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Examining nursing vital signs documentation workflow: barriers and opportunities in general internal medicine units.

https://arctichealth.org/en/permalink/ahliterature128014
Source
J Clin Nurs. 2012 Apr;21(7-8):975-82
Publication Type
Article
Date
Apr-2012
Author
Melanie S Yeung
Stephen E Lapinsky
John T Granton
Diane M Doran
Joseph A Cafazzo
Author Affiliation
Centre for Global eHealth Innovation, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada. melanies.yeung@utoronto.ca
Source
J Clin Nurs. 2012 Apr;21(7-8):975-82
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Anthropology, Cultural
Documentation - methods - trends
Female
Health Care Surveys
Hospital Units
Humans
Inpatients - statistics & numerical data
Internal Medicine
Male
Medical Records Systems, Computerized
Nurse's Role
Nursing Staff, Hospital - standards - trends
Ontario
Point-of-Care Systems - standards - trends
Professional Competence
Time and Motion Studies
Total Quality Management
Vital Signs
Workflow
Abstract
To characterise the nursing practices of vital signs collection and documentation in a general internal medicine environment to inform strategies for improving workflow design.
Clinical workflow analysis is critical to identify barriers and opportunities in current processes. Analysis can guide the design and development of novel technological solutions to produce greater efficiencies and effectiveness in healthcare delivery. Research surrounding vital signs documentation workflow in general internal medicine environments has received very little attention making it difficult to compare the effectiveness of new technologies.
Qualitative ethnographic analyses and quantitative time-motion study were conducted.
Workflows of 24 nurses at three hospitals in five general internal medicine environments were captured, and timeliness of vital signs assessment and documentation was measured.
Clinical assessment of vital signs was consistent, but the documentation process was highly variable within groups and between hospitals. Two themes characterised workflow barriers surrounding point-of-care documentation. First, a lack of standardised documentation methods for vital signs resulted in higher rates of transcription, increasing not only the likelihood of errors but delays in recording and accessibility of information. Second, despite advancements in electronic documentation systems, the observed system was not conducive to point-of-care documentation. Average electronic documentation was significantly longer than paper documentation. Nurses developed ad hoc workarounds that were inefficient and undermined the intent of electronic documentation.
We have identified barriers and opportunities to improve the efficiency of nursing vital signs documentation. Changes in technology, workflows and environmental design allow for significant improvements and deserve further exploration.
Attention to clinical practice and environments can improve the workflow of prompt vital signs documentation and increase clinical productivity and timeliness of information for clinical decisions, as well as minimising transcription errors leading to safer patient care.
PubMed ID
22243491 View in PubMed
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Standardising fast-track surgical nursing care in Denmark.

https://arctichealth.org/en/permalink/ahliterature104325
Source
Br J Nurs. 2014 May 8-21;23(9):471-6
Publication Type
Article
Author
Dorthe Hjort Jakobsen
Kirsten Rud
Henrik Kehlet
Ingrid Egerod
Author Affiliation
Clinical Head Nurse at the Unit of Perioperative Nursing, Rigshospitalet.
Source
Br J Nurs. 2014 May 8-21;23(9):471-6
Language
English
Publication Type
Article
Keywords
Denmark
Evidence-Based Nursing - standards - trends
Humans
Nursing Staff, Hospital - standards - trends
Perioperative Nursing - standards - trends
Quality Improvement
Rehabilitation Nursing - standards - trends
Abstract
Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.
PubMed ID
24820811 View in PubMed
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