1st:
EHR workarounds are very common; however, should not be common. I think that nurses find it easier to collect information, communicate, and chart when they use workarounds in the EHR. At the time of using workarounds methods, nurses can find it quicker and easier than taking the time to chart directly in the EHR at the time; however, it does put patient confidentiality, safety, and integrity at risk. One example that I have seen of EHR workarounds in the clinical setting include taking notes on paper of assessments, communication with the patient, or phone calls with family/physicians rather than putting it directly in the EHR. This can be time friendly at the current moment because nurses do not have to login, find the category to chart, or take the time to detail the charting; however, having paper information of patient’s records can be lost in other patients’ rooms, left on tables for others to see, or eventually taken out of the healthcare setting and spread to others. This could impact patient care also because if a nurse does not chart their assessment right away, physicians or other people of the healthcare team for that patient may not see abnormal or important information in the chart to address during their visit. If a nurse would chart as soon as an assessment is done, changes in the patient’s health could be caught quicker. Charting directly in the room and management following up with their staff’s charting would help implement better patient care and reduce the workarounds to promote safety and efficiency of health records.
Sewell, J. P. (2016). Informatics and nursing: Opportunities and challenges (6th ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
2nd:
Some of the most common EHR workarounds I’ve observed in my clinical experiences include the charting of medications before they are given, charting inaccurate or false data, charting later in the day and rely on memory, ignoring system popups, using paper for their notes and copy and pasting past data entered into a new entry. These EHR workarounds pose a threat to the quality of care a patient receives and jeopardizes their safety because important information or change in patient status can be overlooked. Data integrity is jeopardized because the staff can chart inaccurately trying to rely on their memory, chart false information, or lose their paper notes with patient information
“Organizational resolutions can relate to (1) adapting authorizations, (2) changing the task distribution between physicians, nurses, and administrators, (3) reducing the required data registration, or 4) shifting registration tasks to specific employees, such as scribes” (Boonstra et al., 2021). Continuing educating healthcare workers about the short term benefits but the long term consequences is crucial to try and reduce the occurrence of EHR workarounds and promote more efficient and safe use of EHRs. We can also support the facilities or organizations with training courses on how to become users of the EHR system so they won’t have to workaround and bypass certain steps.
Boonstra, A., Jonker, T., Offenbeek, M., & Vos, J. (2021). Persisting workarounds in electronic health record system use: types, risks and benefits. BMC Medical Informatics and Decision Making. https://doi.org/10.1186/s12911-021-01548-0Links to an external site.
