Nurses must not rely on clinical systems and technology to do all the work for them. It is vital to patient safety that critical thinking and basic nursing assessments skills, along with clinical data review and good electronic documentation standards, remain intact in all aspects of patient care. Nurses providing care must question data and seek clarification or guidance from nursing leadership or the medical provider when they are in doubt. Nursing leaders must be approachable and create a supportive environment so that front line nurses are comfortable and willing to be engaged to solve problems when issues arise.

What Are Some Potential Issues with Informatics and Technology in Healthcare?

• Human error – Even with clinical systems and technology in place, there is always a risk of human error, such as data entry errors, misinterpretations, missed safety alerts, or a lack of safety parameters.

• Alert Fatigue – Often clinical systems or technology such as smart pumps have safety parameters built in to ensure safe patient care. When clinicians see or hear these alerts often, they can become fatigued and employ overrides to skip past them. Vital details can be missed, and errors occur.

• Note Bloat – When clinical notes contain too many non-essential details, key clinical data can be lost within the note and potentially overlooked.

• Clinical Data Skew – Without a single integrated EMR/EHR there is the possibility of skewed patient data or unreconciled data among various systems. This can lead to the lack of a complete and up-to-date clinical picture for a patient, leading to poor clinical decisions.

• IT Infrastructure & Network – In order to support efficient and effective patient care workflows, it is essential for patient care environments to establish strong IT infrastructures and networks to manage ever-expanding informatics and technology requirements.

• Change Management, Lack of Competencies, & Time Management – Introducing a new clinical technology can be overwhelming to clinicians, even for those who are comfortable with technology. Clinicians may be afraid of change and worry about the impact of the change on their day-to-day routines and their ability to provide quality and efficient patient care. Unless clinicians have acquired informatics competency, they may experience a heightened sense of fear and even anger towards the change. Some senior staff may have feelings of being replaced or pushed out of their positions.

• Financial Constraints – New technology and clinical systems are costly to implement and maintain. Some projects, development requests, specialized modules of an existing system, or purchases may be delayed or not possible due to fiscal or financial restraints within a hospital, clinical setting, or department. Vendors incur extra costs for development requests or support.

• Downtime! Whether planned or unexpected, system downtimes can be stressful for staff and impede patient care. It is important to have a downtime plan, including resources for paper documentation and a clear plan for any necessary back-entry. Where possible, downtimes for system upgrades and maintenance should be planned well in advance.  Unexpected downtimes are stressful if they last more than a few minutes so staff should be aware of downtime procedures to prepare for the unexpected, especially with the threat of cyber-attacks resulting in prolonged outages.

What is the Role of Nurse Leaders?

• Nurse leaders should work closely with informatics nurses or analysts/IT to determine which key high-level alerts or best practice advisories should be operational for front-line nurses in order to minimize unnecessary alerts and reduce fatigue. System alert details and decision-making involve a multidisciplinary approach and should include key stakeholders such as nursing, pharmacy, medical providers, quality and risk leaders, and decision support. Nurse leaders can use event or quality reviews as a means of working with direct care nurses to highlight the importance of practice alerts in improving patient safety

• Risk reporting systems can assist direct care clinicians and nurse leaders to key issues with systems or technology-related clinical practice issues. Risk reports are often shared among key hospital stakeholders who can assist in investigation or problem resolution.

• Nurse leadership may be engaged by Project Managers, Informatics/Technology Nurses, or their IT Team to provide an assessment of technology or infrastructure needs in their department before implementation. Determining how many computers/devices are needed for a typical shift, or the best locations for new electrical outlets, shelving, and securing devices. These may seem to be simple tasks, but the success of a systems implementation may depend on an accurate understanding of how and where the system will be used by those delivering care. The nurse leader plays an important role in connecting system designers with end-user practice.

• Nurse leaders create opportunities for staff engagement by listening to staff concerns and implementing supportive strategies for change management. Nursing leaders should participate in the same training as their staff, so they are aware of the expectations and workflows.

Nurse leaders should be visibly present to direct care providers during an implementation.  This will communicate support and instill trust during stressful implementations. In the early implementation period, nurse leaders can ensure that nurses are assigned to be super-users without patient assignment.  This can help alleviate nurses’ stress of learning a new set of skills at the same time as they are providing patient care. The leader needs to prepare well in advance, to ensure enough resources are available. This can be a difficult task in the face of staffing shortages, scheduling, or financial constraints.

• Nurses providing direct care often find gaps or inefficiencies in clinical system workflows. At times, the introduction of a new system may highlight ongoing or issues with existing clinical practice. Nurse leaders should engage with their staff regularly to explore these issues and discuss possible solutions. Nurses are critical thinkers and often have ideas for changes. It is not always possible to build changes into a clinical system due to design restrictions, vendor contracts, downstream impacts, or financial constraints. Informatics teams, however, usually appreciate practical ideas and solutions; even if the change cannot be incorporated into the first version of the new system, these ideas may be integrated into future versions.

Optional Task

Do you use electronic documentation in your care setting? If so, do you have an established downtime procedure guideline to outline for staff what to do if the system goes down? What manual forms, such as paper progress notes, order forms, MAR (medication administration record), etc. do you need in an event of downtime and where are they kept? Meet with your Nursing Manager to review what downtime planning is currently in place, what is the communication strategy for planned outages vs. unplanned? Are there deficiencies that can be improved on?

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