Patient safety perspectives of providers and nurses: the experience of a rural ambulatory care practice using an EHR with E-prescribing.

PURPOSE: The purpose of this study was to identify and describe safety improvements and concerns indicated by providers and nurses in a rural community ambulatory care practice using an electronic health record with an e-prescribing feature (EHR with eRx). METHODS: Two focus groups were conducted; 1 with providers and the other with nurses. Participants responded to questions and discussed their perceptions of safety improvements and concerns with use of an EHR with eRx. Transcripts were analyzed using sequential and continuous analytic methods. FINDINGS: Three themes centered on efficiency and patient safety emerged from data analysis: (1) EHR with eRx adoption has led to new improvements and concerns for patient safety, (2) the EHR with eRx has affected efficiency in the clinic, and (3) EHR with eRx adoption has led to workarounds. CONCLUSIONS: Concerns remain among providers and nurses regarding the use of EHR with eRx applications, although concerns differed between groups. Therefore, When EHR improvements are planned, it is important to consider the differing needs of the professionals who deliver care.

Functional outcomes of adult patients with West Nile virus admitted to a rehabilitation hospital.

BACKGROUND AND PURPOSE: The clinical manifestation of West Nile Virus (WNV) varies in individuals from mild flu-like symptoms to acute flaccid paralysis. Advanced age is the most significant risk factor for developing severe neurological disease and for death. The broad range of neurologic symptoms associated with WNV infection leads to varied body structure and function limitations and participation restrictions that may require rehabilitation. The purpose of this study is to describe the functional impairments upon admission and the functional outcomes at discharge of 48 adult patients admitted with WNV to a rehabilitation facility in the Midwest from 2002 to 2009. METHODS: A retrospective chart review was completed on 48 patients (29 male, 19 female) with mean age 67.8 (SD = 16.6, range = 24-91) years and median age 72.5 years, admitted to inpatient rehabilitation with a diagnosis of WNV after January 1, 2002, and discharged prior to December 31, 2009. General information (sex, age, social history, employment, and living environment), past medical history, and information specific to the current hospitalization (medical conditions, functional status and activity level on admission and discharge as measured by the Functional Independence Measure [FIM], lengths of stay [LOSs] in the acute care and rehabilitation hospital, physical therapy care, discharge destination, and follow-up care provisions) were gathered. The standardized response mean (SRM) was calculated for total, motor, and cognitive FIM scores to provide insight into the effect size and the responsiveness of the FIM for the patients with WNV in this study. RESULTS: All patients were admitted to the rehabilitation hospital from acute care hospitals following LOSs ranging from 1 to 62 days. The rehabilitation hospital LOS ranged from 2 to 304 days. These patients had significant comorbidities including hypertension (43.75%), diabetes mellitus (41.67%), acute respiratory failure (37.5%), ventilator dependency/tracheostomy (33.33%), and pneumonia (29.17%). Their admission FIM scores ranged from 13 to 116 (mean = 45.8 ± 28.2) and discharge FIM scores ranged from 18 to 121 (mean = 75.1 ± 34.2). The change in FIM during inpatient rehabilitation was statistically significant (P < .001). The calculated SRM for the total (1.06) and motor (1.12) FIM indicate a large effect size, whereas the SRM for the cognitive FIM (0.79) indicates a moderate effect. The majority of patients were discharged home or to a nursing facility (46%), skilled or extended care (38%) with a need for continued rehabilitation services. DISCUSSION AND CONCLUSIONS: The manifestation of the WNV and functional outcomes after comprehensive rehabilitation vary from patient to patient. Higher numbers of comorbid conditions lead to more complex presentation and challenge rehabilitation professionals to design individualized plans of care to enable these patients to achieve the highest functional outcomes. Most patients require follow-up physical therapy care after discharge from rehabilitation.

How baccalaureate nursing students value an interprofessional patient safety course for professional development.

Nursing students need foundation knowledge and skills to keep patients safe in continuously changing health care environments. A gap exists in our knowledge of the value students place on interprofessional patient safety education. The purpose of this exploratory, mixed methods study was to understand nursing students' attitudes about the value of an interprofessional patient safety course to their professional development and its role in health professions curricula. Qualitative and quantitative data were collected from formative course performance measures, course evaluations, and interviews with six nursing students. The qualitative themes of awareness, ownership, and action emerged and triangulated with the descriptive quantitative results from student performance and course evaluations. Students placed high value on the course and essential nature of interprofessional patient safety content. These findings provide a first step toward integration of interprofessional patient safety education into nursing curricula and in meeting the Institute of Medicine's goals for the nursing profession.

The relationship between physician practice characteristics and physician adoption of electronic health records.

BACKGROUND: Health information technologies, such as electronic health records (EHRs), can potentially improve patient safety in our health care system. The potential advantages include increased quality and more efficiency in the care of patients. Adoption of EHRs has been slow despite these advantages and a national call for EHR implementation. PURPOSES: This article explores factors associated with the adoption of EHR systems using organizational theory to derive hypotheses as to why physicians would adopt EHRs. METHODOLOGY/APPROACH: : A survey was administered to all office-based physicians in Nebraska and South Dakota using a modified Dillman technique between July and November 2007. The main outcome variable measured physician EHR adoption status at three levels: not planning to use an EHR, planning to use an EHR, and using an EHR. Factors associated with EHR status were analyzed using a multinomial logistic regression. FINDINGS: Approximately 30% of physicians reported using an EHR in his or her practice. Physicians adopting EHRs were younger and had access to internal health information technologies support. In addition, working in an independent practice decreased the likelihood of physicians using and adopting EHRs. PRACTICE IMPLICATIONS: This research provides further evidence of the barriers impeding EHR adoption. One such barrier includes the lack of access to internal information technology support staff versus having to outsource for technical support services. From a resource dependency perspective, barriers illustrated by this example may place undue dependencies on physicians if they pursue an EHR system. By addressing these barriers, physicians may be in a better position to adopt EHR system into his or her practice.

Promoting awareness and understanding of occupational therapy and physical therapy in young school aged children: an interdisciplinary approach.

SUMMARY Public awareness and understanding of the professions of occupational therapy and physical therapy are limited. In this study, we examined perceptions of young school-aged children about occupational therapy and physical therapy as part of a larger grant project funded by the National Institute on Drug Abuse (R25 DA 12168 and R25 DA13522). One hundred three elementary school children (55 boys and 48 girls), grades 3 to 7, from local schools attended a one-day neuroscience and allied health profession exposition held at a local Boys & Girls Club. Children's understanding of occupational therapy and physical therapy was assessed through a pre/post questionnaire prior to and immediately after attending the exposition. At five of the 18 exhibition booths, faculty members and students from occupational therapy and physical therapy introduced and explained what occupational and physical therapists do at their work through interactive demonstrations. The results of the current study revealed that prior to attending the exposition, children's understanding of occupational therapy and physical therapy was limited. On pre-test, children reported they have some understanding of occupational therapy (18.6%) and physical therapy (34.9%). Children's understanding of occupational therapy and physical therapy, however, dramatically increased after the exposition (75.6% vs. 18.6%, 98.9% vs. 34.9%, respectively). Furthermore, the scope and depth of children's understanding also improved considerably. This finding suggests that an interactive neuroscience exposition including occupational therapy and physical therapy is an effective way to promote children's awareness and understanding of the professions. Implications for practice and future research directions are discussed in the study.