Learning computer lingo

Sengstack, Patricia

doi:10.1097/00152193-200309000-00051

Cited by 2 publications

(7 citation statements)

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“…The American Nurses Association and the American Academy of Nursing collaborated to nationally address nursing documentation burden and standardization. 13 The American Nurses Association Principle for Nursing Documentation states, “nurses should aim to ensure that critical and necessary data and information are documented while avoiding duplicative documentation. To do so, nurses need to understand the forces and other factors that shape the requirements of practice-specific documentation.” 14 These efforts, focused on workflow redesign, may progress toward clinician goals to decrease nonvalue-added tasks, add meaning to work and allow more time for fundamental patient care.…”

Section: Background and Significancementioning

confidence: 99%

“…9 12 15 Best practices to improve workflow and usability of documentation include improved visualization of essential data elements and limiting data rows, voice recognition, and integration with mobile technology which result in improved efficiency and less time spent documenting. 1 4 13 16 Despite this knowledge, however, health care organizations have not fully empowered nurses to iterate EHRs to meet their needs. Combining the efforts of professional organizations and individual health care organizations may lead to improved workflow and value of nursing documentation.…”

Section: Background and Significancementioning

confidence: 99%

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Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Lindsay

Lytle

2022

Appl Clin Inform

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Background: Documentation burden associated with electronic health records (EHR) is well documented in the literature. Usability and functionality of the EHR are considered fragmented and disorganized making it difficult to synthesize clinical information. Few best practices are reported in the literature to support streamlining the configuration of documentation fields to align clinical workflow with EHR data entry elements. Objective: The primary objective was to improve performance, reduce duplication, and remove non-value-added tasks by redesigning the patient assessment template in the EHR using best practice approaches. Methods: A quality improvement approach and pre/post design was used to implement and evaluate best approaches to redesign standardized flowsheet documentation workflow. We implemented standards for usability modifications targeting efficiency, reducing redundancy and improving workflow navigation. The assessment type row was removed; a reassessment section was added to the first three flowsheet rows; and documentation practices were revised to document changes from the initial assessment by selecting the corresponding body system from the dropdown menu. Vendor-supplied timestamp data was used to evaluate documentation times. Video motion-time recording was used to capture click and scroll burden, defined as steps in documentation, and was analyzed using the Keystroke Level Model. Results: Results included an 18.5% decreased time in the EHR; decrease of 7-12% % total time in flowsheets; time savings of 1.5 to 6.5 minutes per reassessment per patient; and a decrease of 88-97% in number of steps to perform reassessment documentation. Conclusion: Workflow redesign to improve the usability and functionality decreased documentation time, redundancy, and click burden resulting in improved productivity. The time savings correlate to several hours per 12 hour shift which could be reallocated to value-added patient care activities. Revising documentation practices in alignment with redesign benefits staff by decreasing workload, improving quality, and satisfaction. Keywords: reassessment, documentation burden, electronic health records, workflow redesign

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Section: Background and Significancementioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Lindsay

Lytle

2022

Appl Clin Inform

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“…Nursing informatics leaders Dr Patricia Sengstack and Karen Hughart shared their early standard operating policy (SOP) for minimum documentation requirements and recommendations on how they planned to address the burden with nursing documentation at their facility. Specifically, the SOP concentrated on potential documentation changes or updates to grouped areas such as emergency departments and inpatient and outpatient settings 17 . Over the next 6 months, their SOP emerged as a template for documentation analysts across the nation to start this vital conversation of their own.…”

Section: Background and Significancementioning

confidence: 99%

“…Since early 2020, the urgency and focus of fixing that gap became evident (see Table, Supplemental Digital Content 1, http://links.lww.com/CIN/A155, which demonstrates the preliminary literature review). Three major themes emerged from the literature review: EHR usability issues, cognitive burden with burnout, and overall documentation burden 5–10,13–19,22–27 …”

Section: Background and Significancementioning

confidence: 99%

“…Along with a search of the most recent literature available, national podcasts, symposia, and regulatory guidelines 6,14–19,22,26–28 also were reviewed for a total of 47 sources of literature, data, and guidance. These were integral additions to the COVID-19 aspect of emerging guidance and recommendations around early consensus ideas.…”

Section: Background and Significancementioning

confidence: 99%

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Preparing for the Future

Hoelscher

McBride

Bumpus

2022

CIN: Computers, Informatics, Nursing

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Clinicians across the globe face overwhelming dissatisfaction and burden with electronic health records due to poor usability and the sheer volume of data collection requirements. In the United States, electronic health records are noted to be a principal source of distress, dissatisfaction, and endless workarounds, leading to poor clinician performance and, ultimately, poor patient outcomes.The purpose of this article is to present a detailed review of a 2020 Texas pilot study. The study's focus was the engagement of nursing informatics experts from around the state to gain consensus on nursing documentation's current status and if plans were being developed to modify or decrease documentation, specifically to alleviate burden during a time of crisis. The study consisted of subject matter expert focus groups, a high-level Delphi for instrument development, and the implementation of the statewide instrument to gain consensus. Ultimately, the research team learned that there were gaps in not only what documentation could be removed (either temporarily or permanently) but also what standards dictate the use of crisis documentation (ie, “surge” criteria). The study findings discussed in this article will inform improvement strategies and policy recommendations to increase the value and usability of crisis nursing documentation requirements.

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Learning computer lingo

Cited by 2 publications

References 0 publications

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Preparing for the Future

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