Nursing Documentation Perceptions Preferences Attitudes

Background Government mandate Best practice Informed patients Reduction of medical errors Accessible health records

Before Mandate The Centers for Medicare and Medicaid (CMS) have been shaping healthcare for years through their payment mechanisms: No pay events Payment penalties for readmissions for certain diagnoses (CHF, AMI, Pneumonia) or for developing certain conditions while in the hospital (Hospital Acquired Conditions) Value Based Purchasing-a bonus structure based on results of Core Measures (Quality) & Patient Satisfaction (Service) Patient safety, security, and accessibility through electronic records

Purpose Assess preferences for electronic documentation Identify nurses’ perceptions and attitudes toward system functionality Assess preferences for electronic documentation Identify barriers and problems associated with electronic documentation Identify modifications needed to deliver safe, efficient patient care

Objectives Measure satisfaction Determine preferences Assess computer needs Identify ways to augment nursing workflow identify gaps and resources needed for efficient documentation

Methods Design Sample Tool Procedure

The sample Data Analysis Table 1 Table 1 Years of Experience and Shift Demographics   Experience (Years) n % <1 1 1.9 1-5 4 7.4 6-10 7 12.9 11-20 16 29.6 >21 26 48.2 Age (Years) 20-25 26-35 6 11.1 36-50 17 31.5 >50 30 55.5 Shift 7A-7P 45 83.3 7P-7A 9 16.7

Table 2 Average Agreement Ratings with EMR Benefits   Nursing Assessment of Documentation in the EMR N = 57 Current System Computer access 98.1 Experience 92.6 Paper to computer 30.2 Computer help available when needed 71.7 Computer preference 56.6 Bedside documentation 50.9 Frequent information system problems 44.4 Computer-friendly environment 74.1 Documentation Problems Cannot locate device 10.5 Missing power cord 26.3 Many interruptions 63.2 Preferences for documentation at bedside Medications 79.3 Admission 94.2 Vital Signs 67.9 Progress notes 41.5 Other 36 Values reflected as percentages

Table 3 Average Agreement Ratings with EMR Benefits

Table 4 Correlations: Experience, Age, and EMR Positive Benefits n R P

Major Themes Interruptions in workflow and documentation Support and equipment failure Nursing workload and documentation Improved patient care and safety

Conclusion A descriptive study of nurses using an EMR documentation system produced information that demonstrated some frustration with certain processes, but overall results were positive. The instrument was deemed valid and reliable and should be considered for use by other hospitals in varying stages of conversion to an EMR. The addition of questions about physician order entry and its effect on nurses’ workload should be considered as an addition to this survey. The project was initiated for performance improvement purposes to enhance the work environment of the registered nurse. Reponses from 57/60 nurses were analyzed for trends and action plans were developed according to results. This survey will be replicated in the other Baptist Health facilities to determine any trends in perceptions and attitudes of the nursing staff.

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