Adoption of Electronic Medication System by Nurse Along Evidence-Based Literature Assessment Answer

INTRODUCTION

Electronic medical record system has the potential to transform the healthcare system from multiple paperwork to singe line of information allowing efficient communication driven performance. Consistent and successful implementation of an electronic medication system should be done through planning and strategy. Apt measurement of risk, benefits and challenges in a well-planned action roadmap is helpful in adequate implementation of the change within the organization. This essay identifies the reason for the adoption of electronic medication system in the two hundred bed hospital by nurse unit manager through evidence-based literature. The essay also outlines a plan of action for the successful implementation through Lewin’s model, under proper milestones and timeframes discussion. The best suitable leadership style with critical evaluation and comparison with other leadership style is done. Two aspects of potential resistance in the whole process of planning, execution, and implementation is discussed with effective measures to address this resistance.

REASON TO ADOPT FULLY ELECTRONIC MEDICATION SYSTEM

The electronic medical record is the digital paper records or charts containing all the patient information about treatment, medical history collected through the individual patient. Electronic medical record system has the ability to assess of information easily hence eliminating the poor penmanship. Electronic medical records system documents diagnostic investigations, medical treatment information, clinical decision support system and facilitate communication between healthcare professionals (Schopf et al., 2019). Electronic medical record addresses three functionalities in hospital including quality of care, reduction of cost and clinical decision support system. These benefits can be observed at three-level that is patient, organization and society.  The reason for implementation relates to the care and safety of the patient for better clinical outcomes.

It allows avoiding resource wasting in the form of energy, supplies ideas and equipment as well as redundant diagnostic testing. In the hospital ecosystem, appropriate use of electronic record system may reduce the chances of medical errors. These systems can integrate medication orders, dosing levels, dose frequency through centralized information and communication (Kruse et al., 2016).  An electronic medical record is designed for optimization of the workflow and efficiency for quality health care (Wolfe et al., 2018). Implementation will allow easy access to the social history of the patient for review purpose, allowing the establishment of better communication during patients visit enabling personalized and valuable care. Electronic records can be used to provide direct information to the patient regarding their reports, next visits, self-management information and chronic disease behavior. Information initiation through emails can reduce the effort and cost of visiting the office traditionally and quality time can be distributed for the essential communications only (Wolfe et al., 2018).

LEWIN’S MODEL PLAN OF CHANGE INCLUDES MILESTONES AND TIMEFRAMES

The model was developed by the German social psychologist based on his research on organizational development. Lewin’s change theory in nursing consists of concepts addressing implementation, motivation and adherence to organizational change. Lewin’s change model is simple and critical corresponding to different phases of change management application referred to as unfreeze-change-freeze. The first step is regarding the unfreezing of the current situation (Eden et al., 2016).  This is the step where the personal resistance of individuals may be counterbalanced. Some of the actions aiding the unfreezing step are training sessions, motivation, trust development and recognition of change need (Fritz et al., 2015). A milestone in stage could be the number of employee willing for the training sessions, employees willing to undergo short term course or examination. The time frame can be between 7 to 10 days.

 The second step is regarding moving towards the new equilibrium and target system.  In this step, the nurse unit manager should be connected thoroughly to other nurses through the systemic and strategic introduction of electronic medication system unit by unit.  The milestones include achievement of computer skills enhancements in different departments. The selection process of the appropriate vendor is also a marked milestone of this step. This might take 3-6 months. 

The third step is refreezing whereas a nurse unit manager should solidify the organizational change else the individuals could go back to the old equilibrium or reject the change (Worley & Mohrman, 2014). This takes place after the implementation of an electronic medication system so that the change is sustained for a longer period (Eden et al., 2016). The milestone for this step is the reinforcement of the new pattern of formal and informal institutionalizing ways such as incentive plans and policies. The time frame for this could be 2-3 months.

LEADERSHIP STYLE

Leadership within the organization is responsible for careful planning, preparation, effective communication and a sustainable business plan with mandatory implementation (Vesterinen et al., 2013). In a complex organization like a hospital, a good leadership style and strategy enhances the development and implementation of an electronic medication system. As a nurse unit in charge choice of leadership style best suited is participatory or democratic style. However, the various style of leadership adaptation for the diverse phase is important (Boonstra et al., 2014).  The leadership style must be aligned with the organization acknowledging organizational goal (Lammers & Mc Laughlin 2016).

 In the above-mentioned plan of action, group-level decision making is required in almost every step.   In the plan of action which includes training sessions, learning computer skill set, hiring a vendor, setting up computers and monitoring the progress, all steps require participation from subordinates and employer. In the plan of action through the democratic style, the organizational hierarchy will remain effective influencing the decision but valuing the contribution and participation of employees (Peng et al., 2015). In participative leadership, collaborative energy through share responsibilities and delegations is required. Through democratic style actions are collaborative, conflicts are addressed and talent is synthesized to implement change within the organization. The democratic style of leadership allows consensus formation within the competent team and stakeholders (Jadhav et al., 2017).

 However, another contrasting style of leadership that can be adopted by nurse unit in-charge can be the autocratic style of leadership. Instead of having participatory efforts to adapt the change autocratic leadership provide command in the hands of the nurse unit manager where she holds the complete authority and power (Magbity et al., 2020).  This leadership can be adapted in the forceful streamlined action and function for the implementation of the electronic medical record system, but lack of participation and shared responsibility will reduce the motivation within the team.  In autocratic style, the nurse unit manager takes all the decisions depending on best discretion with no feedbacks and inputs. This type of leadership may although be helpful in disciplined, professional output but will be difficult in implementation of scientific knowledge like electronic medication system which is complex and may require constant updating of knowledge. 

Potential Resistance and how they can be addressed?

 Although numerous healthcare facilities have adopted the system in their day to day activities, the non-compliance of the staff and failure remain higher. Hence addressing resistance from the beginning even before implementation is crucial. One of the major aspects of resistance can appear in the form of lack of readiness of the employees to the change in conventional methodologies. The other resistance can be seen in the form of lack of computer skill knowledge required. Resistance can be reduced with the help of collaboration, teamwork and trust between the stakeholder in the hospital. 

Motivating employees to establish the accountability and responsibility and feeling of being part of systemic strategies and effort needed is an appropriate approach that can be adopted by the nurse unit manager as a leader to address the challenges coming forward in the implementation in the form of resistance. Resistance can be guided through the Lewin’s theory to ensure the transition to the new system is more convenient and progressive. The resistance within the organization can be overcome through participatory teamwork alongside the members of the organization at several levels and departments. The individual can be asked to actively participate, recognize challenges and come up with suitable solutions (Nguyen et al., 2014). The nurse unit manager can urge the employees to observe change, not a challenge but as a new perceptive through persuasion done by the practical evidence-based examples. This can be made through giving them details how in past many communication errors have been found in the organization and how the implementation of electronic medical record system will enhance the efficiency without much effort of keeping the records manually updated.  More motivation-based training sessions should be arranged to enhance the skillset.

CONCLUSION

Electronic medical records are the tool to achieve effective and efficient care through standardized evidence-based guidelines and adherence. Introduction and implementation of an electronic medical record system in 200 bed hospital is a complex and demanding procedure hence a thorough plan of action is required which should be based on the Lewin’s model of change for desired outcomes. There are multiple factors for the successful implementation of the electronic medical record. Persistent attributes of influence include leadership, governance, clinical engagement, strategy and planning, resources availability, vendor commitment, support and training and workflow turnover. All these attributes are required to be addressed for identifying the barriers, challenges and opposition to the program for successful address and resolution.