1. Nursing Documentation
Perceptions
Preferences
Attitudes

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

3. 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

4. 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

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

6. Methods
Design Sample Tool Procedure

7. 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

8. 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

9. Table 3 Average Agreement Ratings with EMR Benefits

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

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

12. 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.

13. References
Health Information Management System Society (HIMSS). HIMSS unveils model for electronic health records. Bio-IT World. July 22, Edwards K, Chiweda D, Oyinka A, McKay C, Wiles D assessing the values of electronic records. Nursing Times. 2011; 107: Dagnone RV, Wilson R, Goldstein DH, Murdoch J, Rimmer MJ,Vandenkerkhof EG. How do patients perceive electronic documentation at the bedside? Journal of Healthcare Quality. 2006; 28: Ward M, Vartek S,Schwichtenberg T, Wakefield D S. Nurses perceptions of how clinical information system implementation affects workflow and patient care. Computers, Informatics, Nursing.2011; 29: Stricklin M I, Bierer SB, Struk C. Home care nurses’ attitudes toward computers: A confirmatory factor analysis of the Stronge and Brodt instrument. Computers, Informatics, Nursing.2003; 21:

14. References
Huryk LA. Factors influencing nurses’ attitudes toward health information technology. Journal of Nursing Management. 2010; 18: Sockolow P S, Weiner JP, Bowles KH, Lehmann HP. A new instrument for measuring clinician satisfaction with electronic health records. Computers, Informatics,Nursing.2011; 29: Banet GA, Jeffe D B, Williams J A, Asaro P V. Effects of implementing computerized practitioner order entry and nursing documentation on nursing workflow in an emergency department. Journal of Healthcare Information Management.2006; 20: Kohle-Ersher A,Chatterjee B, Osmanbeyoglu H U, Hochheiser H, Bartos C. Evaluating the barriers to point-of-care documentation for nursing staff.Computer Informatics Nursing. 2012; 30:

15. References
Krampf S, Robinson S. Managing nurses’ attitudes towards computers. Nursing Management.1984; 15: Moody EL, Slocumb S, Berg B, Jackson D. Electronic health records documentation In nursing: nurses’ perceptions, attitudes, and preferences. Computers, Informatics, Nursing.2004; 22: Waltz CF, Strickland OL, Lenz ER. Measurement in Nursing Research. 2nd ed. Philadelphia: FA Davis; 1991.