Peer Response – Workarounds in Nursing

Peer Response – Workarounds in Nursing

Responding To Savannah

Hello Savannah,

This is a great post. Workarounds in nursing are frequently used to address system inefficiencies, insufficient staffing, or other issues that nurses confront on a daily basis. They are departures from established protocols or procedures that nurses use to complete jobs or deliver care when impediments arise. While workarounds are occasionally necessary in emergencies, they are generally regarded as dangerous since they can jeopardize patient safety and quality of care.

The example you presented exemplifies a typical nurse workaround relating to medication administration. When nurses are understaffed or overburdened with critical patients, they may resort to administering drugs without a direct order in the patient’s chart (Cartwright, 2023). While motivated by the desire to respond quickly to emergencies, this approach carries substantial hazards, including prescription errors, inappropriate dosages, and a lack of documentation, all of which can result in unfavorable patient outcomes.

Working in a short-staffed setting has forced you to adjust to these challenging conditions, in your experience. Your reluctance to override drugs without sufficient documentation is a prudent strategy that helps to limit the hazards associated with workarounds. It also emphasizes the importance of open contact with physicians in order to guarantee that orders are placed swiftly and accurately following an emergency.

Workarounds, in addition to the hazards connected with medicine delivery, can have an impact on other elements of patient care, such as recordkeeping and communication. When nurses are pushed thin owing to staffing shortages, critical patient information may be lost or not appropriately documented, resulting in possible gaps in care coordination. Addressing workarounds not only improves patient safety but also leads to a more efficient and effective healthcare system, allowing nurses to give the highest quality of care possible (Rotteau et al., 2022). Healthcare businesses can adopt a proactive approach to minimizing workarounds, focusing on enough staffing, efficient operations, and ongoing training and support for their nursing staff.

References

Cartwright, A. (2023). Human relations and hospital care. Taylor & Francis.

Rotteau, L., Goldman, J., Shojania, K. G., Vogus, T. J., Christianson, M., Baker, G. R., Rowland, P., & Coffey, M. (2022). Striving for high reliability in healthcare: A qualitative study of the implementation of a hospital safety programme. BMJ Quality & Safety, bmjqs-2021-013938. https://doi.org/10.1136/bmjqs-2021-013938

Responding To Carly

Hello Carly,

This is an enlightening post. Indeed, workarounds in nursing are essential in resolving the obstacles and limits that healthcare professionals confront on a daily basis. They can, as you indicated, be both a solution and a source of concern for patient safety. Your example of circumventing constraints in electronic health record (EHR) systems is a popular nursing solution. Nurses must maintain thorough and correct documentation of patient information, and when EHR systems fail to facilitate this, creative solutions may be required (Cerchione et al., 2022). However, as you indicated, the risk of not scanning patient ID bands and drugs could jeopardize patient safety.

It is difficult to stress the importance of discovering, comprehending, and mitigating workarounds. It’s nice to learn that your ER management actively works with personnel to address scanning percentage difficulties and system issues. This proactive strategy is critical for preserving patient safety and preventing workarounds from becoming established practices. Healthcare facilities can lessen the need for workarounds and increase overall patient care quality by constantly working to improve the underlying systems and operations (Potluka et al., 2023). Workarounds in nursing are a double-edged sword, and your story exemplifies the careful balance between addressing immediate challenges and possible hazards to patient safety. Healthcare institutions should thus foster a culture where workarounds are not stigmatized but rather seen as opportunities for system improvement.

Further, healthcare organizations must establish an open communication culture in which personnel can successfully report and address workarounds, all while working towards system improvements to decrease the need for such adjustments in the first place. Overall, your piece emphasizes the importance of workarounds in nursing practice and the importance of taking a proactive approach to managing them within healthcare systems. Your unique experiences and views are excellent additions to this debate. Great job!

References

Cerchione, R., Centobelli, P., Riccio, E., Abbate, S., & Oropallo, E. (2022). Blockchain’s coming to hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem. Technovation, 120, 102480. https://doi.org/10.1016/j.technovation.2022.102480

Potluka, O., Švecová, L., Kubát, V., Liskova-Nedbalova, V., Nečas, T., Lhotská, L., & Hejdová, K. (2023). Evaluation of eHealth assistance in-hospital care for improved quality of life in patients. Evaluation and Program Planning, 97, 102261. https://doi.org/10.1016/j.evalprogplan.2023.102261

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Please provide a brief (250 words) peer response to each discussion post below

Carly

Workarounds in nursing refer to healthcare professionals finding alternative methods or shortcuts to address issues or challenges in their clinical practice, often due to system constraints, inefficiencies, or suboptimal workflows (Patterson, 2018). While workarounds may be well-intentioned to ensure patient safety and provide efficient care, they can also pose risks if not properly managed or if they become ingrained in practice (Patterson, 2018).

One common reason for workarounds in nursing is the limitations or deficiencies within the healthcare system, including electronic health record (EHR) systems, equipment, staffing shortages, or facility layout. Nurses may resort to workarounds to bridge these gaps in patient care delivery. It’s essential to acknowledge that workarounds are not inherently harmful; they can be innovative solutions to immediate problems. However, they should be thoroughly assessed, understood, and, if necessary, integrated into best practices or used as a basis for system improvements (Patterson, 2018).

One common workaround in nursing is to bypass limitations in electronic health record (EHR) systems. For instance, nurses may find that the EHR system lacks specific functionalities for efficient and accurate documentation (Ratwani, 2017). This can lead to a workaround where RNs document patient information on paper and transcribe it into the EHR system when they have more time. This can also lead to the RN not scanning the patient’s ID band and medication. This workaround allows them to ensure the completeness and accuracy of the patient record while not being hindered by the constraints of finding a computer and logging into the EHR system (Ratwani, 2017). Patterson (2018) emphasizes the importance of identifying, understanding, and mitigating workarounds to optimize healthcare technology while ensuring patient safety.

In summary, workarounds in nursing are adaptations or alternative practices that healthcare professionals employ to address system constraints and inefficiencies. While they can be necessary for patient care in some cases, they also carry potential risks if not correctly identified and managed—for example, my ER awards nurses for their scanning percentages for each shift. Our management approaches staff to find out why our scanning percentage fell below 95% for the shift, and they help mitigate any system issues, such as a malfunctioning computer, missing scanners, etc. This type of support has been very helpful in increasing my department’s scanning percentages and, therefore, increasing patient safety.

References

Patterson, E. S. (2018). Workarounds to Intended Use of Health Information Technology: A Narrative Review of the Human Factors Engineering Literature. Human Factors, 60(3), 281–292. https://doi.org/10.1177/0018720818762546Links to an external site.

Ratwani, R. M. (2017). Electronic Health Records and Improved Patient Care: Opportunities for Applied Psychology. Current Directions in Psychological Science, 26(4), 359–365. https://doi.org/10.1177/0963721417700691Links to an external site.

Savannah

Healthcare is constantly evolving in different aspects to keep up with the technologically advancing times. With these new advancements, unfortunately, come errors and workarounds in nursing. According to the study conducted by Fraczkowski et al.(2020), medication errors due to a significant number of probable causes happen frequently. Some causes include not scanning the patient’s ID band, scanning medications after they were opened and administered, and administering medications without a direct order (Fraczkowski et al., 2020). Another major probable cause of this workaround is related to inadequate staffing ratios (Fraczkowski et al., 2020).  A study conducted by Bridges et al. (2019), results that adverse patient outcomes occur when staffing ratios are not safe. The quality of care nurses deliver to their patients is greatly decreased as well (Bridges et al., 2019). This study also looked at how healthcare assistants (HCA) were included in staffing. Nurses with higher numbers of patients resulted in low interactions with HCA and patients, as well as increased adverse outcomes for patients (Bridges et al., 2019). There were positive outcomes when units had nurses with fewer than 6 patients and healthcare assistants (Bridges et al., 2019).

I personally have experienced working somewhere that was scheduled to be fully staffed so that each nurse has 2 patients, leaving 1 nurse to a 1:1 patient or as a float/resource nurse that would help admit patients/turn/etc. Since other units and floors have been severely short-staffed, they have been pulling nurses and leaving units short in order for the other floors to have somewhat of a nursing staff. Being short-staffed, multiple nurses have 3 critical patients, and it is very hard to get medications administered on time, check their provider’s notes from the day, and chart in a timely manner. There have also been numerous times where an emergent situation has occurred, and we have had to override medications that the doctor has ordered verbally from the bedside and administer them without having a direct order in the chart. Most of the time, after the event, the doctors are diligent about placing the orders they verbally said, but some doctors expect/demand that we place those orders into the patient’s chart and then scan the medications we administered. I personally am not a fan of doing that, and I have requested that doctors place their orders after an event to prevent putting incorrect orders and/or dosages in the system. These workarounds can be very dangerous and harmful to patients. Nurses interact the most with patients out of any other healthcare professional on the medical team. Resolving these workarounds will be beneficial to the patient and improve the quality of care our patients receive (Fraczkowski et al., 2020).

References

Bridges, J., Griffits, P., Oliver E., & Pickering, R. M. (2019). Hospital nurse staffing and staff-patient interactions: An observational study. BMJ Quality & Safety, 28(9), 706-713. https://doi.org/10.1136/bmjqs-2018-008948Links to an external site.

Fraczkowski, D., Matson, J., & Lopez K. D. (2020). Nurse workarounds in the electronic health record: An integrative review. Journal of the American Medical Informatics Association. https://doi.org/10.1093%2Fjamia%2Focaa050Links to an external site.