Question

You are caring for five patients on a busy, 28-bed neurological medical-surgical unit, which recently transitioned to all electronic documentation and healthcare computerized provider order entry (CPOE). There is no longer any bedside paperwork. All of your staff members have completed the required training and you have been assigned as expert lead for any questions that may arise during your shift. The expectation is that all nurses and clinical staff will document all care delivery in the bedside computers located in each patient's room or via the workstation on wheels (WOW). However, you have noticed a trend with experienced nurses spending extra time at the end of their shifts (30 or more minutes) documenting the nursing care provided during the shift. The expectation is that they should be documenting care delivery as soon as it is complete rather than at the end of their shifts. Answer the following questions based on the information provided: Explain how you would address the concern with the delay in nursing documentation with your team. Do you see the transition to all electronic documentation as having a positive or negative effect on patient-centered care? Support your answer with evidence from the literature. Explore the role of advancement in information technology and its effect in patient care. Does more technology use improve time with patients?

Answer 1

Delay in documentation due to a transition from paper records to electronic health records (EHR) or computerized provider order entry (CPOE) is a common problem in healthcare institutions. Nurses and Clinicians spending more time with documentation is an issue which can only be solved by changing routine practices and making healthcare providers more familiar with the technical aspects of EHR. Transitioning to an EHR requires careful consideration from numerous departments throughout the hospital. Common issues with EHRs are:

1. Stress in anticipation of EHR and liability associated with it. Health record content in EHR must not focus solely on patient care, but also comply with standards to enhance the protection of healthcare workers. Nurses feel that record with more details provide greater security in case of patient-nurse liability issues and/or hospital accreditation.

2. EHR being less user-friendly. If system failed to keep pace with the work speed, healthcare providers have to adjust their workflow. In these situations, traditional paper-based health records were considered more flexible than EHRs. It takes time to get used to the system.

3. Insufficient IT support and manpower backup to handle technical problems with EHR. The delay of clinical work due to computer problems creates unnecessary stress for the nursing staff.

Along with advancement in technology, improvement in the above mentioned points helps in making nurses and other healthcare providers more efficient and letting them devote more time towards patient care and maintaining expected standards of patient care. Some advantages of EHR are Better informed team, Beneficial effect on workflow, Reduced errors, Improved patient safety, Better patient outcomes, Risk management and Liability prevention.

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review published in Sep-Oct 2005 supports above points.