Safety risks and workflow implications associated with nursing-related free-text communication orders

Area of Science:

• Healthcare Informatics
• Patient Safety
• Clinical Communication

Background:

• Electronic Health Records (EHR) are critical for clinical communication.
• Nursing free-text orders are a vital communication channel.
• Potential safety hazards exist within nursing free-text communication orders.

Approach:

• Retrospective analysis of 13,193 free-text EHR communication orders from an academic health system.
• Classification of order content by care domain using the Clinical Care Classification system.
• Review of orders for error-prone textual features based on patient safety guidance.

Key Points:

• 13.6% of unique orders contained error-prone symbols or abbreviations, particularly medication-related orders (16.7%).
• Frequently addressed care domains included physical regulation, fluid volume, nutritional, safety, and medication.
• Order content patterns were heterogeneous, indicating varied communication needs.

Conclusions:

• Free-text nursing orders highlight workarounds and EHR design constraints.
• Remediation strategies are necessary to mitigate safety hazards and workflow impediments.
• Analysis reveals opportunities for enhancing EHR functionality and improving patient safety.