You are a nursing educator within a large academic medical center responsible for the annual competency evaluation of nurses within the hospital and clinics. The senior vice president for quality and safety, the chief information officer, and the chief nursing information officer requested a meeting to discuss identified issues related to the electronic health record (EHR) documentation and patient safety issues regarding medication orders, management of the orders within the EHR, and administration of the medications.

Events involving patient safety are increasing, and the senior executives believe that this is largely an issue related to competency in using the new EHR (implemented in the past 2 years). They have asked you to recommend a training and competency evaluation strategy that might affect these measures of patient safety and improve competencies related to the documentation errors they are seeing. They are taking responsibility for monitoring the progress on impact and are asking you to come back with recommendations for the education program.

After meeting with your chief nursing officer, education department staff, directors of nursing on the units, and the staff nurses, all parties agree that it would be helpful to have a training program for the EHR that simulates clinical workflow on some of the common issues concerning medication errors.

You and your department are responsible for the simulation center, and the following are questions for your team to consider as you design a plan for the implementation of the EHR in the simulation lab. Choose ONLY 2 of the questions below to answer in your discussion post:

1. What strategies will you use to fully implement the practice domain that replicates the EHR production domain with which nurses are currently working? Explain your answers with best practices and scholarly support.

2. How will you identify cases related to the patient safety events that are occurring and incorporate them into the EHR to simulate what is happening and allow nurses time to practice on workflow and documentation related to these events? Explain your answers with best practices and scholarly support.

3. How will you evaluate the nurses’ performance and what assessment tools will you need? Explain your answers with best practices and scholarly support.

4. How much time do you believe you need per nurse to run through the simulated case, and how will you manage these time constraints and the schedule in the simulation center? Explain your answers with best practices and scholarly support.

5. Will you manually load data into the EHR representing the clinical data, including data that are clinically representative of the cases in which medication and documentation errors are occurring? Explain your answers with best practices and scholarly support.

6. What other alternative could you consider in loading clinical data representative of the conditions related to medication and documentation errors? Explain your answers with best practices and scholarly support.

7. What challenges do you identify in the data-loading strategies? Explain your answers with best practices and scholarly support.