EMR Benefits: Nurses

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Nurse Satisfaction

Majority of nurses reported that EMR allowed them to better monitor patient progress and finish work faster [1].

A study from 2008, found that nurses in general found a new EMR to be more efficient, accessible and improved accuracy. [2] By improving these interactions with the patient's records and orders prescribed by physicians, nurses feel that they are better able to care for the patient's and ensure the care they deliver is appropriate and effective to the patients.

Three anonymous surveys at interval three consecutive months regarding nurse satisfaction post EMR implementation at a tertiary medical center showed gradual increase in nurse satisfaction in areas like nurse workload, teamwork, ease of documentation, patient safety and medication information accuracy [3].

A study in 2013 asked nurses, in 4 hospitals in Turkey, how they viewed electronic medical records. Most of the nurses thought positively for questions concerning impact of EMR system on clinical care, services quality, Information quality, Information Management and Nursing care management and they particularly feel that the EMR system is an important assest to the hospital. The nurses did think more negatively about the usability of the information in the EMR system. For the most part, the nurses thought positively about the EMR system. They think it will likely lessen their paperwork, improve their ability to monitor patient progress and decrease their workload overall. [4]

Medication Administration errors

One of the most important tasks that nurses perform is to safely administer medications to patients. In a study, 64.55% reported making medication error and 31.37% reported near misses [5]. Medication errors can lead to adverse outcome for patients. In 2011, a study showed that the medication errors events decreased from 11.0 to 5.3 per month after the EMR medication administration was implemented [6].

Legibility of orders

Without EMRs many physician input orders using pen and paper. Illegible orders put the nurse at risk at delivering inappropriate care, which subsequently puts the patient at risk of injury, but with EMRs orders are input into computers and thus eliminating the issue of legibility [2].

Reduced Documentation Time

According to a systematic review of literature.[7], nurses were able to reduce time spent on documentation by 24% using bedside EMR terminals. This may increase nurse satisfaction and allow nurses to perform additional patient-centered care. However, when evaluating EMR benefits and assessing return on investment (ROI) for an EMR implementation, it is best to report time savings as minutes saved per shift per nurse rather than as money saved.[8] A reduction in nursing staff may not be possible even with the increased documentation efficiency. Any reduction in cost of care may need to be derived from improved patient outcomes or reduced lengths of stay. Demonstration of such a causal effect would be difficult and any cost savings may be realized by payers or patients rather than the hospital system.[9]

A 2013 study found that utilizing an electronic EMR-linked method of vital sign capture resulted in significant reduction in time to make the data available for review, dropping from an average of over one hour to just over two minutes. Automated data collection not only reduces time required by nurses but also can reduce errors in transcription. [10] The study showed a significant increase in nurse satisfaction with the directly linked technology as well. The conclusion was that integrating automated data collection with EMR increased nursing efficiency and frees more time for direct patient care.[11]

Nursing Education

Incorporating EMR in academic curricula, specifically during their clinical practicum, benefited nurses by introducing them to the process of patient documentation with the technology they will be using professionally. [12]

However, what about those educational programs in which there is no early introduction to the management and control of EMRs. Considerable time and resources are lost in order to bring newly hired providers ‘up to speed’ with the actual use practices of health organization. Similarly, universities lose valuable clinical training hours when students are required to spend those hours learning organization-specific EMR systems in order to participate in care during clinical rotations. [13].

Clinical Judgement

According to a 2013 study, it was found that further research is needed to fully understand if EMRs improve clinical judgement. This study also looked at nurse communication and found there was little improvement in nurse communication with EMR implementation. Better tools within the EMR could support the communication between the interdisciplinary care team. Further study of EMR tools and capabilities are needed to find out if EMR use supports or interferes with nurse communication.[14]

Other advantages

[1]

  • A single consolidated record for each person
  • Capacity for data interfaces and alerts
  • Improved interdisciplinary communication
  • Evidence-based decision support
  • EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design
  • EMRs reminders help nurses at the bedside.
  • One centralized place for all of the patient information. [15]

References

  1. Likourezos, A., Chalfin, D. B., Murphy, D. G., Sommer, B., Darcy, K., & Davidson, S. J. (2004). Physician and nurse satisfaction with an electronic medical record system. The Journal of emergency medicine, 27(4), 419-424.
  2. 2.0 2.1 Beiter, P.A., Sorscher, J., Henderson C.J., Talen, M. (2008) Do electronic medical record (EMR)demonstrations change attitudes,knowledge, skills or needs?. Informatics in Primary Care, 16, 221-227.
  3. Moreland, P. J., Gallagher, S., Bena, J. F., Morrison, S., & Albert, N. M. (2012). Nursing satisfaction with implementation of electronic medication administration record. Computers Informatics Nursing, 30(2), 97-103.
  4. Top, M., Yilmaz, A., & Gider, O. (2013). Electronic Medical Records (EMR) and Nurses in Turkish Hospitals. Systemic Practice and Action Research, 26(3), 281-297. Retrieved from http://tmclibrary.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwlV1LS8NAEB6KJz34ftQH7EVQMJruJpsuiFBKRQQL1udt2aeKNUqtB_-9s2lSi_WgxySTQGZmZ7_ZeQEwehhHP2wCVdoniW96LkRqrMmMy9CVcCz2zMVxqBtut1j7Pr08z-5qQMcnGfnzYRWgLOz2d-lb6EWGjjCNBG7R0SdaYdyqgo73rm7HLlfoP1XEO0USoeW9r-Kav31h2ihPRUeLTed0AapimDLZJNRjjA8Jhy9mIhl7oqvjP35mEeZLPEpaIwVagprLl2FuokvhCnQ741E5pIzrkJHX-k72jvVJ56J3fKRP9onKLcHrbpEXEm6Rp5xcfwwQoz6SakDJ-yrcnHau22dROYYhegjT0SPvQ2CXNrizJjGpZdqnsfKUNjx6j6loGqYdrmPr0PvxJiBQrxKluOVcWU3ZGszkr7nbAOKa3CdCc5NkOhGuqXWD8lShyxcrhH6iDutBBDIsruFAGYngMs0Qs3F8UklF2n5fUoHiTLlgjTocVEyVb6MOHbLgp0RsQ2XJPxkYK9-sr8PuFDkSsuodLllBu_lHui2YpaMJGSi_bZgZDj7cDsyiFpQK8QXQTt3k
  5. Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse's viewpoint. Iranian journal of nursing and midwifery research, 18(3), 228..
  6. McComas, J., Riingen, M., & Kim, S. C. (2014). Impact of an Electronic Medication Administration Record on Medication Administration Efficiency and Errors. Computers Informatics Nursing, 32(12), 589-595.
  7. Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. Journal of the American Medical Informatics Association, 12(5), 505-516.
  8. Thompson, D. I., Osheroff, J., Classen, D., & Sittig, D. F. (2006). A review of methods to estimate the benefits of electronic medical records in hospitals and the need for a national benefits database. Journal of healthcare information management: JHIM, 21(1), 62-68.
  9. Kaushal, R., Jha, A. K., Franz, C., Glaser, J., Shetty, K. D., Jaggi, T., ... & Brigham and Women's Hospital CPOE Working Group. (2006). Return on investment for a computerized physician order entry system. Journal of the American Medical Informatics Association, 13(3), 261-266.
  10. Byrne, M. D., Jordan, T. R., & Welle, T. (2013). Comparison of manual versus automated data collection method for an evidence-based nursing practice study. Applied Clinical Informatics, 4(1), 61-74. http://dx.doi.org/10.4338/ACI-2012-09-RA-0037/
  11. Wood, J., & Finkelstein, J. (2013). Comparison of automated and manual vital sign collection at hospital wards. Studies in Health Technology and Informatics, 190, 48–50. http://www.ncbi.nlm.nih.gov/pubmed/23823371
  12. Choi M, Lee HS, Park JH. Usability of Academic Electronic Medical Record Application for Nursing Students’ Clinical Practicum. Healthcare Informatics Research. 2015;21(3):191-195. doi:10.4258/hir.2015.21.3.191. http://ca3cx5qj7w.search.serialssolutions.com/OpenURL_local?sid=Entrez:PubMed&id=pmid:26279956
  13. Abrahamson, K., Anderson, J. G., Borycki, E. M., Kushniruk, A. W., Malovec, S., Espejo, A., & Anderson, M. (2015). The Impact of University Provided Nurse Electronic Medical Record Training on Health Care Organizations: An Exploratory Simulation Approach. Driving Quality in Informatics: Fulfilling the Promise, 208, 1.
  14. Kossman, S.P., Bonney, L.A., Kim, M.J. (2013) Electronic Health Record Tools’ Support of Nurses’ Clinical Judgment and Team Communication. CIN: Computers, Informatics, Nursing, 31(11), 539-544.http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00024665-201311000-00004
  15. http://www.nursezone.com/nursing-news-events/devices-and-technology/The-Endless-Nursing-Benefits-of-Electronic-Medical-Records_24676.aspx

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