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## Creating an Electronic Health Record for Clinical Simulation using MS Word

Submitted by: Christine Thomas on January 14, 2016
HomeGrown Solution Number: 274
Identification of the Problem
Nursing students need to learn to use electronic health records (EHR) to access relevant information to inform decision making regarding patient care and interdisciplinary collaboration. While several companies have developed EHR for use during simulation scenarios, their purchase by small simulation programs can be prohibitive.
Unique Idea
No two electronic health records (EHR) are exactly alike, but have similar functions to access patient files/information. Behaviors involved with accessing information from several EHR were examined to help design an inexpensive, functional EHR and medication dispensing cart that contained relevant patient information and medications for student use during simulation scenarios. The materials for the project (computer, software, cart, and pills/vials) were already used in the lab and repurposed for the project. Therefore, the project cost only $15, which was the cost to purchase plastic storage containers at a local craft store. Objectives Supplies/Ingredients  1. laptop computer with MS Word software 2. storage cart with drawers 3. two plastic storage containers with movable dividers ($5-7 at a craft store) 4. individually packaged pills and vials
Steps to Creating the Solution
 1. Using MS Word to create a patient chart using hyperlink functions • To begin using this function, it is best to change the software options for hyperlinks on the computer to a simple click instead of the default setting of ctrl + click. Typically, this change can be done from the MS Word options screen, generally in the Advanced tab/section. Deselect or uncheck the box “use CTL + click to follow hyperlinks”. One can search the “help” section of MS Word to identify where this is located in the MS Word version being used. • Design various documents to link together as a chart (you may already have many of these documents as printed handouts for students): Laboratory reports, Medication Administration Record (MAR), HCP orders, History, Consult reports, X-ray and diagnostic testing reports. Reports can include photos or anything else MS Word supports. Links can also be made to other electronic files such as pdf. • Design a patient chart directory document that lists patient name, medical record number, hospital name/logo, health care provider (HCP) name, and other pertinent information. This document should also list the name of relevant patient care documents listed above (see template).  Store all documents in one file folder and/or flash drive. Storing them on a flash drive allows for easy portability. If documents are copied/saved on a different drive/computer, links between documents will be broken. They will need to be re-linked. 2. Linking chart documents to patient chart directory: Begin in the patient chart directory document.  Click and drag the mouse to highlight the written text/name of the document to be linked to the directory, for example “labs”. Click the “Insert” tab in the formatting tool bar, and then click “hyperlink” function.  From the file list or “look in” drop down box locate the where the laboratory results document is saved, click on it and click “ok”. The “lab” text in the directory document will now change color and be underlined. This indicates that a hyperlink now exists between the two documents.  Use this hyperlink process to link multiple patient documents to the main patient chart directory document.  When documents are linked, one simply clicks on the hyperlinked text “labs” and the laboratory document appears on the screen.  When finished viewing the lab document simply click the “x” close icon at the top right corner to close the document or it can be minimized. MS Word is a familiar program and this process of viewing various documents is easy to use by most computer savvy students during the simulation scenario to access/view patient information. 3. Linking of pages/text within one MAR document: Creating hyperlinks within one document that holds the MAR on the first couple of pages and then corresponding bin numbers on later pages allows one to localize all items in a single document file. This provides back and forth hyperlinking in the same document making it easier to save this one document to multiple flash drives or computers. Typically the MAR is in a table format (see template).  The MAR table should be listed on the first 1-2 pages of the document. In subsequent pages list the following text in large font (36 or larger) for easy reading “Bin #1” and “return to medication sheet”. Do this several times on separate pages depending on how many medications will be administered during the scenario. There will be many pages of the MAR document when complete.  Each bin number in the document will need to be bookmarked with the name of a medication to be used in the scenario that is listed in the MAR table. To create a bookmark, click and drag the mouse to highlight the written text “Bin # 1”, click the “Insert” tab in the toolbar, click “bookmark”, type the name of the medication to be linked to this bin number, click “add”. Do this for as many medications/bin numbers that are needed for the scenario.  Return to the MAR table with the medications listed on the first page. Click and drag the mouse to highlight the text to be linked to a bin number. The text “location” under each medication is used in the attached template, however, the name of the medication cold also be used. click “Hyperlink” in the toolbar, click the “bookmark” box (located on right), click the name of the medication (that was previously bookmarked to a bin number), click the “ok” box, the name of the bookmark will now appear in the “address” box, click “ok”. Do this for each medication and corresponding bin number.  To allow students to return to the MAR table, repeat the process of bookmarking some text in the MAR table. For example, click and drag to highlight a word in the middle of the MAR table, follow the bookmark directions above and label it “MAR”. Then hyperlink “return to medication sheet” to this MAR bookmark.  Each time the student clicks on the medication name (location) in the MAR, the bin number appears. Students can then locate the packaged medication in the drawer, click “return to medication sheet” and visually verify they have the correct medication and dosage listed in the MAR table prior to administration. 4. This may seem complicated at first, but once one learns how to use the hyperlink and bookmark functions the process of setting up the EHR/MAR becomes quick and easy. Also, once the EHR/MAR is set up it can be used over and over again. 5. Medication/EHR cart The medication/EHR cart is easy to set up. Any cart with at least 2-3 drawers for medications and administration equipment can be used. Our lab already used a large cart 34.5"H x 18"D x 18.5"W with 4 large drawers for storing supplies and this was repurposed. A laptop computer with MS Word software and EHR can be placed on top of the cart. In the top-drawer place one to two plastic storage containers, purchased at a local craft store, with movable dividers that fit the dimensions of the drawer. Stick numbered labels on the side of each bin that can be easily read when the draw is opened. Place different individually wrapped or labeled medication pills, syringes, and vials in each bin. 6. This idea was also discussed in the following reference: Thomas, C., & Mraz, M. (2013). Designing a Medication Cart and Computerized Chart on a Budget. CIN: Computers, Informatics, Nursing: CIN Plus. 31(6), 251-254.