Congress Abstracts 2005

71

LINKING SUCCESS AND FAILURE: IMPACTS ON ONCOLOGY NURSES ACCEPTANCE AND USE OF A NEW ELECTRONIC MEDICAL RECORD (EMR). Linda Schiech, RN, MSN, AOCN^®, Fox Chase Cancer Center, Philadelphia, PA, and Marina Douglas, RN, MS, Principal-Beacon Healthcare Consulting, McLean, VA.

Success and failure: strange bedfellows. “The key factor to failure is 15 years of past success”—Peter Drucker. The past successes of an institution, including nursing departments, can decrease the success of new projects. Introducing a complete electronic medicial record (EMR) will cause major changes bringing likely increased anxiety and decreased adaptability for change.

The institution undertook a 5-year strategic Information Technology plan to implement state of the art clinical computing encompassing an EMR. The nursing department has been highly successful achieving ANCC Magnet status, and a fully participatory Shared Governance Model. The longevity of the nursing staff speaks to the success with an average length of employment of 9.5 years and more than 17% of the staff reaching 20+ years of service to the institution. The combination of these factors contributed to a formidable resistance to the initial automation required for an EMR.

To introduce the concept of EMR, nursing staff was mandated to attend an education session facilitated by a nurse and an organizational psychologist. The session focused on how EMR would benefit the patient care delivery in the highly complex oncology world. William Bridge’s Change Theory was utilized as a framework to prepare the staff for a multi-phase approach. The use of “superusers,” staff trained in depth by a training team, were then responsible to train other staff members. This allowed more people with detailed knowledge of the system to be available for troubleshooting. The facility also utilized a “Command Center,” open 18 hours a day during the first 2 weeks of the system’s implementation. Clinical and technical people were immediately available to answer questions and actively rounded through the clinical areas to train abd troubleshoot as needed.

The initiative was deemed successful as evidenced by monitoring the number of calls made to determine if problems noted during the initiation were resolved, and by tracking staff’s general comments about the system.

The successful utilization of change theory and the use of the “superusers” concept can be applied to other major changes in oncology nursing practice, allowing for increased patient safety, improved workflow and enhanced communication.