Background/purpose: Smart pump EHR interoperability can offer significant benefits including improved patient safety, enhanced nursing efficiencies, and increased charge capture.1 Interoperability, however, requires significant change to clinical workflows, and this impact on the nursing experience has not been well documented. This study explored the perceptions of medical/surgical (MS) and intensive care unit (ICU) nurses throughout a smart pump-EHR interoperability implementation. Learn how nurse informaticists can help drive change and optimize performance throughout this process. Method: A non-randomized, exploratory data collection study was conducted at a 172 bed acute-care hospital in upstate New York. MS (n=139) and ICU nurses (n=81) completed a 30-item survey on interoperability expectations, programming confidence, and estimated programming time during 4 study periods: baseline (1 month pre-implementation)and 1, 4, and 6 months post-implementation. Data for each time period were summarized and compared using an analysis of variance (ANOVA).
Results: At baseline, interoperability expectations were very high for both groups (MS mean=90.0/112; ICU mean=90.2/112) and decreased (p.05) and while there were some improvements at 4 months, they remained lower than baseline at six months. Estimated programming time improved at 4 months for both groups. The percentage of ICU nurses that estimated they could program a primary infusion in less than 30 seconds increased from 55% at baseline to 64%, secondary from 45% to 55%, and critical drip from 31% to 50%. The percentage of MS nurses that estimated they could program a primary infusion in less than 30 seconds increased from 46% at baseline to 51%, secondary from 44% to 53%, and critical drip from 13% to 24%. Conclusions: This study illustrated the change in interoperability perceptions over time. Nurses started with very high expectations, leaving little room for improvement and when it came to incorporating interoperability into clinical practice, expectations were reduced. ICU room layout (e.g., having the pumps and computer on opposite sides of the bed) impacted time/efficiency and underscored the need to adapt workflows to each clinical environment. Even though time/efficiency expectations decreased, nurses thought integration improved safety and was easy to learn. While programming time improved, programming confidence did not, suggesting the need for continued support long after implementation. It is imperative to set realistic expectations of interoperability and its impact on clinical workflows. The organization’s nurse informaticist is critical to help drive change, manage expectations, and measure performance, enlisting super users to address workflow issues in real-time and build confidence. Interoperability is a dynamic, continuous quality improvement project that requires constant vigilance, ongoing support, and a plan for sustaining success. Reference: 1) Bartos D, Vitoux RR, Schuster C, Curtin CR. Outcomes from a smart infusion pump and electronic health record integration: Improved patient safety, nursing efficiency and return on investment. JIN. 2022;7(3):13-19.
After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.