Reducing Medication Errors in Acute Care Settings in a Community Hospital by Implementing an Electronic Health Record (EHR)

Introduction

This innovation proposal aims to reduce medication errors in acute care settings in a
community hospital by implementing electronic health records (EHRs) or electronic medical
records (EMR). Evidence suggests that acute care settings – neonatal intensive care, cardiology
care, coronary care, intensive care, emergency department, and other general practice areas
where patients can become acutely unwell and need steadying and transfer to higher dependency
units – are often prone to medication and other medical errors, leading to poor clinical outcomes,
including high mortality and increased rehospitalization rates. The idea is to introduce EHRs to
improve communication and sharing of patient data between clinicians at the point of care.
Typically, EHRs are the digitized version of patient medical information/data, including
medication histories, demographics, lab results, and histories.
Explanation of an Innovative Nurse Leader’s Role
Since nurse leaders are more directly in contact with patients than physicians, they play
an integral role in planning, selection, system design and development, testing, education, “go
live” or implementation, monitoring, ongoing maintenance, improvement, and optimization.
From system design to implementation, nurses provide critical insights into what an EHR must
have to be effective and efficient in addressing medical errors. Nurse informaticists also provide
critical education to other nurses, clinicians, and patients about the use and the importance of
implementing EHRs. They are directly involved in establishing buy-in from the management, the
Board, and other clinicians to support an EHR initiative. Most importantly, nurses collaborate
with HIT professionals, patients, and other healthcare providers in developing and integrating
technology to transform healthcare data into meaningful use (Patricia, 2015).

3

Organizational Characteristics
The primary setting of this paper is the intensive care unit (ICU) and other acute care
settings in Cedars – Sinai Medical Center. The general community hospital’s ICU employs a
hierarchal structure. This means that the facility has many levels of power and authority with a
chain of command linking the different management levels within the institution. In general, an
acute care setting is a secondary healthcare setup or department in which patients obtain active
but short-term therapy/treatment for a severe episode of illness or injury, an urgent clinical
condition, or recovery from a surgical operation.
Acute care setups in question include coronary care, intensive care, emergency
department, neonatal intensive care, cardiology care, pre-hospital emergency care, trauma care,
acute care surgery, and several settings patients are admitted with acute illnesses that require
steadying before transfer to other higher dependency units for additional treatment and
monitoring. Some of the emergency services offered by the facility include diagnosis, treatment,
life support, and 24-hour monitoring and care of critically injured and ill patients. Some of the
conditions targeted include non-stop bleeding, bone breaks, chest pain or stroke, major cuts,
ongoing vaginal bleeding, seizure without a prior diagnosis, snake bite, serious injury to the head
or neck, serious burns, suicidal thoughts, sudden vision loss, coughing or vomiting blood, cut
repairs, X-rays imaging and referrals, acute pain evaluation and management, IV hydration/fluid,
oxygen support, and other life-support services. Cedars Sinai has more than 2,800 licensed
nurses, 2,100 licensed physicians, thousands of other healthcare providers, and a bed capacity of
886.
Ideally, acute services entail palliative, rehabilitative, curative, preventive, and promotive
actions. Acute care settings often record high incidences of medical errors because they involve
the most time-sensitive and individually-oriented curative and diagnostic actions whose principal

4
goal is to stabilize and improve patient conditions. Most patients admitted to acute care face life-
threatening symptoms, injuries, and conditions requiring constant monitoring and comprehensive
care. An example is a patient admitted into a community hospital’s intensive care unit with
severe respiratory issues needing endotracheal intubation or a patient admitted with a seizure
caused by cerebral malaria and requiring urgent medical care. The objective of electronic health
records in critical care units is to improve coordination and sharing of accurate patient
information among clinicians, including nurses, obstetricians and surgeons, and emergency
physicians, to deliver critical urgent care services effectively and efficiently (Hirshon et al.,
2013).
Demographics
The target population is acute care patients admitted in critical care units, especially in a
community hospital’s intensive care units (ICUs), including a trauma intensive care unit (TICU),
surgical intensive care unit (SICU), pediatric intensive care unit (PICU), neonatal intensive care
unit (NICU), medical intensive care unit (MICU), and cardiovascular, coronary, and cardiac
intensive care unit (CICU). PICU attends to children and infants aged up to 17 years, while
NICU specializes primarily in treating newborns that require more tender loving care (TLC).
Other intensive care units (TICU, SICU, MICU, & CICU) cater to adults aged over 17 years
needing specialized care.
ICU patients account for nearly 12 percent of the hospital’s patient population, including
40 percent African Americans, 34 percent Whites, and 15 percent Hispanics. The rest comprises
of Native Americans and foreigners. The male-to-female ratio is 2:1. In terms of age, 15 percent
comprise of children aged between birth and 17 years, 30 percent 18-40 years, 35 percent 41-60
years, and 20 percent above 60 years (Cedars Sinai, n.d.). Respiratory diseases (30 percent) and

5
chronic cardiac arrest (28) were the most prevalent reasons for admission. Others included renal
replacement therapy (10 percent), and mechanical ventilation (8 percent).
Evidence suggests that medical errors are widespread in intensive care units. According
to Moyen, Camire, & Stelfox (2008), medical errors occur in roughly 6 percent of hospital drug
use episodes. The rate of drug errors among critically ill adult patients ranges between 1.2 to 947
per 1,000 ICU days, with a median of about 106 errors per 1,000 ICY days. Approximately 100-
400 medication prescribing errors have been recorded in infants and children per 1,000 patients.
Team Members Roles
i. EHR Team Lead
The EHR team lead is a key stakeholder in the overall EHR design and implementation
process, making the final decisions about the implementation plan. This individual oversees the
entire process and works closely with an EHR implementation manager, nurse lead, and several
other key leads (The Office of the National Coordinator for Health Information Technology,
2019).
ii. EHR Implementation Manager
This individual makes sure the EHR project moves forward swimmingly. As the project
leader, the EHR implementation manager monitors the work plan and ensures the entire project
stays within scope, budget, and schedule. The manager also maintains a list of practice and
vendor issues that require addressing from start to closure. Furthermore, the implementation
manager schedules implementation-related activities, including hardware deliveries and
delegating roles to other implementation teammates. Occasionally, the manager communicates
updates to the rest of the team members and the management (The Office of the National
Coordinator for Health Information Technology, 2019).
iii. Physician Champion

6
Since an EHR is designed to accommodate all healthcare employees, a physician
champion functions as the go-between or link between the implementation team and physicians
(The Office of the National Coordinator for Health Information Technology, 2019). The
physician champion usually operates as the “point of reference” for how physicians want the
technology to function and how things work out from a clinical viewpoint. Essentially, the
physician champion advocates for “physician” issues and perspectives during the design and
implementation of an EHR. They are also responsible for updating physicians on the
implementation process progress and sustaining physician “buy-in.”
iv. Nurse Lead
Like the physician lead acts as the go-between the implementation team and physicians,
the nurse lead operates as the liaison between the implementation team and nurses. The nurse
lead is also responsible for maintaining “buy-in” among nurses and updating them on the
implementation process and project progress. A nurse lead must always be an individual able to
command respect from other nurses and the organization. They must be able to inspire other
nurses to accept and participate in the proposed change (The Office of the National Coordinator
for Health Information Technology, 2019).
v. Medical Assistant (MA) Lead
The MA lead plays an essentially similar role as the physician lead and nurse lead, except
they are responsible for creating “buy-in” and driving consensus among medical assistants. The
medical assistant must command respect from other medical assistants and have substantial
knowledge about medical assistant processes and workflows (The Office of the National
Coordinator for Health Information Technology, 2019).
vi. Information Technology (IT) Lead

7
The IT lead controls and guides all actions related to EHR hardware and software
implementation and operation, including scanners, printers, wireless tablets, and workstations.
The IT lead is the first point of reference or contact for users with questions about the
implementation process and technology use. Essentially, the IT lead engages in trial and error,
training, educating, and familiarizing staff members with the new technology.
vii. Super-User Lead
The super-user lead is an employee who has been trained to use the EMR system before
its deployment to generate staff buy-in and expedite its support. Typically, the super-lead user
leads other super-users’ hiring and training processes. These individuals are technologically tech-
savvy and often play an integral role in implementing the technology, sharing techniques,
insights, and hints with other employees. A core group of super users can lead and expedite the
internal training of clinicians and office staff. This role is indispensable because the needed
training blends special EMR education with training on how the technology will be applied
within an organization to match a specific patient population and internal workflows.
viii. EHR Builder
The EHR builder is the individual or company that designs and develops the EHR system
that the organization integrates into its practice management system (The Office of the National
Coordinator for Health Information Technology, 2019). The EHR builder or developer is a
software engineer with knowledge about system (desktops, mobile phones, tablets)
compatibility, HIPAA-compliance features like end-to-end encryption, image recognition and
handwriting, advanced clinical decision support, dictation, voice assistance, and others.
ix. Other Team Members
Other team members involved in the EHR development and implementation include
workflow redesign lead, meaningful use lead, billing staff lead, laboratory staff lead, registration

8
staff lead, and schedular lead. Each person acts as a vital link between their departmental
colleagues and the implementation team (The Office of the National Coordinator for Health
Information Technology, 2019).
Shared Team Values
a. Integrity
Integrity is the first shared group value that all members of an EHR implementation team
must uphold. Integrity is showing uncompromising and consistent adherence to strong ethical
values and principles, including honesty. In ethics, integrity is measured by how an individual
upholds accuracy, truthfulness, and honesty (Higgs et al., 2018).
b. Respect
Respect is another crucial ingredient of a cohesive team. Respect means having regard for
the differing rights, wishes, feelings, beliefs, and viewpoints. Since effective EHR teams are
comprised of diverse groups based on professional background, sex, race, sexual orientation,
religious affiliation, and cultural backgrounds, having regard for these differences and
appreciating one another is necessary to hold the group together. It means that physicians should
respect the insights and input of other professionals, including nurses, for the implementation
team to work collaboratively (Higgs et al., 2018).
c. Responsibility
Responsibility is the act of being in charge of a specific activity or group and is often
associated with the quality of being reliable and dependable. All members must understand and
execute their tasks diligently and accordingly for the EHR implementation team to work as unit
and within budget and schedule. For example, the ‘nurse lead’ must create and maintain buy-in
among nurses and encourage them to support the proposed initiative.
d. Equity and Justice

9
In ethics, equity is the act of being fair, impartial, and just. Equity is often taken to mean
delivering healthcare that does not differ in quality due to demographic features like
socioeconomic status, geographic location, ethnicity, gender, sex, and sexual orientation. For the
EHR technology to be meaningful and fall within the ethical code of conduct, all team members
must be willing to apply it impartially and justly when delivering care to patients. Equity and
justice are among the ethical issues surrounding the widespread application of health
technologies like electronic health records (Veinot, Ancker, & Bakken, 2019).
e. Accountability and Trustworthiness
Accountability and trustworthiness are two complementary teams. Accountability is
being answerable, liable, responsible, and accountable. On the other hand, trustworthiness is
being truthful, honest, and relied upon. For an EHR implementation team to be cohesive and
collaborative, members must be accountable and responsible for their actions to build trust and
confidence among other teammates. For example, a nurse lead can only command and earn the
respect of other nurses by being accountable and trustworthy or dependable.
f. Effective Communication
While accountability creates trust, effective communication is the critical aspect that
defines roles clearly, allows two-way messaging, brings respect internally, and encourages
transparency and openness. Effective communication occurs when the intended messages are not
only appropriately encoded and transmitted through the right channel/platform but also the
recipient receives, decodes, and understands the messages. Effective communication within an
EHR implementation permits better idea exchange, execution of the proposed ideas, and
interprofessional collaboration (Higgs et al., 2018).
g. Professionalism

10
Professionalism is the general umbrella term that describes adherence to practice and
ethical principles; this includes confidentiality, integrity, honesty, equity, respect, empathy, and
accountability for healthcare workers. A cohesive team is defined as a team that remains as
professional as possible, upholding what the profession dictates and requires.
Discussion of Internal and External Factors That Prompted This Proposal
I. Internal Factors
Multiple internal factors prompted the idea of introducing an electronic health record
(EHR) in the local community hospital, especially within its acute care units, including intensive
care units (ICUs). For the past 3-5 years, the facility has recorded a 50 percent rise in mortality
rates, a 30 percent increase in medical costs, and a 25 percent surge in rehospitalizations among
patients admitted to acute care settings. Nurse and patient satisfaction levels have also
significantly dropped within the same period. All these clinical outcomes have been attributed to
a 30 percent rise in medical errors, including medication errors and adverse drug-related
reactions/events (15%), surgical errors (14%), health-associated infections (10%), patient falls
(9%), laboratory errors (7%), and documentation/computing errors (5%).
A 2020 internal audit established that the sources of these medical errors and adverse
clinical outcomes include communication breakdowns, inadequate information flow within
different ICU service areas and professionals, patient-related issues (inadequate patient
assessment, inappropriate patient identification, failure to seek consent, and insufficient patient
education), and human issues because of failure to follow standards of care procedures,
processes, and policies. The facility also lacks a standardized IT system to effectively and
meaningfully manage workflows and processes.
II. External Factors

11
Externally, the passing of multiple federal legislation over the years mandating all
healthcare facilities to implement standard information technologies, especially EHRs, to
improve patient outcomes (bolster quality and safety of care and lower adverse outcomes,
including medical errors and cost of care) influenced the decision to propose change within the
local community hospital. The journey to the mass roll-out of health IT in the country started in
1996 with the passing of the Health Insurance Portability and Accountability Act (HIPAA). The
HIPAA law mandated the HHS Secretary to craft policies safeguarding the security and privacy
of certain health information, including healthcare data shared through online or digital
platforms.
While HIPAA laid the foundation for protecting health data, the HITECH Act signed into
law by President Obama in 2009 pushed the large-scale adoption of EHR and other health IT in
the country. As part of Title Eight of the American Recovery and Reinvestment Act (ARRA), the
Health Information Technology for Economic and Clinical Health Act (HITECH), the HHS was
required to invest nearly $25.9 billion to champion and build and expand the implementation of
health IT. The HITECH Act consists of Subtitles A, B, C, and D. Subtitle A (Part 1) elaborates
on improving health care safety, quality, and efficiency through EHR implementation. Subtitle A
also describes the need to create EHRs to achieve “meaningful use,” specifically to ensure
adequate security and privacy, improve public and population health, engage patients and their
families, lower health disparities, and bolsters care coordination (Centers for Medicare &
Medicaid Services, 2011). Therefore, designing and implementing a certified EHR at the
community hospital aligns with the federal mandate for all healthcare providers in the country to
implement health IT to improve patient outcomes.
Alignment to Strategic Initiatives

12
There is no question that the proposed innovation or change aligns with the professional
and regulatory/government strategic initiatives. Professionally, nurses must combine their
knowledge, training, and experience with evidence-based tools, including electronic health
records and other health IT, to improve patient outcomes (quality, safety, cost, and effectiveness
of care) and reduce adverse events like medical errors and mortality. The proposed initiative
(EHR) is one of the few evidence-based technologies and tools that have shown success in
enhancing patient outcomes, especially in critical care units. Regulatory-wise, the new initiative
aligns with the 2009 HITECH Act that requires all clinical facilities in the US to roll out EHR
and other health IT to improve clinical outcomes (Centers for Medicare & Medicaid Services,
2011).
Purpose Statement
This project proposal aims to design, implement, and monitor an electronic health record
(EHR) in elderly intensive care units in a community hospital to lower medication errors and
other adverse events and improve clinical outcomes, including quality, safety, and effectiveness
of care.
Innovation SMART Goal
To lower medication errors in elderly intensive care units by 20 percent within six
months by implementing a certified electronic health record.
Relevant Sources Review

Table 1
Relevant Sources Summary Table

Scholarly Peer-Reviewed Sources
Published in the Past 5 Years

that

Summary of Findings Relevant to
Proposed Innovation

Evidence
Strength
Level I–VII

Evidence
Hierarchy

13

Support the Proposed Innovation

APA formatted scholarly reference
with a DOI or retrievable link.

Present a detailed summary of the
findings and

how the findings support the proposed

innovation.

Refer to
WGU Levels of Evidence

SCHOLARL
Y SOURCE 1

Suclupe, S., Martinez-Zapata, M. J.,
Mancebo, J., Font-Vaquer, A., Castillo-
Masa, A. M., & Vinolas, I. (2020).
Medication errors in prescription and
administration in critically ill patients.
Journal of Advanced Nursing, 76(5),
1192-1200.
https://doi.org/10.1111/jan.14322

This study examined the magnitude and
prevalence of medication errors and their
link with patient clinical and
sociodemographic characteristics and
nurses’ work conditions. About 650
prescription errors were found in a
population of 90 patients and 961 drugs.
The prevalence rate was 47.1%, with
omission being the most common error.

Level IV Retrospective

SCHOLARL
Y SOURCE 2

Gracia, J. E., Serrano, R. B., &
Garrido, J. F. (2019). Medication errors
and drug knowledge gaps among
critical-care nurses: A mixed multi-
method study. BMC Health Services
Research, 19(640).
https://doi.org/10.1186/s12913-019-
4481-7

This mixed-method study investigated
drug knowledge and medication errors
among critical care nurses. The
worldwide medication error index stood
at 1.93 percent, with the major risk areas
being antibiotics interval administration,
medication dilution, infusion rate, and
concentration errors.

Level IV Mixed
Method

SCHOLARL
Y SOURCE 3

Vaidotas, M., Yokota, P. K., Negrini,
N. M., Leiderman, D. B., De Souza, V.
P., Dos Santos, O. F., & Wolosker, N.
(2019). Medication errors in
emergency departments: Is electronic
medical record an effective barrier?
Einstein (Sao Paulo), 17(4). doi:
10.31744/einstein_journal/2019GS428
2

This comparative, descriptive,
retrospective and cross-sectional study
examined the potential impacts of
electronic health records in reducing
medication errors in emergency
departments. In their outcomes, the
researchers reported lower medication
errors when using standardized
medical/electronic records while
improving patient safety.

Level IV Cross-
sectional,
retrospective,

SCHOLARL
Y SOURCE 4

Manias, E., Kusljic, S., & Wu, A.
(2020). Interventions to reduce
medication errors in adult medical and
surgical settings: A systematic review.
Therapeutic Advances in Drug Safety,

11. doi: 10.1177/2042098620968309

This systematic review investigated
potential interventions to lower
medication errors in surgical and medical
care settings. The meta-analysis indicated
that prescribing errors were lowered
through pharmacist partnerships,
computerized medication reconciliation,
use of CPOEs, and automated drug
distribution.

Level I Systematic
Review

SCHOLARL
Y SOURCE 5

Laher, A. E., Enyuma, C. O., Geber, L.,
Buchanan, S., Adam, A., & Richards,
G. A. (2021). Medication errors at a
tertiary hospital intensive care unit.

This retrospective chart review examined
medication errors in a tertiary hospital’s
ICU unit in Johannesburg, South Africa.
Out of 3237 drugs and 656 patient days

Level IV Retrospective

14

Cureus, 13(12). doi:
10.7759/cureus.20374

examined, there were roughly 356 drug
errors, including 237 prescription errors
(66%) and 122 administration errors
(34%).

Synthesis of Literature
Medication errors are frequent in ICUs and other critical care units, including surgical
units, because patients admitted in these units are vulnerable, seriously ill, and require
specialized care. This implies that any slight error can be fatal. The sources of medication errors
in critical care units are varied. In one study by Suclupe et al. (2020), the prevalence rate of
medication errors was 47.1 percent. The most prevalent errors were the omission of the
prescribed drug and interruption during medication administration. Other sources of error include
administration through nasogastric tubes; high-risk drug infusion, concentration and dilution; and
interval antibiotics administration (Gracia, Serrano, & Garrido, 2019). According to Laher et al.
(2021), medication errors can also occur due to failure to administer the correct prescribed
medication, administering the incorrect dose, prescribing an inaccurate dosing interval, and
prescribing the wrong dosage.
Since ICU and other critical care patients often face life-threatening predicaments that
require agile and prudent clinical judgments, lowering medication errors is necessary to increase
their survival chances and reduce potential complications, length of hospital stay, future
rehospitalization, and medical expenses. According to Vaidotas et al. (2019), embracing certified
EHRs can significantly lower medical errors. These systems improve collaboration and
communication and ensure clinicians have quick access to accurate patient data/records needed
to make prudent and informed decisions at the point of care. Quick access to correct patient data
can lower errors, improve safety and quality of care, and serve as the difference between a wrong
or correct decision. Other researchers like Manias, Kusljic, & Wu (2020) propose single and

15
combined interventions to address medication errors in critical care units. Single interventions
include medication reconciliation by CPOEs (computerized physician order entries), trained
mentors, prescriber education, pharmacist partnerships, computerized medication reconciliation,
and pharmacist-led reconciliation.
Recommendations
Implementing a certified EHR system can reduce medication errors in intensive care units
in the community hospital. An EHR enables the multidisciplinary team involved in the care of
ICU patients a speedy access to accurate and relevant patient data at the point of care. Overall,
EHR systems can improve communication among clinicians, expedite decision-making, and
guarantee compliance with the use of primordial drugs in specific clinical scenarios. It also
bolsters patient safety, giving clinicians access to quality data and better pharmacovigilance
because of high traceability (Vaidotas et al., 2019).

Data-Collection and Technology

Idea Generation Process
The four steps employed in generating the innovative idea in the community hospital are
an inspiration, framing, prototyping, and validation. This idea generation approach was proposed
by Paris Thomas, one of the leading researchers at GREGHEC, a French-based research
laboratory in the fields of management and economics. Along with Mahmoud-Jouini and Sihem
Ben, Thomas researched ten businesses ranging from the hotel sector to the movie industry and
identified the four steps as integral to idea generation (HEC Paris, 2020). The first step,
inspiration, involved searching for creative new ideas to address medication errors, high
mortality rates, and other adverse clinical outcomes. Walkthroughs, interviews, and
questionnaires were used to collect clinicians’, managers’, and patients’ primary data and views.
In contrast, hospital records and data reviews supplied secondary data about mortality rates and

16
medication errors. In the second step, framing, the proposed idea was transitioned from the
conceptual world to the “real world,” where colleagues could share it. Although an online
evidence search was conducted to establish whether EHR systems can significantly lower
medication errors, potential prototypes have yet to be tested. The idea has yet to reach the
validation step, whereby it will be selected, rejected, or modified.
Data Examples
Examples of small data include views by ICU clinicians (physicians, nurses,
pharmacists), top managers, and ICU patients about medication errors and their experiences with
hospital workflows and processes in intensive care units. This data could be collected through
interviews and questionnaires, or observation. Big data examples include monthly and annual
ICU hospital records, including medication errors, mortality rates, rehospitalization rates, and per
capita costs. Big data can also include statistics about medication errors and previous EHR
approaches used in preventing medication errors in clinical settings. Big data is gathered from
databases owned by the government or non-governmental organizations.
Big Data Support
Big data could be used to examine the magnitude and prevalence of medication errors in
critical care units. It could also provide an insight into past gaps and recommendations about
EHR technologies and approaches implemented to lower medication errors in these clinical
settings. Ultimately, this information can be used to design effective and meaningful EHR to
address medication errors in ICU units in the identified community hospital.
Technology Enhancements
Designing and implementing a certified EHR system is necessary to lower medication
errors and address flaws in workflows and processes, especially drug dispensation and
administration mistakes, within the community hospital’s ICUs. However, the new EHR system

17
must be integrated with other existing decision support systems in the facility, such as CPOEs
and the medical billing practice management system. EHR integration allows electronic records
to seamlessly be accessed and used across multiple digital software solutions and systems.

Interprofessional Collaboration and Disruptive Innovation

Disruption
The new EHR system has the potential to lower medication errors by reducing errors and
blunders from the time a drug is ordered to the moment it is prescribed to patients. The system
will likely reduce errors associated with the wrong time, unauthorized drug, omission,
prescribing, improper dose, and administration errors, including giving extra doses to patients,
giving drugs to the wrong patients, or through the incorrect route (Tariq et al., 2021). However, it
faces a new challenge from disruptive technologies like e-Prescribing systems like CPOEs that
allow prescribers to digitally send error-free, accurate, and understandable medication
instructions to a pharmacy from the ICU or other critical points of care. The facility currently
uses e-Prescribing systems
Strategies to Mitigate Challenges
Marshaling buy-in from all individuals currently using the CPOEs (nurses, physicians,
pharmacists, lab technologies) can improve acceptance and participation in the change process.
This can ensure that all users are involved in the change process from the design to the
implementation, guaranteeing that their views and preferences are considered. Training clinicians
about the proposed EHR system can also reduce resistance and improve technology acceptance
and adoption.
Leverage Benefits of Disruptive Innovation
The best way to leverage the benefits of the CPOE (disruptive technology) is to integrate
it into the proposed electronic medical record. Integrating the two systems will ensure that the

18
proposed EHR system is seamlessly integrated and superimposed into existing digital systems,
including the CPOE. It means that EHR medical records like medical history and personal
information can be easily shared across multiple solutions and systems, not just CPOEs but also
telehealth networks and other decision support systems (Orenstein, 2018).

Plan

Diffusion of Innovation
The diffusion of the proposed innovation will occur through Roger’s five-step decision-
making process using a set of communication channels over a specific period among projected
system (EHR) users. The five steps include knowledge/awareness, persuasion, decision,
implementation, and validation/confirmation/continuation (Huang, Spector, & Yang, 2019). In
the first step, knowledge/awareness, users will be exposed to the EHR system (innovation idea).
Systems users are still unaware of the new system and lack interest. In the second step,
persuasion, users will be inspired to seek information about the new technology. The third phase,
decision, is where users accept the concept and weigh its benefits and setbacks before choosing
whether to accept it. In the fourth phase, implementation, users adopt the EHR technology for
ordering and making prescriptions. In the confirmation/continuation stage, users will affirm their
continued use of the system.
Innovation Action Plan Table
Table 2
Innovation Action Plan

Team Member
Role

Essential Responsibilities to
Implement Proposal

Timeline

EHR Team Lead Oversees the EHR design and
implementation process and works

June 1, 2022 – Dec 31, 2022

19

closely with the EHR implementation
manager

EHR
Implementation
Manager

As the project leader, the EHR
implementation manager monitors the
work plan and ensures the entire
project stays within scope, budget, and
schedule.

June 1, 2022 – Dec 31, 2022

Physician Lead Acts as the go-between or link between

the implementation team and
physicians

June 1 – August 1

Nurse Lead Acts as the go-between or link between
the implementation team and nurses

June 1 – August 1

Super-User Lead Leads the hiring and training processes

for other super-users

June 1 – Dec 31

Financial Implications
Table 3
Financial Budget
Name Cost (US$) Unit Total (US$)
servers 2000 2 4000
Network electronics 225 16 3600
Power backup/ electronics 3195 16 51120
Touchscreen clinical
workstations

1365 151 206115

20

Software configuration 5000
Training 20,000
Installation (materials) 7000
Installation (labor) 18000
Project management 23,012
Total 337,847

Evaluation
The success and effectiveness of the proposed EHR system will be evaluated by
measuring the degree to which medication errors in elderly intensive care units have declined
within a six-month implementation period (between July 1 and Dec 31). The initial goal is to see
errors drop by a 20 percent margin. Alternatively, the effectiveness of the technology can be
comparing multiple clinical outcomes between pre-implementation and post-implementation,
including mortality rates, adverse drug events, and rehospitalization rates due to drug-related
errors.

Conclusion

Purpose and Rationale
This project proposal aims to design, implement, and monitor an electronic health record
(EHR) in elderly intensive care units in a community hospital to lower medication errors and
other adverse events and improve clinical outcomes, including quality, safety, and effectiveness
of care. Medication errors significantly contribute to increased adverse drug complications,
mortality rates, rehospitalization rates, and medical costs. An EHR system can potentially

21
improve interprofessional communication, collaboration, and sharing of accurate patient data at
the point of care.
Reflection
Having worked with critical care patients, especially those admitted to intensive care
units, I have always yearned to find a long-lasting and effective solution to medication errors.
Despite their lives often hanging on a balance, ICU patients are prone to medication errors. Most
of these individuals are usually admitted with serious complications and injuries that require
urgent stabilization before transfer to other wards. Therefore, it was a no-brainer for me to
identify what changes I wished to bring to the intensive care unit.
Strengths and Challenges
When developing this innovation, the primary challenge was getting buy-in (during
awareness creation) from the facility’s top leadership. At first, everyone thought an EHR system
was a more complex technology that would require IT experts to run within the hospital. The
management feared this would be too costly to implement and manage in the long run. There
was fear about its potential benefits to the facility, especially the return on investment,
considering that the hospital is running on a tight budget. However, persuading the management
and other staff members to support the initiative became easier when health informaticists and
other experts were invited to sell and pitch the idea. Everything else fell in place after this
meeting.
Future Initiatives
I plan to roll out electronic health records in all critical care settings to improve
communication, information sharing, and collaboration between clinicians in these sensitive
clinical environments. This will lower medication and medical errors and bolster the quality and
safety of care. Ultimately, this can have a profoundly positive impact on clinical outcomes.

22
However, in addressing the buy-in issue in the future, I intend to start engaging stakeholders
early enough and use the right people to sell the idea to different groups of interest. For example,
I will recruit Nurse Leads specifically to engage nurses and convince them about the benefits of
the new project. However, training the Nurse Leads and other advocates early enough is
necessary. I will also provide a clear rationale for the project, remain explicit as possible,
pinpoint and manage risks, listen and communicate, and ensure all stakeholders comprehend
their contribution to the project.

23

References

Cedars Sinai. (n.d.). Urgent care. https://www.cedars-sinai.org/programs/urgent-care.html
Centers for Medicare & Medicaid Services (2011). CMS EHR meaningful use overview. EHR
Incentive Programs. Center for Medicare & Medicaid Services.
https://web.archive.org/web/20111030081815/https://www.cms.gov/EHRIncentiveProgra
ms/30_Meaningful_Use.asp
Gracia, J. E., Serrano, R. B., & Garrido, J. F. (2019). Medication errors and drug knowledge gaps
among critical-care nurses: A mixed multi-method study. BMC Health Services
Research, 19(640). https://doi.org/10.1186/s12913-019-4481-7
The Office of the National Coordinator for Health Information Technology. (2019). Who are the
key stakeholders during electronic health record (EHR) implementation?
https://www.healthit.gov/faq/who-are-key-stakeholders-during-electronic-health-record-
ehr-implementation
HEC Paris. (2020). The 4 key stages of idea creation in the creative industries.
https://www.hec.edu/en/knowledge/articles/4-key-stages-idea-creation-creative-industries
Higgs, J., Jensen, G. M., Loftus, S., & Christensen, N. (2018). Clinical reasoning in the health
professions e-book. Elsevier Health Sciences.
Hirshon, J. M., Risko, N., Calvello, E. J., De Ramirez, S. S., Narayan, M., Theodosis, C., &
O’Neill, J. (2013). Health systems and services: The role of acute care. Bulletin World
Health Organization, 91(5), 386-388. doi: 10.2471/BLT.12.112664
Huang, R., Spector, J. M., & Yang, J. (2019). Educational technology: A primer for the 21 st
century. Springer.

24
Laher, A. E., Enyuma, C. O., Geber, L., Buchanan, S., Adam, A., & Richards, G. A. (2021).
Medication errors at a tertiary hospital intensive care unit. Cureus, 13(12). doi:
10.7759/cureus.20374
Manias, E., Kusljic, S., & Wu, A. (2020). Interventions to reduce medication errors in adult
medical and surgical settings: A systematic review. Therapeutic Advances in Drug
Safety, 11. doi: 10.1177/2042098620968309
Moyen, E., Camire, E., & Stelfox, H. T. (2008). Clinical review: Medication errors in critical
care. Critical Care, 12(208). https://doi.org/10.1186/cc6813
Orenstein, D. (2018, July 26). EHR integration: Achieving this digital health imperative. Health
Catalyst. https://www.healthcatalyst.com/insights/ehr-integration-digital-health-
imperative
Patricia, D. (2015). Clinical nurses lead the charge with EHR. Nursing, 45(10), 25-26. doi:
10.1097/01.NURSE.0000471426.47075.d2
Suclupe, S., Martinez-Zapata, M. J., Mancebo, J., Font-Vaquer, A., Castillo-Masa, A. M., &
Vinolas, I. (2020). Medication errors in prescription and administration in critically ill
patients. Journal of Advanced Nursing, 76(5), 1192-1200.
Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2021). Medication dispensing errors and
prevention. StatPearls.
Vaidotas, M., Yokota, P. K., Negrini, N. M., Leiderman, D. B., De Souza, V. P., Dos Santos, O.
F., & Wolosker, N. (2019). Medication errors in emergency departments: Is electronic
medical record an effective barrier? Einstein (Sao Paulo), 17(4). doi:
10.31744/einstein_journal/2019GS4282

25
Veinot, T. C., Ancker, J. S., & Bakken, S. (2019). Health informatics and health equity:
Improving our reach and impact. Journal of the American Medical InformaticsAssociation, 26(8-9), 689-695. doi: 10.1093/jamia/ocz132