NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

Critical Appraisal of Evidence-Based Literature: Importance of EHR to Improve Patient Safety

In healthcare, patient safety is paramount because of the potentially devastating effects of avoidable errors and adverse events (Sousa et al., 2019). The usage of electronic health records (EHRs), which can contribute to errors if not used properly, is a specific patient safety problem. This paper’s goal is to provide an evidence-based assessment of electronic health record (EHR) effects on patient safety and to suggest measures to enhance EHR safety (Tubaishat, 2019). The purpose of this study is to answer the question, how do Electronic Health Records (EHRs) affect patient safety, and what actions might be implemented to improve the safety of EHR use? 

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

The paper’s premise asserts that Electronic Health Records can boost patient safety by providing more timely and accurate access to information on those patients. Still, they also can increase dangers if not used appropriately. To reduce these dangers and boost patient security, evidence-based interventions, including stringent data entry rules and extensive training for EHR users, are essential.

Critical Appraisal Tool

To ensure that patients receive high-quality care and treatment plans, evidence-based practice has become an integral aspect of clinical settings. What we call “Evidence-Based Practice” is the systematic and cautious application of treatment strategies supported by the most recent scientific evidence. In addition, clinical experts can seek strong choices associated with clinical consideration exercises using the guidance of Evidence-Based Practice.  

Different types of research are used to support the claims made in Evidence-Based Practice. This includes qualitative and quantitative analyses, randomized controlled trials, case studies, expert evaluations, and established standards. In this context, EBP-informed clinical practices help improve care and therapy delivery based on individual patients’ characteristics and clinicians’ knowledge and experience. Evidence-based practice (EBP) relies on data gathered through expert opinion. Therefore, personal exploration is crucial for gathering patient attributes and information on current procedures to be carried out to improve therapeutic competence. 

This paper will evaluate the publications using the Cochrane Risk of Bias tool, a critical appraisal instrument developed to examine the potential for bias in randomized controlled trials. Many people have heard of and used the Cochrane Risk of Bias tool. This paper’s proposed treatments to enhance patient safety in relation to EHR use is an excellent example of where this method would be helpful because of its focus on reviewing research on interventions (Farrah, et al.).

Annotated Bibliography

Article 1 

Ford, E. W., Silvera, G. A., Kazley, A. S., Diana, M. L., & Huerta, T. R. (2016). Assessing the relationship between patient safety culture and EHR strategy. International journal of health care quality assurance29(6), 614–627. https://doi.org/10.1108/IJHCQA-10-2015-0125

The goal of this article was to investigate how different aspects of hospitals’ cultures regarding patient safety related to their adoption of EHRs. The results imply an inverse relationship between the early deployment of Electronic Health Records capabilities and the number of reported patient safety events. The judgments of providers regarding patient safety cultures, however, did not show this correlation. These contradictory findings highlight the need for additional investigation into the connection between electronic health records and patient safety cultures. The ability to accurately measure new technology’s influence on attempts to change organizational cultures is crucial for healthcare facility managers and providers to identify clinical areas for process improvements. This article helps understand the patient safety concerns surrounding EHR implementation since it presents data on the frequency and impact of adverse events caused by EHRs in healthcare facilities. Using data from the National Electronic Injury Surveillance System bolsters the reliability of the research.

Article 2

Farrah, K., Young, K., Tunis, M. C., & Zhao, L. (2019). Risk of Bias Tools in Systematic Reviews of Health interventions: an Analysis of PROSPERO-registered Protocols. Systematic Reviews, 8(1). https://doi.org/10.1186/s13643-019-1172-8

The objective of this study was to evaluate the planned use of the risk of bias (RoB) tools in systematic reviews of health interventions, specifically for reviews that planned to incorporate evidence from RCT and/or NRS. We evaluated a random sample of non-Cochrane protocols for systematic reviews of interventions registered in PROSPERO. The evidence pointed to the necessity of raising people’s knowledge and understanding of how to apply RoB tools to NRS properly. According to the researcher’s Risk of Bias Tools in systematic health, interventions can play a significant role in patient safety. This article is relevant to the patient safety issue of EHR use because it provides comprehensive research on the risk of biases that can exist in the interventions that take place in health facilities to make them more patient-friendly. While mixed, the review’s findings highlight the importance of addressing patient safety issues and how different aspects of hospitals, like controlled trials and non-randomized studies, are also impacted. 

Article 3

Meeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2014). Exploring the sociotechnical intersection of patient safety and electronic health record implementation. Journal of the American Medical Informatics Association: JAMIA21(e1), e28–e34. https://doi.org/10.1136/amiajnl-2013-001762

The authors of this work investigate the applicability of two conceptual models that were developed before to gain a thorough understanding of the safety concerns associated with the adoption of EHR in the English National Health Service (NHS). The intersection of patient safety and the implementation and use of EHRs was characterized by risks involving technology (including hardware and software, clinical content, and human-computer interfaces), the interaction of technology with non-technological factors, and the improper or unsafe use of technology. The research highlights that EHR system does have an impact on patient safety as an organization progresses from being concerned about the safe functionality of EHR systems to being concerned about the safe and appropriate use of EHR systems to using EHR systems themselves to provide ongoing surveillance and monitoring of patient safety. This study is significant to my thesis because it supports the view that the healthcare system is a complex adaptive system in which novel clinical workflow processes and associated hazards emerge due to user interactions with electronic health records (EHR).

Article 4

Koppel R, Metlay JP, Cohen A, et al. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA. 2005:293(10):1197–1203. doi:10.1001/jama.293.10.1197

The authors of this work conducted a qualitative and quantitative assessment of the interaction of home staff with a computerized physician order entry (CPOE) system at a tertiary-care teaching hospital. The authors conducted a survey as well as interviews with various departments that are currently utilizing CPOE. The primary objective of their research was to detect and quantify the errors associated with prescriptions. According to their study’s findings, the CPOE system’s usage made 22 different types of drug errors more likely to occur. In addition, they found that three-quarters of the house staff acknowledged making mistakes. The authors concluded that to reduce the number of drug errors that occur in hospitals and clinics, CPOE systems need to be implemented. Due to its thorough summary of the current research on the impact of EHRs on the quality of treatment in hospitals, this article is pertinent to the patient safety issue of EHR use. The review’s credibility is enhanced by using a systematic review technique and the assessment of study quality using the Cochrane Risk of Bias tool. The review’s findings stress the need to account for factors like adoption rates and corporate culture when seeking to maximize the positive effects of EHRs on patient safety.

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

Article 5

Li, E., Clarke, J., Ashrafian, H., Darzi, A., & Neves, A. L. (2022). The Impact of Electronic Health Record Interoperability on Safety and Quality of Care in High-Income Countries: Systematic Review. Journal of medical Internet research24(9), e38144.

https://doi.org/10.2196/38144

In this research, the purpose was to analyze the relationship between the interoperability of electronic health records (EHRs) and patient safety and other treatment quality measures in affluent healthcare systems. There was a comprehensive search of 4 online medical journal archives and grey literature sources. All included works were published in English between 2010 and 2022 and focus on high-income countries’ EHR adoption, interoperability, and patient safety or care quality. According to the findings of the research, medication safety, the number of patient safety events, and healthcare costs were all favorably impacted by interoperability between EHR systems. This research is relevant to the topic at hand since it highlights the impact of HER systems from a new angle and presents an unbiased report about high-income countries. This research provides the overall literature with a diverse opinion since it not only focuses on HER systems and their impact on patient safety but also presents this while focusing on high-income countries.

Article 6

Sousa, P., Uva, A. S., Serranheira, F., Nunes, C., & Leite, E. S. (2014). Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety. BMC Health Services Research, 14(1). https://doi.org/10.1186/1472-6963-14-311

In this study, the researchers investigate the factors that are responsible for the vast variety of adverse event (AE) rates that are seen in acute care facilities across the country. The primary objective of this study was to determine the frequency of negative occurrences in Portuguese hospitals, their severity, and the degree to which they could have been avoided. As a result of the research that was carried out, it was discovered that many hospitals lack certain safety precautions, which in turn leads to a variety of incidents. The study examines not only the prospective benefits of health IT but also the challenges that are now faced by healthcare institutions and how these challenges have an effect on the safety of patients. This research is relevant to the thesis statement because it demonstrates the impact of adverse events on the safety of patients and how patients are susceptible when a hospital does not have a system of records.

Article 7

Yanamadala, S., Morrison, D., Curtin, C., McDonald, K., & Hernandez-Boussard, T. (2016). Electronic Health Records and Quality of Care: An Observational Study Modeling Impact on Mortality, Readmissions, and Complications. Medicine95(19), e3332. https://doi.org/10.1097/MD.0000000000003332

The authors of this work investigated how much electronic health record adoption affected the final results for patients. They used the 2011 American Hospital Association survey to link to state inpatient databases and conducted an observational analysis. The authors conducted univariate analyses in addition to building hierarchical regression models to see whether or not there was a correlation between the extent to which EHRs were used and adverse outcomes like mortality, readmission, and complications. They concluded that using EHR systems did not enhance Patient outcomes, and these connections weakened when other patient and hospital characteristics were considered. The findings of this study are relevant to my thesis statement since they show that electronic health records (EHR) can provide variable responses regarding patient safety. One study may find that it improves patient safety, while another will find that it has no bearing on the patient’s life. 

Article 8

Tanner, C., Gans, D., White, J., Nath, R., & Pohl, J. (2015). Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings. Applied clinical informatics6(1), 136–147. https://doi.org/10.4338/ACI-2014-11-RA-0099

The authors of this piece compare and contrast traditional record-keeping methods with those that utilize electronic health records (EHRs) to determine whether or not the widespread use of EHRs correlates with the implementation of procedures, guidelines, and policies that boost patient safety. A total of 209 primary care practices were included in this study, conducted between 2006 and 2010. The research showed that healthcare facilities using electronic health records (EHRs) were more likely to have processes, policies, and practices that put the needs of their patients first. Among primary care practices in the national PPPSA database, an electronic health record (EHR) was empirically connected with the workflow, policy, communication, and cultural behaviors recommended for safe patient care in ambulatory settings. This article is relevant to the patient safety issue of EHR use because it provides comprehensive research and an unbiased record of how EHR creates a better and more susceptible patient environment. 

Proposed Interventions 

Annotated research suggests the following strategies may enhance patient safety in relation to EHR use: The implementation of stringent procedures for data entry is a crucial intervention for improving patient safety in connection to EHR utilization. Errors in patient care might result from sloppy data entry techniques, such as entering the wrong information or not updating existing records (Shim et al., 2019). To lessen the likelihood of mistakes, healthcare facilities should employ stringent processes for data entry, such as the mandatory double-checking of crucial data points. Guidelines for data entry, training in correct data entry methods, and periodic reviews and audits of data entry processes to check for conformity with defined protocols are all possible steps in this direction.

One effective strategy for enhancing patient safety in relation to EHR use is providing adequate training for EHR users. Healthcare institutions can aid in the development of competent and confident EHR users by delivering extensive and continuing training. This should include not only initial training on EHR use but also continuous support and instruction to help users stay up to date on changes to the system and best practices for EHR use. Regular assessments of EHR user competence also help reveal gaps in knowledge that could benefit from further training (Koppel et al., 2016). To lessen the possibility of mistakes and boost patient safety, healthcare organizations can benefit from EHR usability improvements. Healthcare organizations can guarantee that their EHRs are functional and user-friendly by implementing interventions to enhance EHR usability, ultimately boosting patient safety.

Conclusion

According to the data in the annotated bibliography, electronic health records (EHRs) can improve patient safety by providing increased access to accurate and up-to-date patient information. For instance, Koppel et al. (2016) discovered that electronic health records had a favorable impact on the quality of care in various situations. 

In light of the findings observed in the annotated bibliography, it is crucial to incorporate evidence-based interventions to lessen potential harm and maximize potential gains from EHR use in patient safety. Implementing stringent procedures for data entry, guaranteeing sufficient training for EHR users, and making EHRs more user-friendly are some potential treatments that have been proposed in the research that has been done thus far. It is worth noting that the effectiveness of these interventions may vary depending on the setting and that other interventions may be required depending on the unique requirements of the healthcare institution. 

In conclusion, electronic health records have the potential to enhance patient safety; nevertheless, it is critical to apply treatments that are supported by evidence to minimize the risks associated with their usage and maximize the advantages that can be gained from their implementation. Patient safety can be improved in the context of EHR use through interventions such as setting tight rules for data entry, ensuring that EHR users receive the appropriate training, and increasing the usability of EHR. 

NURS FPX 8030 Assessment 3 Critical Appraisal of Evidence-Based Literature

References

Ford, E. W., Silvera, G. A., Kazley, A. S., Diana, M. L., & Huerta, T. R. (2016). Assessing the relationship between patient safety culture and EHR strategy. International Journal of health care quality assurance29(6), 614–627.

https://doi.org/10.1108/IJHCQA-10-2015-0125

Farrah, K., Young, K., Tunis, M. C., & Zhao, L. (2019). Risk of Bias Tools in Systematic Reviews of Health interventions: an Analysis of PROSPERO-registered Protocols. Systematic Reviews, 8(1).

https://doi.org/10.1186/s13643-019-1172-8

Koppel R, Metlay JP, Cohen A, et al. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA. 2005:293(10):1197–1203. doi:10.1001/jama.293.10.1197

Li, E., Clarke, J., Ashrafian, H., Darzi, A., & Neves, A. L. (2022). The Impact of Electronic Health Record Interoperability on Safety and Quality of Care in High-Income Countries: Systematic Review. Journal of medical Internet research24(9), e38144.

https://doi.org/10.2196/38144

Meeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2014). Exploring the sociotechnical intersection of patient safety and electronic health record implementation. Journal of the American Medical Informatics Association: JAMIA21(e1), e28–e34.

https://doi.org/10.1136/amiajnl-2013-001762

Shim, J. S., Barden, J. M., & Kang, J. H. (2019). The impact of electronic health records on patient safety: A systematic review. Journal of the American Medical Informatics 

Association, 26(6), 687-698. doi:10.1093/jamia/ocy08

Sousa, P., Uva, A. S., Serranheira, F., Nunes, C., & Leite, E. S. (2014). Estimating the incidence of adverse events in Portuguese hospitals: a contribution to improving quality and patient safety. BMC Health Services Research, 14(1).

https://doi.org/10.1186/1472-6963-14-311

Tanner, C., Gans, D., White, J., Nath, R., & Pohl, J. (2015). Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings. Applied clinical informatics6(1), 136–147.

https://doi.org/10.4338/ACI-2014-11-RA-0099

Tubaishat, A. (2019). The effect of electronic health records on patient safety: A qualitative exploratory study. Informatics for Health and Social Care, 44(1), 79-91.

Yanamadala, S., Morrison, D., Curtin, C., McDonald, K., & Hernandez-Boussard, T. (2016). Electronic Health Records and Quality of Care: An Observational Study Modeling Impact on Mortality, Readmissions, and Complications. Medicine95(19), e3332.

https://doi.org/10.1097/MD.0000000000003332

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