Title : Are you down with downtime processes? A quality improvement project for downtime process in nursing utilizing an escape room
Abstract:
In recent months, the United States has experienced an increase in natural disasters affecting the healthcare system such as major floods, hurricanes, and tornados that can destroy all connection ability to electronic health record (EHR) systems. There have also been several instances of cybersecurity attacks on EHRs that require downtime and can cause significant negative impact on processes, workflows, and outcomes. Furthermore, many staff members are new to the profession and have limited experience with the loss of EHR connection. These instances put patients at an increased risk of harm due to communication failures and loss of safety nets that the EHR provides. In the ever-evolving world of healthcare and with our continued reliance on digital and virtual technology, this disconnect can be overwhelming for nurses who have never experienced true downtime. In a high acuity telemetry acute floor at an urban quaternary care academic hospital, nurses identified a practice gap with locating the downtime emergency box and implementing the appropriate downtime process and procedures. The project team assessed the unit’s perception of downtime readiness through a survey evaluating the overall perception of readiness. The data showed the unit staff perceived to be unprepared to handle a downtime event. Staff readiness for a downtime of the electronic health record is essential for patient safety to ensure there are no gaps in care. The patient is at a most vulnerable position when lapses of care are inevitable. Staff preparedness can reduce the amount of potential risk exposure to the patient by knowing the proper protocol of paper documentation and record keeping practices. Staff performance of medication administration and order acknowledgement practices can become risky if the staff are overwhelmed by the downtime process. To address the identified gap, gamification in the form of an “Escape Room” was utilized for the educational intervention for nurses and staff to engage them with active learning. There were four separate puzzle clues they had to solve to unlock the box of tools needed to save the patient in the scenario. The in-service utilized printed and written documentation simulation along with form acquisition to improve the staff’s readiness for downtime procedures and close the perceived knowledge gap. A post-survey was provided, and the results demonstrated an improved perception of readiness amongst all team members. As a result of this project, the unit has included this process in its annual competency and will continue with ongoing readiness preparation. This project helped to improve the staff’s perceived readiness to handle downtime processes and procedures. Utilizing simulation and escape room gamification techniques can be applied to other educational efforts to improve staff readiness and knowledge in clinical practice.
