David G. Curry, PhD, APRN Associate Professor of Nursing SUNY Plattsburgh May 26, 2010

1. Selection and Implementation of a Simulated Electronic Medical Record (EMR) in a Nursing Skills Lab David G. Curry, PhD, APRN Associate Professor of Nursing SUNY Plattsburgh May 26, 2010

2. IOM’s “To Err is Human: building a safer health system” (2000) showed need for better systems to prevent errors • Better systems include EMRs • Robert Wood Johnson Foundation, through QSEN project (2007) and NLN Board of Governor’s Position Statement (2008) both recommend integration of informatics in nursing curricula • Students don’t get much informatics experience in their clinical rotations… Why an EMR in the skills lab?

3. Nursing students generally don’t get practice with admission assessments or order entry, for example. • Since simulation is becoming an integral part of student clinical experience, a simulated EMR gives students the opportunity to practice these activities in the safety of the skills lab • So how to find the simulated EMR that fits your needs? Closing the loop

4. We used “evolving scenarios” in skills lab and wished to add e-documentation • We had acquired Laerdal’s SimMan, had integrated him in our med-surg courses and wished to add e-documentation with SimMan simulations as well • Research for a solution began in Summer, 2008 • The solution included an application for a campus technology grant of $25,000 The Plattsburgh experience

5. Three systems were considered: • Elsevier’s Simulation Learning System (SLS) • Cerner’s Academic Education Solution (AES) • Nursing Data System’s NurseSquared (N2) • Criteria for evaluation: • Functionality • Flexibility • Price • We wanted bedside charting for entire skills lab PLUS integration with SimMan PLUS documentation of hospital clinicals What systems to choose from?

6. Functionality – all the systems had fairly comparable functions and features • Flexibility – only NurseSquared allowed scenario creation. N2 also supported documentation of hospital clinicals • We wanted to integrate with SimMan, so writing our scenarios was highly desirable • Price – SLS was least expensive, then N2, with AES most expensive • NurseSquared was chosen Evaluation of the criteria

7. Summer, 2009 – N2 folks made site visit to provide orientation to faculty • Plans were made to include N2 in Nursing Fundamentals and Med/Surg in Fall, 2009 • Used for clinical documentation • During late Fall, plans for using N2 in Spring Med/Surg SimMan lab began • Students would do order entry in advance, as well as real-time documentation of vital signs, medications and assessment during scenarios Acquisition and Planning

8. Fall semester began slowly • Challenge of getting all affected students and faculty online with personal computers • Most challenges were easily overcome with experience • Spring semester was bigger challenge with some adjunct faculty affected • Again, with experience things got smoother • We are now evaluating our first-year experience… Implementation

9. This is a work-in-progress with challenges and successes one might expect when combining two technologies – SimMan and N2 – and moving an entire curriculum toward more informatic content • Please stay for my colleagues’ presentation that follows mine • Tami Pobocik and JoAnn Gleeson-Kreig have focused on students’ perceptions of the technology… Results

10. To Err is Human – summary of the landmark IOM report from 1999 • Preparing the next generation of nurses to practice in a technology-rich environment: an informatics agenda. NLN Position Statement, May 9, 2008 • A Summary of the October 2009 Forum on the Future of Nursing: Acute Care Resources