Rigid MAT EHR Workflows Add to Nurses’ Cognitive Load

Medication administration technology (MAT) system inefficiencies complicate nurses’ EHR workflows, according to a study published in JAMIA.

Researchers conducted interviews with 32 nurses practicing at two urban health systems.

The study found that a major hazard related to MAT is the failure to integrate with health IT systems. Nurses reported that they cannot easily see where a medication order is in processing.

Additionally, they noted that they cannot easily link the EHR to identify relevant labs, the indication for the medication order itself, or other relevant patient characteristics.

Another issue among nurses was insufficient cognitive support across the medication administration process, from understanding the reason for medications to patient education while administering at the bedside.

“Inpatient medication administration occurs in highly dynamic environments characterized by frequent task reprioritization based on rapid changes in patient status and resource availability,” the study authors wrote.

“Cognitive support is needed that integrates essential information to enable nurses to judge the appropriateness of the relevant medications in one place (eg, lab values, vital signs, and patient history), in proximity to the to-beadministered medication, and with clear directions about how to administer complex medications,” they added.

The study gave five suggestions for healthcare organizations to improve MAT workflows.

• Include all clinical roles in software updates and implementation.
• Evaluate software sharing standards and terminologies for within-hospital data sharing. All MAT across units and tools should support data sharing.
• Address rigidity in hospital protocols that discourage across-shift and across-setting documentation of medication administration.
• Inform users regarding MAT functionality to decrease overreliance on safety features.
• Perform user-centered design and summative testing at the organizational level to support continuous MAT improvement.

The researchers suggested that future research focus on understanding nurses’ workflow, communication processes, and decision-making.

“When deciding on the appropriateness of the medication plan, nurses review and sift through data across multiple EHR screens (eg, medications, history, physician notes) in their search for relevant information,” the authors wrote.

“Advances in information search and visualization techniques might direct attention based on nurses’ search patterns providing breadcrumbs and support for alternative searches and views,” they added.