Table 4 SIEPS 2.0 System simulation recommendations with select examples

Tools/Technology

Consider usability, functionality, level of automation etc.)

117

• Electronic Consents: Update consent form build to improve usability & align with workflows. Risk uncovered for potential wrong site surgery through ongoing consent build issues

• Visibility of completed consents: intra-op nursing requires easier access to view consents during timeout (e.g., add to main side bar for their view)

• Ready for Procedure Status: indicators only showing for RN roles, other roles such as Anesthesia would benefit from this information. The surgeon ready for procedure also needs to update automatically or allow for manual update by the surgeon or physician assistant

• Alert Notices: Ensure alerts are firing properly (e.g., weight-based medication alert should not fire for non-weight-based medications)

• Fire risk score: incorrect calculation of fire risk rating based on the current build, it is not aligning with hospital policy (e.g., calculating a lower fire risk score than they currently indicate)

• Chart locking finding: patient chart locked with concurrent documentation from different roles. Issue with aligning to current workflows that require access, especially in these quick turnaround cases

• Pain Scales: incorrect pains scales were included in the build and do not match the established one

• Aligning Language: e.g., change to surgical incision versus surgical “wound”; different roles show “case start” versus “procedure start” times

• Positioning Templates: not correct for the default positioning that would be used in these cases

• Missing key fields: e.g., FiO2 and EtCO2 data streaming for Anesthesia views; patient weight missing on the Anesthesia intra-procedure screen, e.g., order sets missing key medications

• Weight-based medication rounding: system not rounding to appropriate amounts for administration (e.g., 12.49 mL of oxycodone or 311.3 mL of acetaminophen)

Organization

Consider staffing, workload, schedules, education and training, work culture etc.)

6

• Systematic review of all previous usability recommendations (i.e., internal process to review and address usability findings prior to simulations)

• Staff Comfort/Education: participants requested additional simulations sessions to practice workflows prior to launch

• Staff requests: Increase staffing or reduce surgical case load in the initial launch period while learning

• Super-Users: request they are only educators during launch and not assigned patient care duties. Super users not feeling prepared due to receiving the same education as all staff (just earlier)

• Patient/Family Portal: improve communication with parents/families on changes to the patient portal; address upcoming downtime

Environment

Consider how environment impacts their role- distractions, layout, space etc.)

5

• Computer Supply: Ensuring enough mobile computer workstations for various roles in the Operating Room to chart at the same time (e.g., Anesthesia and Nurse Anesthetist)

Roles/responsibilities/tasks (who and what is required—difficulty, complexity etc.—what do they need to function effectively?)

14

• New role allocation: Additions to training for new tasks that users will have to complete (e.g., nursing placing orders in the Operating Room)

• New tasks: Determine who is responsible for completing specific tasks in the sequence and ensure all users are aware of the correct workflows (e.g., patient movement/event steps, medication orders), as this is different from current practices

Process

What processes are impacted?- Select examples

9

• Uploading Paper Consents: Clarify workflows for paper consents to be uploaded into the EHR. Note: consents can be attached to case even with missing signatures, posing a risk

• Clinical Event Debriefings: Staff ask to initiate clinical debriefings during launch to aid in sharing learnings

• Ensure that placing discharge orders in advance does not impact the subsequent care areas ability to complete their tasks (e.g., PACU nurses must be able to action post op orders and complete their documentation tasks)

• New process between surgeon and physician assistant in Otolaryngology clinic: Develop a workflow for ordering and consent signing in high throughput clinic using the HER

Total # of recommendations

151