MMHA 6600 Week 10 Downtime Drill Report Example

Four Hours on Paper: A Scripted Record Downtime Drill and What the After-Action Review Found

Student Name

Walden University

MMHA 6600: Healthcare Informatics and Technology Management

Instructor Name

Month Day, Year

Four Hours on Paper: A Scripted Record Downtime Drill and What the After-Action Review Found

Purpose of the Drill

Bramble Creek Hospital, the invented community hospital this course uses, has a written downtime procedure for its electronic record but had never tested it on a live unit. The procedure assumes that paper forms, printed medication records and a read-only backup computer will carry the unit through an outage. This drill tested that assumption on one 28-bed medical unit for four hours on a weekday afternoon, with scripted events, assigned observers and an after-action review.

The need is not hypothetical. When researchers read safety reports filed during record outages, they found medication errors, laboratory delays and lost information among the most common problems (Larsen et al., 2018). Recommended practices for contingency planning include regular drills with clinical staff rather than relying on written procedures alone (Sittig et al., 2014).

Design

The drill used a training copy of the record for the unit, which was switched to read-only at 13:00 to simulate an unplanned outage. Real patients continued to receive real care; staff documented care on paper during the drill and entered it into the live record afterward, so no care depended on the simulation. A controller released scripted events, called injects, at set times. Four observers, each assigned one area, recorded what happened against a checklist.

Table 1

Scripted Injects

Each inject was chosen because the written procedure addressed it; the drill tested whether the procedure worked in practice.

Observers and Measures

Observers were posted at the nurses' station, the medication room, the unit clerk's desk and with the rapid response team. Each recorded the time taken for key tasks, any information that staff could not find, and any workaround they invented. The charge nurse kept a log of decisions. After recovery, the controller, observers, charge nurse, two staff nurses, a hospitalist and a pharmacist met for forty-five minutes to review the logs together, following a simple order: what was expected, what happened, why the two differed and what should change. Findings were rated by severity using the hospital's existing safety event scale so they could be compared with real incidents.

What Paper Carried Well

Several parts of the procedure worked. Staff recognized the outage within four minutes and the charge nurse notified the house supervisor using the posted phone tree. The printed medication administration records, generated every four hours by the downtime computer, were current and complete for the patients already on the unit, and every scheduled medication in the drill window was given on time. The verbal order was written on the paper order sheet, read back and faxed to pharmacy within ten minutes, which matched the procedure.

What Paper Could Not Carry

Four problems emerged, summarized in Table 2 with their severity and cause.

The pattern is consistent with what earlier work on downtime describes: the procedure protected the routine work it was designed around, scheduled medications, while the unscheduled events, new patients, urgent results and emergencies, exposed information that existed only on screen (Nelson, 2007).

Table 2

After-Action Findings

Three of four high-severity findings occurred where information lived only in the electronic record's display rather than in any printed report.

Corrective Actions

Table 3

Actions, Owners and Due Dates

Each action responds to one finding, and the repeat drill will show whether the changes worked.

Limits

The drill ran in daylight with full staffing and advance knowledge among leaders, conditions better than a real outage at night. Observers may have changed behavior, since staff knew they were being watched and may have followed the procedure more closely than usual. The training copy of the record also behaved more predictably than a real failure, which often starts with slowness and partial function before a full stop, leaving staff unsure whether to switch to paper. Four hours did not test the longer outages that would exhaust printed records. The next drill should run on an evening shift without advance notice to staff below the charge nurse.

Conclusion

Bramble Creek's downtime procedure carries scheduled work well and unscheduled work poorly. The drill showed where: information that lives only on screen, such as code status, and patients who arrive after the last printout. These are fixable, and the fixes are inexpensive. The more important lesson is that a written procedure is a hypothesis until it is tested; the drill turned it into evidence. The same approach should be applied to the pharmacy and laboratory downtime procedures next, since both departments feed the units that depend on them.

References

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: An analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187-191. https://doi.org/10.1093/jamia/ocx057

Nelson, N. C. (2007). Downtime procedures for a clinical information system: A critical issue. Journal of Critical Care, 22(1), 45-50. https://doi.org/10.1016/j.jcrc.2007.01.004

Sittig, D. F., Gonzalez, D., & Singh, H. (2014). Contingency planning for electronic health record-based care continuity: A survey of recommended practices. International Journal of Medical Informatics, 83(11), 797-804. https://doi.org/10.1016/j.ijmedinf.2014.07.007