NR 643 Week 2 Implementation Report Example

Implementation Report: The PRN Reassessment Task as Specified Against the Task Live in Production on 4 West, Version 1.2

Student Name

College of Nursing, Chamberlain University

NR 643: Informatics Nurse Specialist Concluding Graduate Experience II

Instructor Name

Month Day, Year

Implementation Report: The PRN Reassessment Task as Specified Against the Task Live in Production on 4 West, Version 1.2

The Build Delivered

Name and version: PRN Pain Reassessment Task, version 1.2. Environment: production. Location: worklist task rule "NUR PRN REASSESS," linked to the flowsheet activity for the Pain Reassessment row group. Change request: CR-27-0142, approved by the change advisory board on 2 February 2027. Live on 4 West from 07:00 on 9 February 2027. The earlier versions, 1.0 and 1.1, exist only in the test environment.

A configuration sitting in the test environment is not delivered. Version 1.2 in production is the only version this report describes.

Specified Against Existing

Two Kinds of Difference

Things the system would not do: filter the trigger by administration action. The vendor's task rule supports filtering by medication and route but not by action. The workaround is the added dismissal reason.

Things change control would not approve inside the term: the amber overdue color. The board deferred it to the spring review of visual standards, which meets in May. It is not a failure of the build; it is a decision outside the project's reach.

The report keeps these apart because they lead to different next steps. The first needs a vendor enhancement request, filed on 12 February as ticket 03381. The second needs a proposal to a standards review.

Screenshots

Three screenshots from production, cropped to the worklist panel, show a test patient created for training: the task as it appears, the Pain Reassessment row it opens and the dismissal reasons. No real patient record appears.

Tested by Somebody Else

The build was tested by the clinical documentation analyst against an 18-case test script written by the student, by the pharmacy informatics pharmacist for the medication list and by three 4 West superusers in a usability session on 26 January. Two cases failed in version 1.1: the task did not complete when the value "Patient asleep, not disturbed" was filed, and a task fired twice when a dose was rescanned. Both were fixed in version 1.2 and retested by the analyst, not the student.

A build tested only by the person who designed it has been tested for what the designer expected. The analyst and superusers found the rescan problem by doing what nurses do, not what the script described.

The Workaround Register

Each workaround is something a person does by hand outside the build. The register will be reviewed in the sustainment plan, because a workaround that outlives the student becomes part of the system whether anyone intended it or not. Workarounds commonly appear where a system and the work do not fit (Koppel et al., 2008).

How Delivery Was Confirmed

On go-live morning, the analyst and a superuser scanned a listed dose for a training patient on 4 West at 07:15 and confirmed the task appeared with a due time 60 minutes later. At 09:00 the analyst checked the task log for real tasks and found 11, all on listed doses. At the end of the first day the log held 39 tasks, of which 2 had fired for held doses, the first sign of the trigger difference. Each check is recorded with its time in the go-live log kept by the analyst.

Support During Go-Live

Superusers covered day and evening shifts for the first five days and answered 23 questions, logged on a sheet at the nurses' station. Most were about the "Dose not given" reason and about tasks that did not clear when the score was filed in the routine row. No question needed the analyst, and none reported a task blocking other charting. Night shift had no superuser cover, which the adoption write-up will need to consider.

What Was Not Built

A daily trigger report for charge nurses, offered in the project plan as the version that would survive a cut. It was not needed, since the task was approved, but the query that would produce it exists and is noted in the handover.

What the Differences Mean for Evaluation

Neither difference changes how the criterion is counted. The extra tasks for held and refused doses will appear in the adoption figures as dismissals and must be separated out there. The missing overdue color may lower completion after the due time, which the adoption write-up can examine through task timestamps.

How This Compares With Published Experience

A neonatal project credited record reminders, alongside a trigger report, with helping to sustain a rise in reassessment documentation (Israel et al., 2023). The live task here is a reminder of the same kind, built more narrowly. Fidelity, the degree to which a change is delivered as designed, is one of the implementation outcomes that should be reported before effectiveness (Proctor et al., 2011), which is why this report comes before any results.

References

Israel, S., Perazzo, S., Lee, M., Samson, R., Safari-Ferra, P., Badh, R., Abera, S., & Soghier, L. (2023). Improving documentation of pain reassessment after pain management interventions in the NICU. Pediatric Quality & Safety, 8(5), e688. https://doi.org/10.1097/pq9.0000000000000688

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

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7