Evidence map›Paper›PMID 34077971›Full record

ArticleApplied clinical informatics2021

Clinician Perceptions on the Use of Free-Text Communication Orders.

Swaminathan Kandaswamy, Zoe Pruitt, Sadaf Kazi, Jenna Marquard, Saba Owens, Daniel J Hoffman, Raj M Ratwani, Aaron Z Hettinger

Abstract read
In one paragraph

Article in Applied clinical informatics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Safety risks and workflow implications associated with nursing-related free-text communication orders.Journal of the American Medical Informatics Association : JAMIA · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Swaminathan KandaswamyDepartment of Pediatrics, Emory University, School of Medicine, Atlanta, Georgia, United States.
Zoe PruittMedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States.
Sadaf KaziMedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States.
Jenna MarquardDepartment of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, Massachusetts, United States.
Saba OwensMedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States.
Daniel J HoffmanRobert H. Smith School of Business, University of Maryland College Park, Maryland, United States.
Raj M RatwaniMedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States.
Aaron Z HettingerMedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States.

Funding

PA-20-070 Improving Medication Safety and Nursing Workflow during COVID Through eMAR RedesignR01HS025136 · AHRQ · MEDSTAR HEALTH RESEARCH INSTITUTE · PI HETTINGER, AARON ZACHARY, RATWANI, RAJ M · 2018 to 2022
$2.2M
Context is Critical: Understanding When and Why EHR Related Safety Hazards HappenR21HS024755 · AHRQ · MEDSTAR HEALTH RESEARCH INSTITUTE · PI HETTINGER, AARON ZACHARY · 2017 to 2018
$298k
AHRQ HHS R01 HS025136AHRQ HHS R21 HS024755
6 · The paper itself

Abstract

objectiveThe aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information.

methodsWe performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes.

resultsParticipants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders. DISCUSSION: Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders.

conclusionClinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process.

Indexed as

CommunicationElectronic Health RecordsHumansPerceptionPhysiciansWorkflow

Identifiers

PMID34077971
PMCPMC8172259

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.