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Clinician Perceptions on the Use of Free-Text Communication Orders.

MedStar author(s):

Citation: Applied Clinical Informatics. 12(3):484-494, 2021 05.PMID: 34077971Institution: MedStar Institute for Innovation | MedStar Washington Hospital CenterDepartment: Emergency Medicine | National Center for Human Factors in HealthcareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, U.S. Gov't, P.H.S.Subject headings: IN PROCESS -- NOT YET INDEXEDYear: 2021 ISSN:

1869-0327

Name of journal: Applied clinical informaticsAbstract: CONCLUSION: Clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process. Copyright Thieme. All rights reserved.DISCUSSION: Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders.METHODS: We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes.OBJECTIVE: The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information.RESULTS: Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders.All authors: Hettinger AZ, Hoffman DJ, Kandaswamy S, Kazi S, Marquard J, Owens S, Pruitt Z, Ratwani RMFiscal year: FY2021 Digital Object Identifier:

https://dx.doi.org/10.1055/s-0041-1731002

Date added to catalog: 2021-06-28

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34077971	Available		34077971

CONCLUSION: Clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process. Copyright Thieme. All rights reserved.

DISCUSSION: Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders.

METHODS: We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes.

OBJECTIVE: The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information.

RESULTS: Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders.

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