The Inclusion of Nurses in the Systems Development Life Cycle
Title The Inclusion of Nurses in the Systems Development Life Cycle
At my previous employer, the electronic health record system was put into place by the CEO and executive director (who are brothers) and staff within the company were not consulted or even warned. As staff, we learned about the new electronic record via email on a Monday morning, where we were each encouraged to reach out to the rep for the EHR to obtain login information. Once we received login information, we were informed by the rep that “there is no manual; just watch the videos in the FAQ section” to learn the system and how to utilize it. Needless to say, it was not a smooth transition and one where patient care suffered greatly. While the list of problems in our setting was long, the most notable one for medical staff was the medication administration record (MAR). The MAR was tied to the EHR company’s “ideal” pharmacy, which is not something we have up in the mountains. For our opiate detox program, we had protocols listed for suboxone. Within the EHR, we could only input “suboxone” if we had sublingual films from the pharmacy as our house stock. We could only input “buprenorphine” if we had sublingual tablets from the pharmacy as our house stock. The EHR forced a hard stop so that one would have to enter “tablet/capsule/film” etc. for each medication and there was not a way around this. This became a problem as the pharmacy stock would change depending upon availability of medications; sometimes we had tablets, sometimes we had films. While this may not seem too complex, two issues arose from this specific detail.
The first issue was when the RN was performing an admission, protocol medication had to be entered and house stock was used. The RN would have to go the med room on the second floor and check the med cart to see what house stock we had before the RN could input any medication orders for the patient, which was overly time consuming.
The second issue that arose from this was the State regulatory agency informed us the medication record must match the actual medication. I totally agree with the State on this and fully understand the reasoning behind it. However, this was almost impossible with the current EHR. Per the State regulation, if the MAR states “suboxone film” then we must have it in the med cart. And likewise, if the MAR states “buprenorphine tablets” then we must have it in the med cart.
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