It really is amazing how many of these stories I have read over the years. Why do they recur?
Bendigo Health staff survey reveals safety concerns over electronic patient records
ABC Central Victoria / By Anna Chisholm
29-11-2023
"Massive safety risk", "threat to patient safety", and "moral distress" are phrases used by unidentified Bendigo Health workers responding to an "experience survey" about the service's Electronic Patient Record (ePR) system.
Key points:
- The ABC has obtained a copy of a report on the results of a staff "experience survey" understood to have been shared internally
- The report includes unidentified Bendigo Health workers' comments, with some staff sharing concerns about patient safety
- It found more than 50 per cent of clinicians surveyed had plans to leave Bendigo in the next two years
The ABC has obtained a copy of the survey report prepared by KLAS research, which was shared with some staff internally last Thursday.
It included comments from staff that the system was putting patients at risk and exhausting workers.
According to the document, more than 50 per cent of clinicians reported plans to leave Bendigo in the next two years with nurses and allied health professionals reporting high levels of burnout.
"The ePR, as it stands now, is a threat to patient safety, which is increasing mortality and morbidity in this hospital," a consultant staff specialist commented.
Bendigo Health's website states the ePR was introduced in late November 2020.
"Using an ePR improves patient safety, improves medication safety, and allows decisions to be made about your care with up-to-date information available to care teams," the service stated on its website.
'Death from a thousand cuts'
The comments from staff included in the report repeatedly referenced stress and exhaustion.
"Since the introduction of this system during the first wave of COVID-19, my work stress, mental fatigue, and general displeasure of coming to work and having to troubleshoot this system every time have significantly increased," one nurse stated.
A consultant staff specialist commented: "The difficulty accessing information in an efficient manner for even minor things feels like death from a thousand cuts."
"There are potential risks imposed by the incomplete or difficult-to-access information, but the difficulty getting solutions makes me give up trying to do anything about it," they wrote.
"This causes moral distress on a near daily basis."
The report was circulated internally and includes a number of comments from staff.(Supplied)
A staff member in nursing and midwifery said: "I have reduced my hours at Bendigo Health and am seriously considering my future here."
"I used to believe I was a good nurse and provided excellent care to my patients, but I no longer feel that way," they said.
'Just don't click it'
The report stated using the system to record medications was a repeated concern for doctors and nurses.
"The drug chart is significantly difficult to read and interpret, often misleading the nursing staff to actual dosages prescribed, leading to many and multiple drug errors that have significantly affected patients," a survey response from a nurse read.
"Nurses have access to change the dosage and medications prescribed, which isn't safe, but we have been told, 'just don't click it'," the nurse continued.
"I can't think how this system passes national regulations since nurses could change prescriptions on a whim or with a mis-click."
Another nurse said they were in a group that tested the system initially and brought up concerns around its "usability".
They said "on many occasions" staff in the surgical services department "cannot see medications given in other departments, let alone give medications chartered by doctors".
Another nurse commented the ePR was complicated for doctors to prescribe medications, and "increases the likelihood of drug errors".
"We spend a lot of time interrupting [doctors] to amend orders," they said.
'Not easy to use, learn or maintain'
A worker in nursing and midwifery said in their survey response the system was difficult to "orient new staff to, particularly if they are also new to the ICU environment".
"In some respects, the program is a barrier to safe documentation," they said.
A consultant commented: "It is not easy to use, learn, or to maintain, and it does nothing to enhance the clinical experience."
"This is especially detrimental for our rotational doctors who are only with us for a short period of time and have little motivation to learn the system," they said.
The report also noted a number of responses in the section for other comments or concerns "mentioned patient safety issues", which it said was "atypical".
"This underscores the need for reliable functionality, excellent training, and strong communication, and shared ownership," it continued.
Some positive responses
A consultant staff specialist — who also described the system as a threat to patient safety — said they "feel like a guinea pig being constantly and systematically bullied and harassed by a computer".
"We should move back to a paper-based system and then move to one of the programs which are proven to actually work," they said.
An allied health worker commented: "The ePR seems to be an alternative system that does not provide improved efficiency or safety when compared to paper."
The report also included positive comments from staff members.
"As someone who is tech savvy, it has helped me greatly with efficiency," an allied health professional commented.
A nurse said integrated information was "helpful and they do improve patient safety and care outcomes".
A registrar or fellow also noted that "overall it is a pretty good system once you are familiar with it".
Staff concerns taken 'very seriously'
In the following statement, a spokesperson for Bendigo Health said it was taking concerns about the ePR system "very seriously".
"The survey was proactively initiated by Bendigo Health's leadership team to ensure staff had an opportunity to speak up and provide feedback as part of our commitment to continuous improvement for our ePR program.
"The ePR program involves a combination of hardware and
software components and like any major digital transformation initiative it
entails significant change management. Our core clinical system is purpose
built and successfully deployed across Australia and 26 other countries.
"We would like to reassure our staff and our community that upon receipt
of the survey results we met with the clinical system provider to work together
to coordinate an action plan to address issues identified. We are working through
this action plan now to ensure patient safety is at the heart of how this
system operates.
"We acknowledge all major software implementation projects require enormous change management, time and continued support so any and all risks are appropriately managed and mitigated. We have advertised for more senior positions to provide this increased level of support to our staff. Some of the issues raised in the survey have already been solved; others will be resolved by initiatives underway, including replacing our existing Patient Administration System. We would like to assure that the action plan to address the issues is being constantly monitored by the CEO and the Board of Directors."
Here is the link:
Here is a link to the system page:
https://www.bendigohealth.org.au/ePR/
The system was provided by TrakCare who have seen all this many time before:
Here is a link to a press release.
What can I say other than that I have seen all of this zillions of time before and we can all be confident that in a year or so it will all have settled down and that most will be totally relaxed with using the new system.
There is always a struggle in the middle of this processes but at the end of the day the vast majority are a success!
All that is needed is for time to pass I reckon, and the edges to be smoothed.
David.
1 comment:
Reminds me of the Rozelle Interchange
https://www.abc.net.au/news/2023-12-01/rozelle-interchange-explainer-first-week-congestion/103172454
"It's not only structural concerns being raised — communication has also been criticised.
One communication and road safety expert said she was frustrated to see road users being blamed for some of the issues.
"The public unfortunately is seen to be the diabolical naughty people in all this and it's not the road user, it's the way it's designed," Emeritus Professor Ann Williamson with UNSW's School of Aviation, Transport and Road Safety Research Centre said."
and
"This is usability 101 but unfortunately, Transport for NSW doesn't seem to have done that course and they need to," Professor Williamson said.
"It's time they started designing a road system and acknowledging that you design for the road user.
In the future, she said transport authorities needed to carry out far more usability testing, where roads are open to a small number of naive road users who report back on what worked and what did not well before the road opens to the public."
Replace "road-user" with "patient" and you get the same-old-same-old -- technologists and public service managers implementing what they think is a good idea; which comes back to bit ethem in th ebutt.
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