NR 360 Week 7 Fall-Risk Alert Informatics Project Example

Retiring an Interruptive Fall-Risk Alert: An Informatics Project Outline for a Medical-Surgical Unit

Student Name

College of Nursing, Chamberlain University

NR 360: Information Systems in Healthcare

Instructor Name

Month Day, Year

Retiring an Interruptive Fall-Risk Alert: An Informatics Project Outline for a Medical-Surgical Unit

The Proposed Change

Replace the interruptive fall-risk reassessment alert in the electronic health record on a composite adult medical-surgical unit of 32 beds with a passive task on the nurse's shift worklist. At present, the alert appears as a pop-up window every time a nurse opens the chart of a patient whose fall-risk score has not been documented in the last 12 hours, and it cannot be closed without choosing a reason. Under the proposal, the same requirement would appear as a task on the worklist, marked overdue after 12 hours, with no pop-up. The fall-risk assessment itself, its frequency and its content would not change.

The Problem

Nurses on the unit describe the alert as the one they dismiss without reading. It fires on chart opening, which means it interrupts a nurse who opened the chart for another reason, often in the middle of giving medications or responding to a call. A report from the informatics team for one month showed that the alert fired about 2,900 times on the unit, roughly 97 times a day, and that in 91 percent of firings the nurse chose the reason will complete later and closed the window. Fall-risk scores were still documented on time for most patients by the end of the shift, which suggests that the alert did not change when nurses completed the assessment; it only interrupted them.

This pattern is well described in the informatics literature. Research on medication safety alerts has shown that prescribers override most of them, often because alerts are poorly timed or not relevant to the task at hand (van der Sijs et al., 2006). In a study of alerts in primary care, repeated exposure to the same alert was associated with lower acceptance of that alert, a pattern the authors described as alert fatigue (Ancker et al., 2017). The unit has no data showing whether the fall-risk alert contributed to missed alerts of other kinds, and the outline does not claim that it did; the claim is only that this alert has become noise. Experts in clinical decision support have recommended that alerts of lower severity be presented in a non-interruptive form so that interruptive alerts are reserved for situations where immediate action is needed (Phansalkar et al., 2013), which is the principle this proposal applies to a nursing alert.

Stakeholders, With Gains and Costs

Staff nurses: Gain fewer interruptions, about 97 fewer pop-ups a day across the unit. Cost: must now check the worklist for overdue fall-risk tasks, which requires a habit they do not currently need.

Nurse manager: Gains a quieter record and staff satisfaction. Cost: accepts the risk that fall-risk documentation could become later, and owns the decision if it does.

Fall prevention committee: Gains attention restored to the alerts that matter. Cost: loses a tool it championed, which was introduced after a serious fall two years ago; the committee is the stakeholder most likely to object, for a legitimate reason.

Clinical informatics analyst: Gains an example of alert reduction the hospital's alert committee has been asking for. Cost: about eight hours of build and testing time.

Patients: Gain nothing directly unless fewer interruptions reduce other errors; stand to lose if the change delays fall-risk assessment for high-risk patients, which is why the evaluation watches for it.

Approvals and Sequence

The change requires three approvals in order. The fall prevention committee reviews the proposal first, because it owns the alert and because its objection would stop the change later if it were not consulted early. The nurse manager approves a 60-day pilot on the unit. The hospital's clinical decision support committee approves the build change, which informatics then carries out. The sequence runs over about eight weeks: committee review in weeks 1 and 2, build and test in weeks 3 to 5, a five-minute huddle segment on checking the worklist in week 6, and go-live at the start of week 7, followed by the 60-day pilot.

Evaluation

Three measures will be compared for the 60 days before and the 60 days after the change, using reports the informatics team can already run. The primary measure is the percentage of fall-risk assessments documented within 12 hours of the previous one, which shows whether removing the alert delayed assessments; the pre-change value is 94 percent, and a drop below 90 percent would trigger review. The second is the number of interruptive alerts per day on the unit, expected to fall by about 97. The third is falls per 1,000 patient days, from the safety reporting system, watched as a balancing measure; because falls are uncommon, this will be reviewed case by case rather than as a rate, with each fall checked for whether a fall-risk assessment was overdue at the time.

Risks and How They Are Handled

Two risks are foreseeable. The first is that nurses who relied on the pop-up as a reminder will forget the reassessment once it becomes a quiet task, particularly float nurses and new graduates who do not yet use the worklist routinely. The pilot handles this by adding the overdue fall-risk task to the charge nurse's midshift review, which already covers overdue restraint and pain reassessment tasks, so a missed reassessment is caught within a few hours. The second risk is political rather than clinical: the fall prevention committee may see the change as weakening a safety measure introduced after a serious event. The outline answers this by keeping the assessment requirement unchanged, sharing the firing and override data with the committee before any build work, and offering the committee a standing role in reviewing the pilot results. If the committee declines, the proposal can be narrowed to changing only when the alert fires, from chart opening to the start of each shift, which would still remove most of the interruptions.

What the Writer Can Start and What Needs Others

The writer can request the alert firing report from informatics, present the data at a staff meeting and draft the proposal for the fall prevention committee. Everything after that depends on others: the committee's agreement, the manager's approval of the pilot and the decision support committee's approval of the build. The outline is written so that each of those decisions can be made from the information in it, and so that the change can be reversed in a single build step if the primary measure falls below its threshold.

References

Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Medical Informatics and Decision Making, 17, Article 36. https://doi.org/10.1186/s12911-017-0430-8

Phansalkar, S., van der Sijs, H., Tucker, A. D., Desai, A. A., Bell, D. S., Teich, J. M., Middleton, B., & Bates, D. W. (2013). Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. Journal of the American Medical Informatics Association, 20(3), 489-493. https://doi.org/10.1136/amiajnl-2012-001089

van der Sijs, H., Aarts, J., Vulto, A., & Berg, M. (2006). Overriding of drug safety alerts in computerized physician order entry. Journal of the American Medical Informatics Association, 13(2), 138-147. https://doi.org/10.1197/jamia.M1809