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Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

Publication ,  Journal Article
Richardson, KJ; Sengstack, P; Doucette, JN; Hammond, WE; Schertz, M; Thompson, J; Johnson, C
Published in: Comput Inform Nurs
February 2016

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

Duke Scholars

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Published In

Comput Inform Nurs

DOI

EISSN

1538-9774

Publication Date

February 2016

Volume

34

Issue

2

Start / End Page

62 / 70

Location

United States

Related Subject Headings

  • Stroke
  • Software Design
  • Nursing Records
  • Nursing Informatics
  • Nursing Evaluation Research
  • Nursing
  • Humans
  • Follow-Up Studies
  • Emergency Nursing
  • Electronic Health Records
 

Citation

APA
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ICMJE
MLA
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Richardson, K. J., Sengstack, P., Doucette, J. N., Hammond, W. E., Schertz, M., Thompson, J., & Johnson, C. (2016). Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support. Comput Inform Nurs, 34(2), 62–70. https://doi.org/10.1097/CIN.0000000000000206
Richardson, Karen J., Patricia Sengstack, Jeffrey N. Doucette, William E. Hammond, Matthew Schertz, Julie Thompson, and Constance Johnson. “Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.Comput Inform Nurs 34, no. 2 (February 2016): 62–70. https://doi.org/10.1097/CIN.0000000000000206.
Richardson KJ, Sengstack P, Doucette JN, Hammond WE, Schertz M, Thompson J, et al. Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support. Comput Inform Nurs. 2016 Feb;34(2):62–70.
Richardson, Karen J., et al. “Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.Comput Inform Nurs, vol. 34, no. 2, Feb. 2016, pp. 62–70. Pubmed, doi:10.1097/CIN.0000000000000206.
Richardson KJ, Sengstack P, Doucette JN, Hammond WE, Schertz M, Thompson J, Johnson C. Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support. Comput Inform Nurs. 2016 Feb;34(2):62–70.

Published In

Comput Inform Nurs

DOI

EISSN

1538-9774

Publication Date

February 2016

Volume

34

Issue

2

Start / End Page

62 / 70

Location

United States

Related Subject Headings

  • Stroke
  • Software Design
  • Nursing Records
  • Nursing Informatics
  • Nursing Evaluation Research
  • Nursing
  • Humans
  • Follow-Up Studies
  • Emergency Nursing
  • Electronic Health Records