NR 583NP Week 6 Training and Adoption Plan Example

Training and Adoption Plan: Teaching Tablet Depression Screening by Task Rather Than Title, Starting From the Workarounds the Westgate Pilot Turned Up

Student Name

College of Nursing, Chamberlain University

NR 583NP: Informatics for Advanced Nursing Practice

Instructor Name

Month Day, Year

Training and Adoption Plan: Teaching Tablet Depression Screening by Task Rather Than Title, Starting From the Workarounds the Westgate Pilot Turned Up

Start From the Workarounds

The Westgate pilot ran for four weeks. Three workarounds appeared, and each one shapes this plan.

At check-in, two front desk staff told patients to "just tap through it," because explaining each question slowed the line. Patients who tapped through left items blank or chose the first answer.

In the rooms, two MAs asked the PHQ-9 aloud again even when the tablet had been completed, because they did not trust a score they had not heard. That doubled the work the tablet was meant to save.

At the end of the day, the tablets were often left uncharged on the counter, so the first patients the next morning got paper forms.

None of these is a compliance problem. Each shows where the design or the teaching left a gap. Koppel et al. (2008) found the same with barcode medication systems: workarounds clustered where the technology did not fit the work.

Audiences Defined by Task

Rather than training front desk staff, MAs and NPs as separate groups, I grouped people by the task they do with the tablet.

Handing out and collecting: front desk staff, and MAs at Hilltop, where MAs check patients in after 17:00.

Responding to a positive item 9: MAs, NPs and the BHC, all of whom may receive the flag.

Reviewing scores in the visit: NPs.

Charging, cleaning and swapping a broken tablet: front desk leads and evening MAs.

Covering for a downtime: everyone who might be at the desk.

An MA at Hilltop therefore attends two task sessions, and an NP attends one.

The Few Tasks That Carry Risk

Three tasks carry almost all the risk, and they get most of the teaching time.

First, the positive item 9 flag. Anyone who receives it must go to the room, confirm the answer and bring in the NP or BHC before the patient leaves. This is taught by walking through the flag on a live training patient, twice.

Second, matching the tablet to the right patient. The front desk scans the patient's wristband label onto the tablet; in the pilot, one tablet was handed out without a scan and its answers were filed to the previous patient. The session shows how to check the name on the tablet's first screen.

Third, an incomplete or declined questionnaire. Staff learn to record "declined" or ask the missing items aloud, rather than leaving the screen blank, which the quality report counts as not screened.

Everything else, from adjusting the font to reading the score history, is on a one-page reference card at each desk.

Teaching at the Elbow

Each site has two super-users, one front desk and one MA, chosen by the site lead. They train in the week before the site goes live and then stand at the desk or in the rooming area for the opening fortnight. The schedule covers every session, including Tuesday and Thursday evening clinics until 19:00 and Saturday morning clinic at Eastland, so that nobody meets the tablet for the first time without someone beside them. Stevens et al. (2015) reported that hands-on, role-specific training close to go-live improved how prepared physicians felt for a new record system.

The Second Month and the New Hire

In week 5 after each go-live, the super-users run a ten-minute refresher at the morning huddle focused on whatever went wrong most often. After that, a new front desk staff member or MA completes the reference card walkthrough on the first day and shadows a super-user for one full session before handling tablets alone. The site lead adds this to the onboarding checklist. Training is therefore a recurring cost: I estimate about two hours per new hire.

What to Teach About Tapping Through

The front desk sessions include a short script: "These questions help your clinician. Please answer each one honestly; it takes about two minutes." Staff practice saying it until it sounds natural. The MAs are shown the item-by-item answers in the flowsheet so they can see a completed tablet score is a full PHQ-9, not a summary, which addresses the reason they gave for re-asking.

Measures That Separate Use From Satisfaction

Attendance at training will be recorded but not reported as adoption. The measures are:

- Completed tablet PHQ-9s out of screens due, by site and by front desk staff member

- Median time from a positive item 9 flag to a clinician entering the room

- Number of PHQ-9s re-asked aloud by MAs after a completed tablet, from a weekly sample of 20 visits

- Tablets uncharged at opening, recorded by the front desk lead

A short staff survey will ask about ease of use, but it will be reported separately. Greenhalgh et al. (2017) note that technologies are often abandoned after an apparently successful start; tracking use by person, not just by site, should show early if one group stops using the tablet.

The Patient Side of Training

Staff training will not fix a tablet that patients find hard to use. During the pilot, older patients most often asked for help with the scroll between items, and two patients with low vision could not read the answer buttons. The front desk sessions include five minutes on how to help without answering for the patient: point to the screen, read the question aloud if asked and step back. Where a patient asks a family member to help, staff offer the paper form or the MA instead, because the questions are personal. These moments were the source of the "tap through it" habit, so teaching staff what to do instead is part of removing it.

Who Owns the Plan

I own the plan and the measures. Each site lead owns the super-user schedule for their site and the onboarding checklist. The IT analyst owns the reference card and updates it when the screens change. If a super-user leaves, the site lead names a replacement within two weeks.

Review

At the end of the second month at each site, I will review these measures with the site lead and change the sessions for the next wave based on what they show. If one staff member's completion rate stays well below the site's, the super-user spends a session beside that person before anyone treats it as a performance issue.

References

Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., A'Court, C., Hinder, S., Fahy, N., Procter, R., & Shaw, S. (2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), e367. https://doi.org/10.2196/jmir.8775

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616

Stevens, L. A., Mailes, E. S., Goad, B. A., Longhurst, C. A., & Pantaleoni, J. L. (2015). Successful physician training program for large scale EMR implementation. Applied Clinical Informatics, 6(1), 80-95. https://doi.org/10.4338/ACI-2014-09-CR-0076