NURS 6051
Week 9 Discussions
Initial Post
Involvement of nurses in the Systems Development Life Cycle
According to Cresswell, Bates, & Sheikh, 2016, implementation of health information technology interventions in many organizations is at the forefront. It, however, requires the collaboration between the technologists and the nurses for the nurses to understand how the technology works and the technologists to interface the systems with the existing technology appropriately. Failure to involve nurses at all the SDLC stages increases the chances of system failure. It is caused by difficulties in the buy-in of the system by nurses, which makes the transition of the new technology difficult. According to Laurette Education, 2018, nurses have a high chance of adopting new technology if they had the opportunity to provide input during the planning and implementation stage.
SDLC Stages and Nursing Involvement
The SDLC is a project management model that includes all the stages involved from the onset of the project to completion (Singletary & Baker, 2019). The first phase is the initiation and the concept phase. This phase includes an analysis of the needs of the organization, and a plan is designed to explore whether the facilities’ current architecture can support a new system. The project must be aligned with the facilities’ needs, and therefore, a SWOT analysis is essential at this stage. Costs estimates, timelines, and financial approaches are provided at this stage. One of the challenges faced at this stage is an equipment design flaw and difficulties in user buy-in. For instance, some nurses may be computer illiterate, and this makes them reluctant to learn the computer-based system. Including nurses at this stage makes them feel that the equipment is safer and easy to use. They might even suggest some champions among themselves to teach and motivate nurses who are reluctant to adopt the system
The second stage is the planning phase. It includes the scope, deliverables, and milestones of the project once approved by the stakeholders. Challenges faced during this stage may include difficulties in identifying the training needs of the nurses, and how the system would enhance the current procedures. Involving nurses at this stage can help the developers ensure that the best practices are achieved. For instance, if the system is the EHR system, nurses can give insights on their experience with keeping the health records manually and how the system would affect patient care during its transition.
The third stage is the design phase. This stage focuses on the actual functioning of the proposed project (Singletary & Baker, 2019). For instance, if the system were the EHR system, this stage would include looking for software that would meet the requirements of the organization after initial testing. The stage provides an opportunity for active nurse participation by providing feedback on the parts of the system that are not user friendly. Failure to include nurses may make it difficult to backtrack system failures.
The next stage is the implementation and testing stage. This stage includes training, data migration, and the operational impact of the project. The training should be thorough in equipping the nurses with appropriate knowledge to use the system. Nurses should be provided at this stage to give crucial feedback on the modifications needed. With electronic health records, failure to properly train the nurses can lead to medical errors. Proper testing of this system can give adequate time for nurses to analyze the system and make recommendations.
The last phase is the maintenance and evaluation phase. It includes constant evaluation of the system by the technologists and the nurses. Since the maintenance phase depends on the users, nurses should be involved in this phase to make observations and give recommendations to the technologists. Nurses can also identify all the unnecessary steps in this system, save time and avoid workarounds; therefore, circumventing the systems’ safety parameters.
Personal Experience with Health Information Technology Systems
The Bar Code Medication Administration (BCMA) system is one of the systems that I oversaw its development. It is a system that was introduced in our facility to reduce medical errors by verifying the five rights’ of medication administration (Shah, Lo, Babich, Tsao, & Bansback, 2016). During the project development, I learned that involving nurses at all stages during the project’s implementation facilitates a smooth transition. For instance, some equipment design flaws resulted in humorous and costly situations due to a lack of nurse involvement. The first BCMA system lacked documentation of IV fluids except to mark the fluid as ‘hanging’ or ‘discontinued. Although the nurses could read the fluid on the barcode, there was no link between the drug file and the BCMA system leading to medication errors. The system lacked safety checks. Another version of the BCMA version had to be developed, and this was costly. If nurses were, therefore involved in the design process, then some of the adverse events experienced could have been avoided. It could have also reduced the learning curve of many users
References
Cresswell, K. M., Bates, D. W., & Sheikh, A. (2016). Ten key considerations for the successful optimization of large-scale health information technology. Journal of the American Medical Informatics Association, 24(1), 182-187. doi:10.1093/jamia/ocw037
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD:
Author.
Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar code medication administration technology: A systematic review of impact on patient safety when used with computerized prescriber order entry and automated dispensing devices. The Canadian Journal of Hospital Pharmacy, 69(5). doi:10.4212/cjhp.v69i5.1594
Singletary, V., & Baker, E. L. (2019). Building informatics-savvy health departments. Journal of Public Health Management and Practice, 25(6), 610-611. doi:10.1097/phh.0000000000001086