| Course | NR 361 RN Information Systems in Healthcare |
|---|---|
| Week | 2 |
| Paper type | EHR workflow analysis |
| Length | About 1,100 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 361 Week 2
Following One Penicillin Allergy From Admission to Discharge: An EHR Workflow Analysis
Student Name
College of Nursing, Chamberlain University
NR 361: RN Information Systems in Healthcare
Instructor Name
Month Day, Year
Following One Penicillin Allergy From Admission to Discharge: An EHR Workflow Analysis
The Item and Why It Was Chosen
This analysis follows one piece of information through the electronic health record of a composite community hospital: a patient's reported allergy to penicillin, from the moment it is entered at admission to the moment it appears on the discharge paperwork and the record sent to the patient's primary care clinic. Penicillin allergy was chosen because it is common and consequential. In an analysis of drug allergy documentation across a large health system, about a third of patients had at least one drug allergy recorded, and penicillins were the most frequently recorded class (Zhou et al., 2016). A recorded penicillin allergy changes antibiotic choice for the rest of the patient's life, and most patients labeled penicillin-allergic turn out not to be allergic when evaluated (Blumenthal et al., 2019), which makes the accuracy and structure of the entry matter far beyond one admission.
The analysis traces four points: where the allergy enters, whether it enters as a coded selection or as typed text, where it crosses from one setting to another, and which downstream uses depend on the coded version surviving the trip.
Where the Item Enters
In the composite hospital, the admitting nurse enters allergies in the Allergies activity of the admission navigator. The nurse searches for the allergen and selects it from a coded list, then records the reaction type and severity. The reaction field offers a coded list, rash, hives, anaphylaxis, swelling, gastrointestinal upset and others, plus a free-text comment box. When a patient cannot remember the reaction, or describes it in words that do not fit the list, such as my mother said I broke out as a baby, many nurses type that phrase into the comment box and leave the reaction field blank or choose unknown.
The allergen itself is almost always coded, because the search box forces a selection. The reaction is where structure is lost. On one medical unit, a review of 50 recent admissions with a penicillin allergy found the reaction coded in 22, marked unknown in 17 and recorded only as free text in 11.
Coded or Typed: Why It Matters
The coded allergen drives the drug-allergy checking in order entry and pharmacy verification: any order for a penicillin or a related beta-lactam generates an alert. The coded reaction determines whether the alert is shown as high or low severity in some systems, and it is what an allergist or pharmacist would use to decide whether the allergy can be safely removed or tested. Free-text reactions are invisible to both. The alert fires with the same severity for a documented anaphylaxis and for a childhood rash recorded only as a phrase in the comment box, and prescribers see the same warning for both. Over time, prescribers override most drug allergy alerts, and a study of a decade of data in one health system found that override rates were high and rising (Topaz et al., 2016). Alerts that cannot distinguish serious from trivial allergies are part of the reason.
The Crossing Point
The allergy crosses settings twice. At discharge, the allergy list prints on the after-visit summary and is included in the continuity-of-care document sent electronically to the primary care clinic. The allergen transfers as a coded element that the clinic's system can import. The reaction field transfers if it is coded. The free-text comment does not import into the clinic's allergy list in structured form; it arrives as part of a narrative document that someone would have to read. At the clinic, a medical assistant reconciling the allergy list sees penicillin with reaction unknown and, without the phrase that explained it, has no basis to question it.
The second crossing is back into the hospital on the next admission, where the imported allergy appears pre-filled. The admitting nurse sees penicillin, reaction unknown, and confirms it. The original uncertainty, a possible childhood rash, is now a permanent, unqualified allergy.
Which Downstream Uses Depend on the Code
Three downstream uses depend on the coded reaction surviving. First, penicillin allergy evaluation programs, which identify patients whose allergy is low risk and may be removed through testing or a supervised dose, rely on reports filtered by reaction type; a patient whose reaction is free text or unknown is harder to find. Second, antibiotic stewardship reports on the use of second-line antibiotics in patients labeled penicillin-allergic depend on knowing which allergies are high risk. Third, the severity of the allergy alert shown to future prescribers depends on it. Zhou et al. (2016) found that a substantial share of drug allergy entries in the system they studied lacked reaction information, which limits all three uses.
The cost of a label that never gets questioned falls on the patient. Patients labeled penicillin-allergic are more often treated with broader-spectrum or second-line antibiotics, which are associated with higher rates of antimicrobial resistance and Clostridioides difficile infection, and many will never know that their label rests on a vague memory from childhood (Blumenthal et al., 2019). The nurse at the admission desk is the first and often the only person who hears the patient's own account of the reaction. If that account is lost to free text, every later clinician inherits a label with no history attached.
What the Analysis Suggests
The analysis suggests a small change at the entry point rather than a new system. When a patient reports a penicillin allergy, the admission navigator could ask three coded questions in place of the free-text box: how long ago the reaction occurred, what happened, choosing from a short list that includes rash in childhood, and whether the patient has taken any penicillin-related antibiotic since. Those answers would travel with the allergy to the clinic and to future admissions, and they are the questions a pharmacist or allergist would ask first. Nurses would spend perhaps thirty seconds more per patient with a penicillin allergy, and the unit could measure the change by repeating the 50-chart review three months later and counting how many reactions are coded.
The change would also give the discharge nurse something useful to say. A patient whose reaction was coded as a childhood rash with no reaction since could be told, at discharge, that the allergy may not be real and that the primary care clinician can arrange an evaluation.
References
Blumenthal, K. G., Peter, J. G., Trubiano, J. A., & Phillips, E. J. (2019). Antibiotic allergy. The Lancet, 393(10167), 183-198. https://doi.org/10.1016/S0140-6736(18)32218-9
Topaz, M., Seger, D. L., Slight, S. P., Goss, F., Lai, K., Wickner, P. G., Blumenthal, K., Dhopeshwarkar, N., Chang, F., Bates, D. W., & Zhou, L. (2016). Rising drug allergy alert overrides in electronic health records: An observational retrospective study of a decade of experience. Journal of the American Medical Informatics Association, 23(3), 601-608. https://doi.org/10.1093/jamia/ocv143
Zhou, L., Dhopeshwarkar, N., Blumenthal, K. G., Goss, F., Topaz, M., Slight, S. P., & Bates, D. W. (2016). Drug allergies documented in electronic health records of a large healthcare system. Allergy, 71(9), 1305-1313. https://doi.org/10.1111/all.12881
The Chamberlain NR 361 Week 2 instructions
In Week 2 you track how one type of information moves through the electronic health record and where the workflow helps or fails. Points are attached to choosing a specific item, describing where it enters, how it is stored, where it travels, who uses it, the problems you find and a recommendation, with sources in APA. Pick something small enough to follow, like one allergy rather than the whole medication module. State why the item matters, with a source. Describe where structure is gained or lost, since coded and typed entries behave differently. Show what survives each crossing between settings. Recommend a change at the exact point where the trouble starts.
How the NR 361 Week 2 example is put together
The first section explains why the allergy was chosen and names the four points to trace. The entry section describes the Allergies activity in the admission navigator, where the allergen is selected from a coded list but the reaction is often typed, and reports a local review of 50 admissions. The next section explains that the coded allergen drives order checking while the coded reaction decides severity and later evaluation. The crossing section follows the allergy into the after-visit summary and the continuity-of-care document, then back on the next admission as penicillin, reaction unknown. The downstream section lists allergy evaluation, alert relevance and antibiotic choice, citing Blumenthal and colleagues. The last section proposes three coded questions at admission and says how to measure them.
Where the points sit in the NR 361 Week 2 rubric
Workflow analysis rubrics in NR 361 usually reward selection of a focused item, an accurate description of the workflow, analysis of where it breaks down, attention to data quality and interoperability, a feasible recommendation, scholarly evidence and APA. Analysis is the decisive row, and the paper secures it by showing exactly where structure is lost and what that costs later. The description row is credited because each point names the screen and the person entering data. Interoperability scores through the two crossings and what survives them. The recommendation earns feasibility points for targeting one entry point and costing it in seconds. Zhou and colleagues and Topaz and colleagues support claims about documentation and alert overrides, and Blumenthal and colleagues ground the harm to patients.
NR 361 Week 2 help from the desk
The costliest version of this paper describes a system, module by module, instead of following an item, which answers no question the rubric asks. Another frequent loss is choosing something too large to trace, so the analysis never reaches a destination. Students also skip the crossing between settings, where the most important finding usually sits, or recommend a new system rather than a change at the point of failure. A diagram can help but does not replace the written route. Standards such as HL7 deserve a sentence, not a page. If the item you follow never leaves your unit, show where it is reused within the hospital. If you have another item in mind, name it and an NR 361 workflow analysis can be routed for it.
Get a NR 361 Week 2 example written to your instructions
Send us the Week 2 assignment file, any headings your section requires, and the item you want followed, and a custom example is built to those instructions and returned inside 24 to 48 hours. The first one costs nothing. If your classroom uses a particular record system, say so and the route is drawn around it.
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NR 361 Week 2 questions, answered
Do I need a diagram?
Many sections ask for one and it helps, provided each box is an event rather than a department. A three stage picture with the coding decision marked communicates more than a detailed swim lane nobody can read at page width. If your section does not require a figure, the same information fits in a short numbered sequence, and graders tend to mark what the sequence says rather than how it was drawn.
What if the item never leaves my unit?
Then that is the finding, and it is a better paper than a route invented to look complete. Show the point where the item was expected to travel and did not, name the person elsewhere who would have used it, and describe what they do instead. A dead end documented honestly demonstrates the systems thinking the assignment is testing.
How much detail about standards belongs in it?
Enough to explain why one system understood what another sent. Naming a terminology and then reciting its history spends words the analysis needs elsewhere. The productive sentence says that because the entry was selected from a coded list, a second organization could count it alongside its own cases, and the sentence after that says who counted and what the count was for.
Where can I find a free NR 361 Week 2 sample paper?
This page carries the full Week 2 analysis of one penicillin allergy from entry to discharge and back, the local review figures, the downstream uses, the three-question proposal and three references.
Where does the NR 361 Week 2 analysis say structure is lost?
In the reaction field. The allergen is chosen from a coded list, but the reaction is often typed as free text, so later checks and allergy evaluation programs cannot read how severe it was.