Samples / NURS FPX 8022 / Assessment 2
SAFER Guides and Evaluating Technology Usage
NURS FPX 8022 · Assessment 2
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Slide 1:
Hi, I'm , and today I'll be walking you through my SAFER Guides evaluation of barcode medication administration technology at Cleveland Clinic
Slide 2:
Self-assessment tools were created to be implemented locally across the country to maximize EHR safety: the Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides. These guides are regularly updated by informatics safety researchers and can be used by healthcare organizations to proactively assess technology-related risks (Sittig et al., 2025). This presentation uses the SAFER Guides to the technology proposed in the previous assessment for Cleveland Clinic, which is the barcode medication administration technology. Findings include an area of strength, area of risk, and a reflection on the self-assessment experience. This structured evaluation ultimately is used to inform the risk mitigation plan that will be created in the next phase of this project.
Proposed Technology/Informatics Implementation
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A technology proposal can be used to identify the safety risks and opportunities for improvements in any healthcare organization. Cleveland Clinic suggests extending bar code medication administration, combined with predictive, clinical decision support, to their acute inpatient units. This is a technology that corrects known deficiencies in medication administration accuracy and hand hygiene compliance, which have been identified in the previous Leapfrog performance information. Structured monitoring tools can support integrated systems to reduce override rates, as demonstrated in earlier studies (Boehme et al., 2022). This practice change directly relates to the reduction in organizational safety performance associated with information and communication technology gaps.
SAFER Guides Findings: Areas of Strength
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The Computerized Provider Order Entry with Decision Support SAFER Guide highlights several strengths of Cleveland Clinic's organization. Medications are entered into the computer system each order and will be verified by the pharmacist prior to delivery of any barcoded medication to the nursing unit. It is a structured sequence and verification routine that follow recommended safe use practices from Sittig et al. (2025) in the updated SAFER Guide framework. The results indicate that the organization has developed a solid base for safe medication ordering and medication verification.
Other HPPs identified included further improvement of system accountability and clinician training on barcode scanning procedures. Structured onboarding training to nursing staffs on scanning workflows to help foster consistent understanding of correct system use. Those that have structured training on how to use the barcode scanning tend to demonstrate higher nursing confidence and longer consistency (Grailey et al., 2023). The above strengths are good starting points for further enhancements aimed at technology-induced safety measures.
SAFER Guides Findings: Areas of Risk
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There were also some key gaps in current practice identified through the SAFER Guide assessment. Nursing and physician staff often turn off clinical decision support (CDS) alerts for no recorded or documented clinical reason. It has been found that frequent dismissals of warnings during periods of alert cause their critical, high-risk messages to become more likely to be ignored (Wang et al., 2022). This is a “Not Implemented” or “Partially in Some Areas” rating on multiple of the recommended decision support practices.
Secondly, there is a lack of uniformity in how barcodes are scanned on high acuity nursing units. Manual overrides often occur in the workflow because the scanner fails or due to workflow interruptions, which can lead to medication safety errors. However, longitudinal data shows that non-compliance with scanning can occur over time if there's no structured monitoring and feedback (Williams et al., 2025). The risks are directly linked to the low scores for medication administration and medication safety in earlier organizational performance data.
Reflection on Using the SAFER Guides
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The self-assessment of the SAFER Guide provided important information and insight that went beyond the information provided by typical performance metrics. The format of the structured checklist promoted a more systematic and practice-level analysis of technology risk as opposed to a review of isolated incidents. This reflective approach is consistent with research that suggests that structured EHR safety assessments can provide earlier identification of risks than reactive reporting (Sittig et al., 2022). This experience underlined the need to evaluate technology proactively and based on evidence for future technology safety.
Conclusion
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Through this presentation, the SAFER Guides will be shown to be a structured, evidence-based approach to evaluating technology-related patient safety risks. Cleveland Clinic demonstrates strong performance on order entry and pharmacist verification, while moderate performance on alert response and scanning compliance. The identified risks serve as a starting point for the risk mitigation plan during the next assessment, as they are data-driven and focused. The SAFER Guides will continue to be vital for maintaining safe and reliable use of health information technology moving forward.
References
Boehme, S., Wohlt, P., Valentine, J., & Ensign, R. (2022). Sustained barcode medication administration rates less than 2 percent in a large healthcare system. Journal of Patient Safety and Risk Management, 27(6), 268–274. https://doi.org/10.1177/25160435221137145
Grailey, K., Hussain, R., Wylleman, E., Ezzat, A., Huf, S., & Dean Franklin, B. (2023). Understanding the facilitators and barriers to barcode medication administration by nursing staff using behavioural science frameworks: A mixed methods study. British Medical Center Nursing, 22, e378. https://doi.org/10.1186/s12912-023-01382-x
Sittig, D. F., Sengstack, P., & Singh, H. (2022). Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER guides. Journal of American Microbiology Association, 327(8), 719–720. https://doi.org/10.1001/jama.2022.0085
Sittig, D. F., Flanagan, T., Sengstack, P., Cholankeril, R. T., Ehsan, S., Heidemann, A., Murphy, D. R., Salmasian, H., Adelman, J. S., & Singh, H. (2025). Revisions to the Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guides to update national recommendations for safe use of electronic health records. Journal of the American Medical Informatics Association, 32(4), 755–760. https://doi.org/10.1093/jamia/ocaf018
Wang, L., Goh, K. H., Yeow, A., Poh, H., Li, K., Yeow, J. J. L., Tan, G., & Soh, C. (2022). Habit and automaticity in medical alert override: Cohort study. Journal of Medical Internet Research, 24(2), e23355. https://doi.org/10.2196/23355
Williams, R., Kantilal, K., Man, K. K. C., Blandford, A., & Jani, Y. (2025). Barcode medication administration system use and safety implications: A data-driven longitudinal study supported by clinical observation. British Medical Journal Health Care Informatics, 32(1). https://doi.org/10.1136/bmjhci-2024-101214