Florence Nightingale, widely known as the "The Lady with the Lamp" for her nighttime patient rounds, could also be called the "Lady of Documentation."
As far back as the 1850s, this nursing pioneer was shedding light on the importance of charting, gathering data on anyone she cared for, writing her observations down and compiling statistics from those findings to help improve patient outcomes.
Today, increasingly complex and demanding workloads combined with shorter patient stays limit the valuable minutes nurses can spend with each patient. At the same time, patients who once would have been considered critical are now more rapidly moved to lower acuity areas such as med-surg.
This rising patient acuity combined with shorter stays requires more energy, effort and attention from nurses, increasing their obligatory chore of documentation. While evolving regulatory and public policy expectations for documentation contribute to even more time spent in charting.
As technology deployment explodes in the healthcare industry, its use in nursing documentation continues to be debated.
In their increasingly technical and digital environment, nurses are expected to learn new technologies and still provide safe, compassionate care. And while certainly not always the case, it can be an overwhelming task for a nurse to learn new technologies while maintaining high clinical standards.
Meanwhile, the internal silos in which hospitals often operate (IT, nursing and other disciplines) may not align, creating needless redundancies in documentation for the nurse. The end result of a using a few of the new technologies is a loss in direct patient care time.
In fact, the 2008 time and motion study, "How do Medical Surgical Nurses Spend their Time?", revealed a frightening 35 percent of the nurses' time was spent on documentation, a process rife with inefficiencies.1
In October 2009, an article in the New England Journal of Medicine estimated this documentation inefficiency to be more than $50 billion annually.
Yet, hospitals continue to struggle to effectively integrate technologies that reduce documentation while bringing the highest value to nurses and patients.
Reversing the Paradigm
As a nurse with more than 19 years experience, I find it disheartening that the increasing nursing documentation demands has a direct impact on a nurse's ability to provide the best possible care.
In the day-to-day world of nursing, it has become more challenging for the nurse to do both documentation and patient assessment simultaneously, and well, without one suffering. When the nurse attends to manual charting, then patient surveillance suffers.
There is mounting evidence linking inadequate surveillance to poor patient outcomes including failure to rescue.
Hospitals simply need to find a way to reverse this paradigm.
Nursing documentation is a central part of the patient care process. But in a climate with workforce shortages, rising acuity with shorter lengths of stay combined with regulatory requirements, new documentation solutions must be considered.
Changes to clinical technologies promise to make documentation more meaningful and efficient for nurses. They are effective tools that decrease documentation redundancy and save nurses time. Such technologies include medical device integration, barcode scanning, speech recognition systems and tablet PCs.
Integration is Key
Medical device integration is a technology that automatically records vital signs data from bedside devices and sends that data seamlessly to the patient's record. It removes the nurse as the "human bridge" linking the devices to the patient record and helps minimize the competing forces a nurse often encounters, i.e., they can document frequently in real time or consistently assess and care for the patient.
The easiest way to understand how the technology works is to think of device integration as a language translator with all the devices monitoring and servicing a patient speaking a different language.
Device integration takes all the data coming from these various devices, translates it, filters it, normalizes it and sends it to the electronic medical record (EMR) so the clinician can review and validate the data when they have time to chart. Such integration is proven to save each nurse as much as 3 hours per day, per patient.3
Another technology increasingly employed by nurses is barcode scanning, which is often used throughout a facility for capturing information on drugs and devices, enabling positive patient identification (PPID) and tracking assets. Barcode scanning can even be used to enable PPID for device integration in the med-surg environment where routine vital signs can be automatically documented at the point of care.
Additionally, speech recognition systems can capture clinical documentation simply by a nurse speaking her assessment into a microphone. This system works well in dedicated spaces, such as the patient bedside, and based on much the same premise as the "nursing Dictaphone."
Tablet PCs increasingly are used to enable validation and data entry at the point of care rather than the clinician having to go to the central station to document. The tablet PCs are lightweight and be an appropriate substitute to the nursing clipboard.
While available documentation tools have unique technological strengths for helping automate the process, here's a word of caution regarding implementation:
It is very important for hospital staff, including frontline nursing staff, to carefully review implementation to ensure the technology not only meets the technical requirements of the hospital, but also will easily integrate with the established or planned clinical work process.
Because too often technologies are introduced that don't fit the way a nurse works, resulting in poor adoption and potentially decreasing time for direct patient care. This can be avoided when all hospital staff are involved with the decision.
Documentation technologies have come a long way since Florence Nightingale, who provided nurses with the basic understanding of the need to document patient care. However, that doesn't mean nurses need to be held captive in the 1850s, not when there are better, faster, more accurate ways to get data into the patient's chart, and when there are effective technologies available that can improve the overall quality of patient care.
When technological solutions allow nurses to do what they are trained to do and what they want to do, which it to focus on the care of their patients, all can be assured of the best possible outcome.
After all, isn't that why nurses decided to join Nightingale, to provide high quality care? That is what nurses should fight for. And if technologies to give nurses back precious minutes to spend on patient care be seamlessly added to the hospital, why not consider them?
References for this article can be accessed here.
Susan Niemeier, MHA, RN, is Chief Nursing Officer of Capsule, providing the company with significant insight to the challenges and obstacles clinicians face to ensure that innovative clinical and workflow solutions are part of Capsule's overall product strategy.