My experience with learning how to navigate the EHR is through classes given by the hospital I worked at. This workshop is only given one time and it is a 5-day class. Most of the work is done individually with an instructor who has questions. Since covid-19 this work was completed at home and with instruction from skype or zoom. The class consist of the instructor showing you how to complete a task and you performing it, of course not remembering how you completed it once you hit the floor. So, through the several years working on Epic I have learned through trial and error and through co-worker’s explanations how to make my page easier. If I were to design a program for my clinical environment centered on EHR it would be several people in the class and two instructors. They would explain the system and basics, we would all sign on. Then the students would be given tasks to perform on program. They would have a certain amount of time and could ask questions. I feel the only way to learn these systems is to roll up your sleeves and begin the tasks. When there is an issue one can x out and try again. I also believe there should be someone working in the hospital and would be on the floor once every two weeks or once a month and would look at the employee’s setup and work with them to make things more efficient.
A data mining project that would be wonderful for the Emergency room which would extract data using these techniques would be prior visits. A majority of patient which come into the ER are “frequent flyers”. Although we are not supposed to use this term it is because it is true. Several patients present to the ER looking for something specific. Most of the time narcotics is the reason for admission. If the EHR would use mining techniques to see the patterns of dates, times, what medications were given and what the diagnosis was along with medications they say they have allergies too. What was the first allergic reaction to Toradol? This data would be used to help show a pattern, another mining method would be to take blood work from several different visits and explain how there is a specific pattern evolving. For instance. Say a patient has an A1C which is increasing over the past five years. This is a pattern that should be alerted to the provider.
Twelve-hour shifts are not problematic for patient and nurse safety, hospitals continue to keep the 12-hour shift schedule. This increases continuity of care and better flexibility for work and family balance. In a number of qualitative studies, 12-h shift patterns were seen as positive, contributed to staff satisfaction and also both a good recruitment and retention strategy. Results from (battle, 2018) highlighted a positive impact on physical and psychological well-being and increased work satisfaction, for the nursing staff working the 12-h shift pattern. Increased continuity of patient care was identified as a positive outcome of the 12-h shift. Rarely have I seen nurses working longer than a 12-hour shift. Most single parents have chosen this profession because of the ease of schedule.
What recommendations I would give to the management team is during a 12 hour shift the nurse must take all of her breaks. Nurses become busy and they sacrifice their lunch to help better flow of the unit. This is unacceptable. All nurses should enjoy breaks, lunch, and the ability to use the bathroom when needed. Management team could educate nurses on the problems with working several 12 hour shifts in a row, how it would cause fatigue and then mistakes could be made. I would suggest looking at incident reports whether it be falls, medication errors etc. Look at the times of the incident and graph them to see a better picture of whether they are happening after 8 hours.
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