Impact of using data from electronic protocols in nursing performance management: A qualitative interview study

Abstract

AimTo explore the impact of using electronic data in performance management to improve nursing compliance with a protocol.BackgroundElectronic data are increasingly used to monitor protocol compliance but little is known about the impact on nurses’ practice in hospital wards.MethodSeventeen acute hospital nursing staff participated in semi‐structured interviews about compliance with an early warning score (EWS) protocol delivered by a bedside electronic handheld device.ResultsBefore electronic EWS data was used to monitor compliance, staff combined protocol‐led actions with clinical judgement. However, some observations were missed to reduce noise and disruption at night. After compliance monitoring was introduced, observations were sometimes covertly omitted using a loophole. Interviewees described a loss of autonomy but acknowledged the EWS system sometimes flagged unexpected patient deterioration.ConclusionsIntroducing automated electronic systems to support nursing tasks can decrease nursing burden but remove the ability to record legitimate reasons for missing observations. This can result in covert resistance that could reduce patient safety.Implications for nursing managementProviding the ability to log legitimate reasons for missing observations would allow nurses to balance professional judgement with the use of electronic data in performance management of protocol compliance.

Evaluation of NEWS2 response thresholds in a retrospective observational study from a UK acute hospital

“…These problems relate in part to the fact that NEWS2 was evolved for paper-based, or stand-alone implementation. In these settings, alert censoring by ward staff is well documented, whether appropriate or not 19 20. EHR’s automate alerting, thereby generating different problems, associated with high alert-rates.…”

“…This is in the context of limited evidence of survival benefit from an EWS triggered response,8 10–16 or definition of the resource required to deliver a response 17. Since electronic systems directly link a threshold EWS to a response recommendation,18 high rates of alerting may arise, unmoderated by human intervention,19 20 creating an opportunity for clinical resource to be diverted in ways that could be counterproductive 9…”

How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

“…There is growing evidence that adherence to Early Warning Score-based monitoring protocols is poor ( Hands et al., 2013 ; Tysinger, 2014 ; Redfern et al., 2019 ). The perception that many vital signs assessments are unnecessary in low-risk patients may be one of the underlying causes of poor adherence ( Redfern et al., 2019 ), with staff reporting they have to prioritise some tasks such as responding to rapid deterioration over scheduled observations ( Hope et al., 2019 ). New technology aiming to improve the fidelity of vital signs monitoring, including wearable devices and even providing patients with devices to measure and record their own vital signs ( Weenk et al., 2018 ), promises considerable time savings for nursing staff ( Wong et al., 2017 ; Bellomo et al., 2012 ; Wager et al., 2010 ).…”

Participatory co-design and normalisation process theory with staff and patients to implement digital ways of working into routine care: the example of electronic patient-reported outcomes in UK renal services

“…In healthcare, end users can be both patients and professionals. Working with staff may ensure fidelity of the ePRO system, including collection and review processes, as staff can engage in covert resistance to what they perceive as disruptive digital collection protocols [10]. Similarly, including patients may account for notable differences in how service users anticipate digital interventions compared to staff [11], which can impact on patient engagement with ePRO collection and their expectations of how ePRO results are integrated into the service.…”