by Michal Beiningen, Senior Consultant
As a nurse for the past 15 years, I understand and appreciate the many complexities that software implementation presents to nursing care. Working acute care presents days of chaos, fast-paced decision making, and attention to detail. So, as you would imagine, with the implementation of electronic records, a new challenge was presented. In 2010, the US Department of Health and Human Services published findings that the average age of registered nurses ranged from age 45-59 in the US. So when determining how to train users on electronic health records, you must factor in the different learning styles to foster adoption. Using simulations to evaluate user readiness has been shown to decrease time to complete routine tasks and allow quicker turnaround time for achieving baseline levels of patient care1.
Nurses have used paper to document findings for decades. Forms had been revised and fined tuned frequently. Our brains develop muscle memory. Our fingers move through the paper seamlessly, we recall where each piece of documentation lives, checks, what box choices are available and the free text comments that we frequently use. These challenges are especially evident as it relates to the documentation of code. Classroom training allows for the interaction of code documentation functionality, but it is nearly impossible to replicate the fast-paced, complex, and inconsistent situation of a code.
I previously worked with a large academic medical center in the Northeast that planned to transition code documentation from paper to electronic. After listing out several pros and cons to different operational readiness activities, simulation for code documentation was identified as the best way to train our users on code documentation. Using the academic medical simulation lab in collaboration with EMR build team, nurses, pharmacy, physician residents, and respiratory therapy we were able to practice documentation during a simulated code.
Hands-on Practice In this example, the simulation lab was utilized for the hands-on practice. The script for the code documentation was derived from PALS and ACLS training that were often performed in this simulation lab. Each nurse participating in the training was given a workstation and 15-20 nurses were identified for each simulation scenario. During each session, a nurse would start out in the documentation alone, then an additional nurse was added to collaborate on the documentation. Peer mentoring and shadowing were leveraged as they are methods frequently used in nursing orientation to foster collaboration.
Collaborative Feedback Loop The hands-on simulation allowed the end-users to access the system and provide feedback in real-time, This was valuable for training, but also for a system build. The analyst team was able to take this feedback and adjust functionality on the spot to allow further practice and exposure. Enhancements made during simulation were tracked and adopted for go-live.
Interactive E-Learning An archive simulation video was produced and edited for future training needs. This allowed for convenient, cost-effective future training and practice within the electronic records sandbox environment. An e-learning tool was created to train the functionality and supplemented it with the code simulation video.
The Benefits
Reduce Training Cost Simulation lab was recorded and a video was produced and edited for future training needs. This video decreased the need for in-classroom training or additional time in the simulation lab for future trainees.
Collaboration The simulation lab allowed subject matter experts to collaborate with the CNIO, build team, and project management team to address areas that would inhibit the adoption of the code documentation prior to go-live.
Subject Matter Experts and Super Users Allowing time in the system exposed subject matter experts and superusers the opportunity to develop skills navigating the system and therefore allowing them to be a more qualified resource supporting the system at the time of go-live.
1 Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: April 2014 – Volume 9 – Issue 2 – p 102-111 doi: 10.1097/SIH.0000000000000005
