NR 642 Week 5 Current State Analysis Example

Current State Analysis: One Oral PRN Oxycodone Dose Followed From the Scan to the Quarterly Pain Committee Report

Student Name

College of Nursing, Chamberlain University

NR 642: Informatics Nurse Specialist Concluding Graduate Experience I

Instructor Name

Month Day, Year

Current State Analysis: One Oral PRN Oxycodone Dose Followed From the Scan to the Quarterly Pain Committee Report

The Route, in Order

The item followed is one oral dose of PRN oxycodone given at 14:05 on a Tuesday in September on a medical-surgical unit, and the reassessment that should follow it. The route was traced by watching the nurse, reading the build documentation with the clinical documentation analyst and asking the quality analyst how the report finds the row.

In this example the reassessment happened at about 14:55, inside the window, and the report counts it as missed.

Watched, Not Read About

Steps 1 to 6 were observed. The nurse in the example scrolled to the Pain Reassessment row only once in the four-hour observation, for a patient the nurse described as "the one the pain nurse is following." Watching made two things clear that the documentation did not: nurses start at the top of the flowsheet and use whichever pain row appears first, and the "taken" time is usually set to the filing time unless the nurse changes it, so late filing can push a reassessment outside the window even when the bedside check was on time. Workflow research warns that studying documents alone misses how systems are actually used (Unertl et al., 2010).

Where the Item Is Stored

In discrete fields: the administration, the routine row and the reassessment row each have their own field and time. That is good news for any change, because the report can count discrete fields. Notes are the exception: a reassessment typed into a note is stored as text and is invisible to the report.

What Moves It Onward

The overnight warehouse load at 02:00 is a duration, not an instant: any change in documentation shows in the warehouse the next day at the earliest, and in the committee report only once a quarter. The stewardship dashboard refreshes weekly, which makes it the faster place to watch for early effects.

Manual Repairs

The paper tracker on the medication cart repairs the record's lack of a timer.

Phone timers repair the same gap for individual nurses.

On one medical-surgical unit, the charge nurse keeps a spreadsheet of missed reassessments from the paper trackers, to discuss at huddles. It repairs the lack of a daily report.

Before each survey, the quality analyst hand-reviews 30 charts for reassessment in any location, repairing the report's blindness to the routine row and notes.

Each repair marks a place where the design fails the people using it. The cart tracker and the charge nurse's spreadsheet are the clearest evidence that nurses want a reminder and a list.

The Last Reader Decides What Is Possible

The quality analyst's query looks for the Pain Reassessment row by its row identifier and uses the "taken" time. Any change must therefore send the nurse to that exact row and keep the "taken" time meaningful. A change that created a new row, or that relied on the routine row, would require the report to be rebuilt and the committee to accept a new definition, which the project has ruled out. The stewardship dashboard uses the same identifier. These two downstream readers decide the design more than the nurse at the bedside does.

Where a Change Could Act

At step 2, where the record already knows that a reassessment will be due and when, but does nothing with that knowledge. A worklist task created at step 2, due at the right time and opening the Pain Reassessment row directly, would act exactly where the nurse's paper tracker and phone timer now step in. It would not touch steps 7 to 10.

A Description in Words of the Diagram

The appendix diagram shows the ten steps as boxes in three lanes: the nurse, the record and the reporting chain. Manual repairs are drawn as dashed boxes beside the steps they patch. The proposed task appears as a single new box between steps 2 and 4.

What the Workarounds Cost

The paper tracker takes perhaps 20 seconds per dose and is lost when the cart is wiped down between shifts. Phone timers belong to individual nurses and stop when the phone is silenced in a patient room. The charge nurse's spreadsheet takes about 30 minutes a week. None of these feeds the report. Workarounds of this kind are the visible cost of a system that does not fit the work, and they tend to persist until the system offers something better (Koppel et al., 2008).

Limits

One dose, followed in detail, plus four hours of observation on each unit. Night shift was not observed, and its pattern may differ, since fewer nurses cover more patients and the paper tracker is used less. The match logic was described by the analyst rather than read in code.

Fit With Published Findings

Electronic pain records have been found to hold reassessment data in scattered, duplicated and inconsistent fields, making it hard to evaluate care from the output (Samuels & Kritter, 2011). This route shows how that happens in one hospital, step by step.

References

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

Samuels, J. G., & Kritter, D. (2011). Pain management documentation: Analyzing one hospital's computerized clinical records. CIN: Computers, Informatics, Nursing, 29(9), 512-518. https://doi.org/10.1097/NCN.0b013e31821a1582

Unertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010). Traversing the many paths of workflow research: Developing a conceptual framework of workflow terminology through a systematic literature review. Journal of the American Medical Informatics Association, 17(3), 265-273. https://doi.org/10.1136/jamia.2010.004333