A Study to Determine Consensus for Nursing Documentation Reduction in Times of Crisis.
Journal
Computers, informatics, nursing : CIN
ISSN: 1538-9774
Titre abrégé: Comput Inform Nurs
Pays: United States
ID NLM: 101141667
Informations de publication
Date de publication:
16 Aug 2024
16 Aug 2024
Historique:
medline:
17
8
2024
pubmed:
17
8
2024
entrez:
16
8
2024
Statut:
aheadofprint
Résumé
Nurses faced numerous challenges during the pandemic, particularly with the increased burden of electronic documentation. Surges in patient volume and visits led to rapid changes in nursing documentation, prompting diverse responses from regulatory and healthcare organizations. Nurses expressed safety concerns and struggled with changes, calling for national standards and regulatory support. Policy relaxations, such as the 1135 Waiver, sparked debate on the future of nursing care plan documentation. Using mixed-methods exploratory design, the study identified modifications of nursing documentation during crises, commonalities in documentation burden reduction for applicability beyond pandemics, and consensus on the definition of "surge." Documentation patterns were assessed from February to November 2022, involving 175 North American nurse leaders and informaticists. Data analysis included descriptive statistics, thematic analysis, and Pearson correlation coefficient. Significant differences were found between rural and urban settings (P = .02), with urban areas showing higher odds of changes to care plans (odds ratio, 4.889; 95% confidence interval, 1.27-18.78). Key findings highlighted the persistence of postcrisis documentation changes and varied definitions of surge criteria based on organizational leadership, policy, and mandates. The study yielded insights for modifying documentation, offering policy recommendations, and emphasizing ongoing collaboration and evidence-based approaches for future nursing practices.
Identifiants
pubmed: 39152097
doi: 10.1097/CIN.0000000000001180
pii: 00024665-990000000-00223
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Hoelscher SH, McBride S, Bumpus S. Preparing for the future: establishing a national consensus on nursing crisis documentation. CIN: Computers, Informatics, Nursing. 2023;41(2): 86–93. Published 2023 Feb 1. doi:10.1097/CIN.0000000000000896.
doi: 10.1097/CIN.0000000000000896
Holub M, Giegerich CA. Decreasing the nursing documentation burden during the COVID-19 surge. Nurse Leader. 2023;21(1): 38–41. doi:10.1016/j.mnl.2022.11.006.
doi: 10.1016/j.mnl.2022.11.006
McBride S, Hoelscher SH, Bumpus S, Mitchell MB, Tietze M. Crisis documentation strategies to reduce burden of documentation during the pandemic: Texas' pilot to generate consensus. CIN: Computers, Informatics, Nursing. 2021;39(10): 524–526. doi:10.1097/CIN.0000000000000842.
doi: 10.1097/CIN.0000000000000842
Collins S, Couture B, Kang MJ, et al. Quantifying and visualizing nursing flowsheet documentation burden in acute and critical care. AMIA Annual Symposium Proceedings. 2018;2018: 348–357. Published 2018 Dec 5.
Gesner E, Gazarian P, Dykes P. The burden and burnout in documenting patient care: an integrative literature review. Studies in Health Technology and Informatics. 2019;264: 1194–1198. doi:10.3233/SHTI190415.
doi: 10.3233/SHTI190415
Harmon CS, Arp Adams D, Davis JE. Nursing cognitive-overload and electronic documentation burden: a literature review. Journal of Informatics Nursing. 2020;5(3): 16–21. https://www.mydigitalpublication.com/publication/?m=43594&i=676363&P=16. Accessed April 2, 2024.
Harris DA, Haskell J, Cooper E, Crouse N, Gardner R. Estimating the association between burnout and electronic health record–related stress among advanced practice registered nurses. Applied Nursing Research. 2018;43: 36–41. doi:10.1016/j.apnr.2018.06.014.
doi: 10.1016/j.apnr.2018.06.014
McBride S, Tietze M, Hanley MA, Thomas L. Statewide study to assess nurses' experiences with meaningful use-based electronic health records. CIN: Computers, Informatics, Nursing. 2017;35(1): 18–28. doi:10.1097/CIN.0000000000000290.
doi: 10.1097/CIN.0000000000000290
Padden J. Documentation burden and cognitive burden: how much is too much information? CIN: Computers, Informatics, Nursing. 2019;37(2): 60–61. doi:10.1097/CIN.0000000000000522.
doi: 10.1097/CIN.0000000000000522
Staggers N, Elias BL, Makar E, Alexander GL. The imperative of solving nurses' usability problems with health information technology. The Journal of Nursing Administration. 2018;48(4): 191–196. doi:10.1097/NNA.0000000000000598.
doi: 10.1097/NNA.0000000000000598
Chandra M, Kumar K, Thakur P, Chattopadhyaya S, Alam F, Kumar S. Digital technologies, healthcare and COVID-19: insights from developing and emerging nations. Health and Technology (Berlin). 2022;12(2): 547–568. doi:10.1007/s12553-022-00650-1.
doi: 10.1007/s12553-022-00650-1
Harper KB. Texas hospitals hit by staffing crisis as burnout depletes workforce and COVID-19 surges. The Texas Tribune. 2021. https://www.texastribune.org/2021/08/05/texas-hospitals-nurses-covid/. Accessed April 7, 2024.
Helman A, Kollek D. Ep 138 COVID-19 part 2—ED surge capacity strategies in COVID-19 pandemic [podcast]. Emergency Medicine Cases. 2020. https://emergencymedicinecases.com/surge-capacity-strategies-covid-19.
Lasater KB, Aiken LH, Sloane DM, et al. Chronic hospital nurse understaffing meets COVID-19: an observational study. BMJ Quality and Safety. 2021;30(8): 639–647. doi:10.1136/bmjqs-2020-011512.
doi: 10.1136/bmjqs-2020-011512
Melnick ER, West CP, Nath B, et al. The association between perceived electronic health record usability and professional burnout among US nurses. Journal of the American Medical Informatics Association. 2021;28(8): 1632–1641. doi:10.1093/jamia/ocab059.
doi: 10.1093/jamia/ocab059
Hoelscher SH, Bumpus S. Addressing Nursing Documentation During a Time of Crisis: Background Document. Washington, DC: 2023 ANA Membership Assembly Policy Dialogue Forum. June 16, 2023; 2023. https://www.nursingworld.org/~498d8f/globalassets/ana/leadership--governance/ma/2023/background-doc-addressing-nursing-documentation-in-a-crisis-2023-ma.pdf.
Moy AJ, Hobensack M, Marshall K, et al. Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments. Journal of the American Medical Informatics Association. 2023;30(5): 797–808. doi:10.1093/jamia/ocad038.
doi: 10.1093/jamia/ocad038
American Nurses Association. (2020). Crisis standard of care COVID-19 pandemic. https://www.nursingworld.org/~496044/globalassets/practiceandpolicy/work-environment/health--safety/coronavirus/crisis-standards-of-care.pdf.
Hoelscher SH. First, do no harm: dDocumentation in time of declared crisis [webinar]. Advanced Accreditation Education Series 2020 Program 4: Record of Care—Trials & Tribulations/Vizient. Vizient Continuing Education Web site. https://continuingeducation.vizientinc.com/sites/default/files/AAES%20Presentation%20April%202020%20Record%20of%20Care%20VFinal%204.17.2020%20Trials%20Tribulations.pdf. Updated 2020.
Moy AJ, Schwartz JM, Chen R, et al. Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review. Journal of the American Medical Informatics Association. 2021;28(5): 998–1008. doi:10.1093/jamia/ocaa325.
doi: 10.1093/jamia/ocaa325
Parker CD. Rapid response: sharing informatics knowledge and processes. CIN: Computers, Informatics, Nursing. 2020;38(10): 483. doi:10.1097/CIN.0000000000000680.
doi: 10.1097/CIN.0000000000000680
Sengstack P, Hughart K. Vanderbilt University Medical Center nursing informatics experts on COVID-19 crisis [podcast]. American Nursing Informatics Association. https://www.youtube.com/watch?v=shLx6WcTCIQ. Updated 2020.
Summers D. Henry Ford Health System expert interview on COVID-19 [podcast]. American Nursing Informatics Association. https://www.youtube.com/watch?v=lFbgcm7G_90. Updated 2020.
American Nursing Informatics Association. Cheryl Parker—interviews with nursing informatics leaders. American Nursing Informatics Association. https://www.youtube.com/playlist?list=PLi42cdgkMqOVzYpy1gowCsqvp5AD6Y5Jo. Updated 2020.
Centers for Medicare and Medicaid Services. (2020). 1135 Waivers. Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-emergency-preparedness/1135-waivers.
Centers for Medicare and Medicaid Services. (2012). § 482.23 Condition of participation: Nursing services. https://www.govinfo.gov/content/pkg/CFR-2012-title42-vol5/pdf/CFR-2012-title42-vol5-sec482-23.pdf
Toney-Butler TJ, Thayer JM. Nursing process [updated 2023 Apr 10]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2024. https://www.ncbi.nlm.nih.gov/books/NBK499937/.
Rosseti SC, Rosenbloom ST, Dtemer D, Johnson K, Cato K, Cohen D, Williamson J, Murphy J, Moy A, Schwartz J, Lucas E, Hobensack M, Withal J, Lee R, Sachson C (2021). Report from the 25 by 5: symposium series to reduce documentation burden on US clinicians by 75% by 2025. https://www.dbmi.columbia.edu/wp-content/uploads/2021/08/25x5_Executive_Summary_V2.pdf.
Centers for Disease Control and Prevention. The All-Hazards Preparedness Guide. Centers for Disease Control and Prevention; 2013. https://www.cdc.gov/orr/documents/ahpg_final_march_2013.pdf.
Centers for Disease Control and Prevention. Pandemic All-Hazards Preparedness Act Reauthorization. Centers for Disease Control and Prevention; 2023. https://www.cdc.gov/washington/testimony/2023/t20230504.htm.
Eisenberg F. (2016). All hazards approach: the business case. https://www.healthit.gov/sites/default/files/facas/HITJC_Zika_Response_2016-10-05_final.pdf.
US Government Publishing Office. Federal Register. 2023;88(202): 22931–22933. https://www.govinfo.gov/content/pkg/FR-2023-10-18/pdf/2023-22931.pdf.
Lynn MR. Determination and quantification of content validity. Nursing Research. 1986;35(6): 382–385.
Hoelscher SH, Bumpus S. Reducing Nursing Documentation Burden in a Time of Crisis [conference presentation]. Orlando, FL: HIMSS Global Conference and Exhibition; 2022, 2022.
Makar EV, McBride S, Roberts DW. Using Delphi to develop a high value survey: determining awareness of the SAFER guides among nurse informaticists. Journal of Informatics Nursing. 2017;2(3): 6–13. https://www.mydigitalpublication.com/publication/?m=43594&i=440059&P=6&ver=html5.
Nowell LS, Norris JM, White DE, Moules NJ. Thematic analysis: striving to meet the trustworthiness criteria. International Journal of Qualitative Methods. 2017;16(1): 1609406917733847. doi:doi.org/10.1177/1609406917733847.
doi: doi.org/10.1177/1609406917733847
Braun V, Clarke V. Thematic Analysis: A Practical Guide. London: Sage; 2021.
Scarborough N. EHRs ranked by market share. In: Healthgrades for Professionals. 2023. https://www.healthgrades.com/pro/ehrs-ranked-by-market-share.
Centers for Medicare and Medicaid Services. (2020). COVID-19 emergency declaration blanket waivers for health care providers [PDF]. Centers for Medicare and Medicaid Services. https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf.
Dymek C, Kim B, Melton GB, Payne TH, Singh H, Hsiao CJ. Building the evidence-base to reduce electronic health record–related clinician burden. Journal of the American Medical Informatics Association. 2021;28(5): 1057–1061. doi:10.1093/jamia/ocaa238.
doi: 10.1093/jamia/ocaa238