific event and nurses were not conceptualized by their role in the communication process (documenting and receiving nurses, for example).
CONCEPTUAL FRAMEWORK: Tenets of Information Theory guided this research: sender, device, receiver, redundancy, and noise. Redundancy or repetition of the message increases information while noise is a disruption of the message, decreasing information. For this study, the sender was the documenting nurses, the device was the EHR, and the receiving nurses received the message. The perceived strengths and limitations of the EHR were characteristics of redundancy and noise, respectively.
METHODS: Twenty documenting and 17 receiving nurses (N=37) were interviewed. Twenty-one clinical events were captured. Semi-structured interviews were used to elicit the nurses' perceptions. Trustworthiness was achieved through panel agreement of the coding scheme, an extensive audit trail, and documentation of decisions made during the study. Qualitative content analysis was used to identify the emergent thematic units.
RESULTS: Five categories emerged: usability, legibility, communication, collaboration, and workaround. Documenting and receiving nurses differed in their perceptions of the effectiveness of the EHR as a communication system. Documenting nurses perceived structured documentation (communication) as a strength of the EHR and lack of retrievability and barriers (usability) as limitations. Receiving nurses perceived retrievability and easy to use (usability) as strengths and lack of structured documentation (communication) and save without signature (workaround) as limitations of the EHR. Both documenting and receiving nurses perceived the documentation as lacking relevance (communication).
IMPLICATIONS: These results suggest that the EHR both supports and constrains nurse to nurse communication of patient status associated with a clinical event. Those elements of the EHR that interfere with nurse to nurse communication need to be further explored to better understand nurse to nurse communication and failure to rescue.
1. Silber, JH., Williams, SV., Krakauer, H., & Schwartz, JS. (1992). Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Medical Care, 30(7): 615-629.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFAILURE TO RESCUE AND LINKS TO NURSE TO NURSE COMMUNICATIONen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157464-
dc.description.abstract<table><tr><td colspan="2" class="item-title">FAILURE TO RESCUE AND LINKS TO NURSE TO NURSE COMMUNICATION</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Carrington, Jane M., RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Colorado Denver</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">13120 E 19th Ave, Room 4227 Mail stop C288-19, Aurora, CO, 80045, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jane.carrington@ucdenver.edu</td></tr><tr><td colspan="2" class="item-abstract">PURPOSE: The purpose of this research was to explore nurses' perceptions of the strengths and limitations of the electronic health record (EHR) to effectively communicate patient status associated with a clinical event. A clinical event was defined as an unexpected event experienced by a patient on medical, surgical, or telemetry nursing units that did not require a patient transfer. <br/>BACKGROUND: The link between nurse to nurse communication and failure to rescue or patient death associated with hospital complications, is not well understood.1 Failure to rescue has been associated with organizational and unit level systems issues. However, few have studied nurse to nurse communication as an antecedent to failure to rescue. Nurse to nurse communication was defined for this study as nursing documentation using the EHR. Few studies have explored the effectiveness of the EHR as a communication system. These studies were limited in that nurses did not focus their perceptions on a specific event and nurses were not conceptualized by their role in the communication process (documenting and receiving nurses, for example). <br/>CONCEPTUAL FRAMEWORK: Tenets of Information Theory guided this research: sender, device, receiver, redundancy, and noise. Redundancy or repetition of the message increases information while noise is a disruption of the message, decreasing information. For this study, the sender was the documenting nurses, the device was the EHR, and the receiving nurses received the message. The perceived strengths and limitations of the EHR were characteristics of redundancy and noise, respectively. <br/>METHODS: Twenty documenting and 17 receiving nurses (N=37) were interviewed. Twenty-one clinical events were captured. Semi-structured interviews were used to elicit the nurses' perceptions. Trustworthiness was achieved through panel agreement of the coding scheme, an extensive audit trail, and documentation of decisions made during the study. Qualitative content analysis was used to identify the emergent thematic units.<br/>RESULTS: Five categories emerged: usability, legibility, communication, collaboration, and workaround. Documenting and receiving nurses differed in their perceptions of the effectiveness of the EHR as a communication system. Documenting nurses perceived structured documentation (communication) as a strength of the EHR and lack of retrievability and barriers (usability) as limitations. Receiving nurses perceived retrievability and easy to use (usability) as strengths and lack of structured documentation (communication) and save without signature (workaround) as limitations of the EHR. Both documenting and receiving nurses perceived the documentation as lacking relevance (communication). <br/>IMPLICATIONS: These results suggest that the EHR both supports and constrains nurse to nurse communication of patient status associated with a clinical event. Those elements of the EHR that interfere with nurse to nurse communication need to be further explored to better understand nurse to nurse communication and failure to rescue. <br/>1. Silber, JH., Williams, SV., Krakauer, H., &amp; Schwartz, JS. (1992). Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Medical Care, 30(7): 615-629.<br/></td></tr></table>en_GB
dc.date.available2011-10-26T19:53:47Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:53:47Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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