Appl Clin Inform 2021; 12(03): 484-494
DOI: 10.1055/s-0041-1731002
Research Article

Clinician Perceptions on the Use of Free-Text Communication Orders

Swaminathan Kandaswamy
1  Department of Pediatrics, Emory University, School of Medicine, Atlanta, Georgia, United States
,
Zoe Pruitt
2  MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
,
Sadaf Kazi
2  MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
3  Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
,
Jenna Marquard
4  Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, Massachusetts, United States
,
Saba Owens
2  MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
,
Daniel J. Hoffman
5  Robert H. Smith School of Business, University of Maryland College Park, Maryland, United States
,
Raj M. Ratwani
2  MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
3  Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
,
Aaron Z. Hettinger
2  MedStar Health National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
3  Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
› Author Affiliations
Funding This study received its financial support from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (grant numbers: R01 HS025136 to R.R. and R21 HS024755 to A.Z.H.).

Abstract

Objective The 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.

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

Results Participants 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.

Conclusion Clinicians' 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.

Author Contributions

S.K. (1), J.M., A.Z.H., and R.R. conceived and designed the study. S.K. (1), D.H., S.K. (2), and Z.P. collected the data. S.K. (1), Z.P., and S.O. analyzed the data. S.K. (1), S.K. (2), and Z.P. drafted the manuscript. All authors made critical manuscript revisions and approved the final version for submission.


Protection of Human and Animal Subjects

This study was approved by the health system's institutional review board.


Supplementary Material



Publication History

Received: 16 December 2020

Accepted: 28 April 2021

Publication Date:
02 June 2021 (online)

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