| Course | NR 558 Informatics for Professional Nursing Practice |
|---|---|
| Week | 5 |
| Paper type | System problem escalation memo |
| Length | About 820 words, 1 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 558 Week 5
Memorandum
To: Clinical Informatics Help Desk; copy to Nursing Informatics Specialist and Unit Manager, Medical-Surgical Unit
From: Staff Registered Nurse, Medical-Surgical Unit
Date: Month Day, Year
Re: EHR shift assessment: Morse Fall Scale items auto-copy from previous shift; request change for four items
Summary
In the start-of-shift assessment, the six Morse Fall Scale items arrive filled with the previous shift's answers. If a nurse files the section without changing them, the previous answers are recorded as the current assessment and feed the High Fall Risk decision support rule. On our unit, this has led to patients whose condition changed overnight being scored too low and missing high-risk interventions. I am asking the informatics team to confirm the behavior and to change four items, history of falling, IV or heparin lock, gait and mental status, so that they arrive blank each shift.
Steps to Reproduce
These steps can be followed in the training environment.
1. Open a test patient admitted to a medical-surgical unit.
2. In the day shift assessment, complete the Morse items with IV or heparin lock "No" and mental status "Oriented to own ability," then file. Total: 25.
3. Place an order for intravenous fluids so that the patient has an IV line documented in the line and drain section.
4. Log in as a night shift nurse and open the night shift assessment for the same patient.
Expected result: the Morse items should require review, or at minimum the IV item should reflect the IV line documented in the line and drain section.
Observed result: all six items arrive pre-filled with day shift's answers, including IV or heparin lock "No," although an IV line is documented elsewhere in the record. Filing without changes records a total of 25. The High Fall Risk rule does not fire, because it reads the filed total.
5. Change IV or heparin lock to "Yes" and mental status to "Forgets limitations." The total becomes 60 and the rule fires. This confirms that the rule works when the items are current; the fault is in the input.
Scale, Counted
With the unit manager's approval, I reviewed 40 patients on our unit over two weeks who had a new IV line placed or a documented change in mental status between shifts. In 17 of the 40, the next shift's Morse section was filed with the IV or mental status item unchanged from the previous shift. In 11 of those 17, the correct total would have been 45 or higher, which is our high-risk threshold, but the filed total was below 45, so the banner did not appear and the fall prevention order set was not suggested. One of those 11 patients fell during the affected shift, without serious injury.
Our dashboard reports 98.6% reassessment compliance because it counts filed sections, so this problem does not appear in any current report.
Why This Matters
Copy-forward documentation can make records appear complete while carrying forward inaccurate information, and has been identified as a patient safety concern (Tsou et al., 2017). Here, the copied values feed a decision support rule, so the inaccuracy changes what the system does, not only what the record says. The problem sits where a configuration choice, a busy workflow and a measurement meet, the kind of interaction sociotechnical models of health IT describe (Sittig & Singh, 2010). The Morse items most likely to change between shifts are exactly the ones that most affect the score (Morse et al., 1989).
What I Am Asking For
1. Confirm the behavior in the training environment.
2. Change the four items that change most often, recent falls, IV access, gait and mental status, to open blank at each new shift assessment, while leaving secondary diagnosis and ambulatory aid pre-filled.
3. If a full change needs committee approval, as an interim step, pull the IV or heparin lock item from the line and drain section rather than from the previous shift.
I understand the copy-forward setting was introduced to save documentation time, so I have estimated the cost: re-answering four items takes about 30 seconds per patient per shift, or roughly two to three minutes per nurse per shift on our unit.
Related Requests
If the change is approved, the quality department will need to revise the fall risk reassessment compliance measure, which currently counts a filed section as a reassessment. I have copied the unit manager so that request can go forward in parallel.
Contact and Availability
I am on the unit on day shift Monday, Tuesday and Thursday this week and can demonstrate the problem on a live workstation. The unit manager is copied and has approved the review. The patient identifiers for the 40 reviewed cases are available to the informatics team through the secure quality folder, not in this memo. I would appreciate a ticket number and an estimated time for a first response.
Thank you for looking into this.
References
Morse, J. M., Morse, R. M., & Tylko, S. J. (1989). Development of a scale to identify the fall-prone patient. Canadian Journal on Aging, 8(4), 366-377. https://doi.org/10.1017/S0714980800008576
Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085
Tsou, A. Y., Lehmann, C. U., Michel, J., Solomon, R., Possanza, L., & Gandhi, T. (2017). Safe practices for copy and paste in the EHR: Systematic review, recommendations, and novel model for health IT collaboration. Applied Clinical Informatics, 8(1), 12-34. https://doi.org/10.4338/ACI-2016-09-R-0150
Reading the NR 558 Week 5 instructions
The fifth week asks you to escalate an information system problem. Expect the prompt to want a description of the problem, its impact, steps to reproduce, evidence and a proposed solution, in a professional format. Write a subject line that names the system, the fault and the request, so it still makes sense when forwarded. Give numbered steps a stranger could follow, with the expected result beside the observed one. Count the scale of the problem instead of describing it as widespread. Explain why it matters for patients. Make a specific request, with an interim option and the cost of the change. State when you are available to demonstrate it. Keep patient identifiers out of the memo. Cite relevant evidence in APA 7.
How the NR 558 Week 5 example is put together
The memo opens with a summary of the fault and the request. A numbered section reproduces the problem in the training environment: day shift enters fall risk items, an IV is ordered, night shift opens the assessment, and the items arrive unchanged, so the rule does not fire until the items are corrected. A section counts affected patients from a two-week review and notes one fall, and explains that the dashboard hides the problem. A section cites copy-forward risk and sociotechnical research. A section makes three requests, including an interim fix, and estimates the time cost. A final section gives availability and notes where identifiers are held. The tone throughout is factual.
NR 558 Week 5 rubric: what full points look like
Escalation memos are generally evaluated on clarity, reproducibility, evidence of scale, a specific request and professional communication. A subject line that survives forwarding shows awareness of how such messages travel. Numbered steps with expected and observed results let the recipient confirm the problem instead of weighing credibility. Counting affected cases gives the problem weight. Linking the fault to patient safety shows why it deserves priority. A specific request with an interim option and a stated cost makes it easier to act on. Keeping patient identifiers out shows privacy awareness. Evidence cited in APA 7 supports the memo. Brevity matters, since help desks triage quickly.
Common NR 558 Week 5 mistakes, and how to avoid them
Escalation messages often describe frustration rather than a reproducible fault. Give steps. Another weakness is claiming a problem is widespread without counting. Count cases. Some students ask for a general fix, such as make the system better; request a specific change. Avoid including patient names or record numbers in the memo. Offer an interim option in case the full change needs approval. State the cost of your request honestly, since the setting may have been chosen for a reason. Say when you can demonstrate the problem, which speeds the response. Ask for a ticket number and an expected response time so the request can be followed up.
Get a NR 558 Week 5 example written to your instructions
Send the Week 5 instructions along with the scenario or fault your section supplied, and a custom memo is written to them and returned inside 24 to 48 hours, with the first one free. If your section publishes a memo template with fixed heading blocks, send that too and the example arrives already inside it.
More NR 558 papers and MSN samples
- NR 558 Week 1: EHR Default Setting Discussion
- NR 558 Week 2: EHR Screen Default Review
- NR 558 Week 3: Dashboard Report Interpretation
- NR 558 Week 4: Decision Support Rule Critique
- NR 558 Week 6: Privacy in Practice Analysis
- NR 558 Week 7: Committee Position Brief
- NR 558 Week 8: Technology Impact Paper
- NR 557 Week 5: Red Flag Case Analysis
- NR 549 Week 5: Conceptual Framework Write-Up
- NR 544 Week 5: Accountability Case Analysis
- NR 500 Week 5: Practice Problem Brief
NR 558 Week 5 questions, answered
What if the fault only happens sometimes?
Say so and quantify the sometimes. An intermittent problem is harder to escalate and more worth escalating, so record the conditions under which it did occur: the time of day, the log-in used, the machine, whether anything else was open at once. Patterns looking random from one nurse's seat are often obvious to somebody holding the server logs, and your job is handing them enough to look.
Should the memo suggest a fix?
One line, offered rather than asserted, and only where you have grounds. The recipient owns the solution and knows constraints you cannot see, so a memo arriving with a design attached invites an argument about the design instead of an answer about the fault. What you can legitimately state is which outcomes would count as resolved, which is not the same as prescribing how.
Who gets it if I do not know who owns the system?
Then finding out is part of the assignment and part of the job. Work through the help desk record, the education team or a super user, and name a role in the header even where you cannot name a person. A memo addressed to whom it may concern is filed rather than read, and sections tend to mark the header as evidence of whether the writer understood the route.
Where can I find a free NR 558 Week 5 sample paper?
The copy-forward escalation memo is laid out above as the NR 558 Week 5 sample, start to finish. If your system problem is different, describe the steps to us and a memo a stranger could act on can be written.
Why include steps to reproduce in the NR 558 Week 5 memo?
So the recipient can confirm the problem directly instead of deciding whether to believe the sender. The sample's steps show the fault in the training environment.