NSG 600 Module VII-VIII Discussion 1 Wilkes University

Watch the SAFER Guide video and information (https://www.healthit.gov/topic/safety/safer-guides).  As mentioned, completion of the SAFER Guides is required for eligible and critical access hospitals as part of the Promoting Interoperability Program (CMS, 2022). 

Complete two of the SAFER Guides and summarize the findings (do not include the PDF document with findings but document in a narrative format).  One of the SAFER Guides must be either High Priority Practices or Organizational Responsibilities. The other SAFER Guide can be from the other remaining categories:  Infrastructure and Clinical Process. 

Discuss what you learned and include the role of the DNP as a member of a committee responsible for managing completion of the chosen guide.  Feel free to use the resources located in the course content section to support the information shared in your post.

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59pm EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resource module. 

I completed the SAFER Guides on High Priority Practices and selected Domain One: Safe Health IT Checklist. During my assessment, I found a deficiency in 1.3, which highlighted that some diagnostic test results, including interpretations of those results labeled as normal and high, were not being monitored effectively. Specifically, I discovered that we only scan and document lab work on the patient’s chart, without having a system in place to alert us when results are abnormal. This manual process can lead to critical lab results being missed or delayed in receiving appropriate care, potentially compromising patient safety and outcomes. According to research, passive alerts highlight significant or unusual data without causing disruptions to the electronic health record (EHR) workflow. It is important to note that implementing such a system may require coordination and collaboration between different departments or teams within the healthcare organization, including IT, laboratory services, and clinical staff.

The second guide that I completed was on clinician communication. Effective communication among healthcare providers is critical for ensuring that patients receive safe and effective care. Fortunately, in this area, I did not find any deficiencies as my company is very diligent in ensuring safe and effective communication. However, for organizations that may struggle in this area, the SAFER guides provide a useful framework for improving communication practices and preventing errors.  Effective communication is crucial for healthcare providers (Asan et al., 2018). As a Doctor of Nursing Practice (DNP), the role of the DNP on a committee responsible for managing the completion of SAFER guides is critical. DNPs can lead the implementation of the guidelines, monitor compliance, and evaluate effectiveness. DNP can help ensure that their organization provides safe and effective care to patients while using electronic health records. As a DNP I can help and guide my organization towards best practices in patient care, resulting in better outcomes for patients and improved organizational performance.

References

Asan, O., Yu, Z., & Crotty, B. H. (2021). How clinician-patient communication affects trust in health information sources: Temporal trends from a national cross-sectional survey. PLOS ONE, 16(2). https://doi.org/10.1371/journal.pone.0247583

Arthurs, B. J., Mohan, V., McGrath, K., Scholl, G., & Gold, J. A. (2018). Impact of passive laboratory alerts on navigating electronic health records in intensive care simulations. SAGE Open, 8(2), 215824401877438. https://doi.org/10.1177/2158244018774388

Electronic health record (EHR) usability can be a contributable factor for patient harm events, including events related to patient privacy and data confidentiality (Howe et al., 2018). For this reason, beginning in 2022, the Centers for Medicare & Medicaid Services (CMS) implemented the SAFER Guides, self-assessment tools for health organizations to explore how EHRs are maintained, monitored, used, and updated (Sittig et al., 2022). As the DNP committee member responsible for completing the SAFER Guides Organizational Responsibilities self-assessment, I learned that my practice is responsible for the EHR system, not the IT contractor. My psychotherapy practice currently refers matters relating to the EHR to an IT contractor. Having an IT contractor makes sense financially because my organization is small compared to large hospitals having the resources to maintain an on-site IT department. However, the Organizational Responsibilities self-assessment indicates my practice does not have the necessary input from clinicians, administration, and support staff for an effective EHR system. For instance, Safer Guides suggests that clinicians, support staff, and clinical administration have input when testing or correcting problems, but they rarely do. Given that clinicians, support staff, and clinical administration use the EHR daily, they definitely should have input on how it works. The Organizational Responsibilities self-assessment was enlightening about how much involvement clinicians, administration, and support staff should have with the EHR system.

I also did the Safer Guides Contingency Planning self-assessment, which considers what my practice would do if the EHR became inaccessible because of some unforeseen circumstance. The first topic was about having other hardware in an emergency. I know the EHR data has a backup process. I do not know about the hardware. What surprised me about the topic was that it advises that clinicians, support staff, and clinical administration should have input on hardware in an emergency. I assumed anything to do with hardware was primarily the IT contractor’s job. Safer Guides provided an example of alternate hardware sources as having another cable outlet for the Internet. What displeased me was SAFER Guides did not elaborate on what type of input clinicians, support staff, and clinical administration should have concerning duplicate hardware. Clinicians, support staff, and clinical administration should know what to do if other hardware is needed. Given the rationale for this topic, which is to keep the practice running, I assume the input from clinicians, support staff, and clinical administration needed is how to prevent hardware failures. It also indicated that in case of a power outage, clinicians, support staff, and clinical administration should have input on electric generators and fuel; policies, procedures, and processes to manage downtime; availability of paper forms; backup and recovery procedures; ransomware attacks; system downtimes; communication strategies not reliant on the computer system; and, staff training during power outages. These different topics seem like a lot with the everyday workload of healthcare. I had to remember that these are not hard fast rules that clinicians, support staff, and clinical administration must follow. They are suggestions to ensure that during a power outage, my practice can continue to provide healthcare.

References

Howe, J. L., Adams, K. T., Hettinger, A. Z., & Ratwani, R. M. (2018). Electronic health record    usability issues and potential contribution to patient harm. JAMA, 319(12), 1276–1278. 

Sittig, D. F., Sengstack, P., & Singh, H. (2022). Guidelines for US hospitals and clinicians on     assessment of electronic health record safety using SAFER Guides. JAMA, 327(8), 719–    720. 

Within the foundational guide group, two SAFER guides are found, which include high-risk practices and organizational responsibilities: the high-priority practices focus on identifying any risk and concerns with the EHR. Furthermore, the format of this guide comprises different domains that users will use as a checklist to ensure appropriate usage of the EHR. Although using an EHR may be preferred and viewed as a positive experience by many, some challenges indicate that risks may be involved. For example, if users were to enter data on an EHR, then forget to save, and turn the computer off, there is no backup, meaning this information would need to be entered again.  Furthermore, this disrupts workflow, thereby creating hazards with the system interface, the configuration of systems, as well as EHR hardware (Health Information Technology, [HIT], 2018).

Furthermore, the purpose of this guide is to facilitate users to maintain EHR safety and work through any risks that may be apparent. The SAFER guide ensures that persons within a practice collaborate to complete a self-assessment focusing on domains. Within these domains are recommended practices, for example, in domain 1, which is safe health IT and focuses on data, hardware, and EHR configuration. In addition, there is a checklist for each section under the domain that indicates the task was implemented fully in all areas, partially in some areas, or not implemented.  In using these checklists, the users in the practices can attest to what was implemented, whether it is working, and if not, what the recommended practices for improvement are (HIT, 2018).

As staff and their team complete these guides, the patient’s electronic health records are always prioritized. The role of the DNP-prepared nurse as it relates to this SAFER guide includes identifying the needs of each group and assessing whether or not the SAFER guides have worked. In addition, it is also essential the DNP identifies a group of users within the organization to collaborate on implementing each domain and its effectiveness. Sittig et al. (2022) write that individuals from departments such as nursing, administrative, and ancillary services could be chosen. Once the team is developed, meetings should be held regularly to assess what has been implemented, as well to troubleshoot any concerns (Sittig et al., 2022).

Patient Identification

In contrast to the high-priority practices SAFER guide, there is also the patient identification guide. It is this guide that identifies the recommended safety practices that are associated with the reliable identification of patient data in the EHR. Furthermore, because electronic health data is more prevalent, it is essential to ensure that patient data is accurately reported and entered into the correct patient electronic health record. However, sometimes there are errors, and while this needs to be avoided, different strategies must be implemented. For example, all staff should be trained in entering data and understanding the systems.

Just as the other SAFER guides have self-assessments for staff to complete, the assessment follows the same pattern, thus allowing the team to identify where patient identification occurs.  For example, domain 1 focuses on patient safety, which concerns keeping patient information and patient demographic information protected.  this assessment sheet also has checkmarks for staff to indicate whether the recommended practices are implemented fully or partially in some areas or not implemented. Furthermore, in using this checklist, the goal is to prevent any problems with duplicate records or patient mix-ups. Again, using this guide helps organizations identify and prioritize EHR-related safety concerns. Furthermore, clinician leadership, in this case, the DNP, and the organization should assess whether and how any particularly recommended practice affects the organization’s ability to deliver safe, high-quality care (Health Information Technology, [HIT], 2018).

In closing, patient safety is always the top priority, and the DNP nurse, first and foremost, addresses safety issues while also ensuring that the proper use of the electronic health record is initiated (McBride et al., 2021). In addition, the DNP is also instrumental in ensuring all users are trained on the system and attest that the SAFER guides are being completed at least once monthly, which allows tracking of progress and implementation, as well as and ensuring all users adhere to practice guidelines (McBride et al., 2021).

                                                References

Health Information Technology. (2018). Self-assessment: High-priority practices. Safety Assurance Factors for EHR Resilience

https://www.healthit.gov/sites/default/files/safer/guides/safer_high_priority_practices.pdf

Health Information Technology (2018). Self-assessment: Patient Identification. Safety Assurance Factors for EHR Resilience

https://www.healthit.gov/sites/default/files/safer/guides/safer_patient_identification.pdf

McBride, S., Makar, E. V., Ross, A. M., Simmons, D., & Elkind, E. C. (2021). Determining awareness of the SAFER Guides among nurse informaticists. Journal of Informatics Nursing, 6(4), 6.

Sittig, D. F., Sengstack, P., & Singh, H. (2022). Guidelines for US Hospitals and clinicians on assessment of Electronic Health Record Safety using SAFER Guides. JAMA, 327(8), 719–720. https://doi-org.authenticate.library.duq.edu/10.1001/jama.2022.0085