Location
Virtual
Start Date
1-3-2024 10:15 AM
End Date
1-3-2024 10:30 AM
Keywords:
california; plcmmc
Description
Background: Electronic Medical Record (EMR) education and training for RNs should be multifaceted and targeted to the RN clinical workflow. Input from direct care RNs is essential to ensure EMR education is relevant and effective. Shared Governance at a community hospital identified quality and safety concerns among inpatient RNs. RNs reported that belongings inventories were not consistently documented in the EMR for Emergency Department (ED) admissions. Hospital policy requires belongings inventory EMR documentation for all admitted patients. An audit of charts for ED admissions over three months revealed only 5% compliance with this policy.
Purpose: The purpose of this project was to increase the rate of belongings inventory EMR documentation for all ED admissions to greater than 75% over a one-month period.
Methods: As part of a quality improvement project, Shared Governance asked a group of ED RNs and technicians to analyze documentation rates and explore how the department could better align with hospital policy. Staff responded that they were unaware of the hospital's belongings inventory policy. They suggested that providing education about the policy, adding “Belongings” to their favorites in the EMR, creating computer tag reminders, and auditing in real-time by charge nurses would increase compliance with the policy. Based on this input, Shared Governance developed a 1-page education sheet informing staff of the hospital’s policy and instructing them to add “Belongings” to their favorites in the EMR. The sheet was emailed to staff and posted in a centralized area. Staff signed a form confirming they completed the education and committed to following the policy. Charge RNs verified “Belongings” was added to staff favorites in the EMR and audited ED charts for belongings inventory prior to admissions, intervening as needed to ensure completion. Computer tags were placed on all ED monitors to reinforce education. ED RNs and technicians completed education during March 2023. The following month, all ED admission charts (n=345) were audited for four consecutive weeks and progress reports were posted weekly in the staff lounge.
Results: Compliance with the policy increased from 5% to 79% post-intervention.
Conclusions: Multifaceted intervention increased compliance with a policy requiring EMR documentation in the ED. Staff input led to the development of targeted education. Weekly progress reports kept staff engaged while they integrated belongings inventory EMR documentation into their workflow.
Implications for practice: Although there is evidence that belongings documentation education can reduce lost belongings, insufficient data was available to measure the impact of the intervention on lost belongings for this project. Further research is needed to determine the impact of belongings inventory documentation on patient and staff safety. Belongings inventory EMR documentation education will be included in ED orientation for future RNs and technicians, and ED chart audits will determine the rate of compliance. Education will be reinforced as needed. Inpatient units will determine their educational needs and implement targeted education. Regular chart audits will determine the impact of interventions on compliance with the hospital’s belongings inventory policy
Recommended Citation
Lai, Stefanie, "Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation Rates" (2024). Providence Nursing Research Conference 2023 – Present. 13.
https://digitalcommons.providence.org/prov_rn_conf_annual/2024/podiums/13
Specialty
Emergency Medicine
Specialty
Health Information Technology
Specialty
Nursing
Improving Emergency Department Belongings Inventory Electronic Medical Record Documentation Rates
Virtual
Background: Electronic Medical Record (EMR) education and training for RNs should be multifaceted and targeted to the RN clinical workflow. Input from direct care RNs is essential to ensure EMR education is relevant and effective. Shared Governance at a community hospital identified quality and safety concerns among inpatient RNs. RNs reported that belongings inventories were not consistently documented in the EMR for Emergency Department (ED) admissions. Hospital policy requires belongings inventory EMR documentation for all admitted patients. An audit of charts for ED admissions over three months revealed only 5% compliance with this policy.
Purpose: The purpose of this project was to increase the rate of belongings inventory EMR documentation for all ED admissions to greater than 75% over a one-month period.
Methods: As part of a quality improvement project, Shared Governance asked a group of ED RNs and technicians to analyze documentation rates and explore how the department could better align with hospital policy. Staff responded that they were unaware of the hospital's belongings inventory policy. They suggested that providing education about the policy, adding “Belongings” to their favorites in the EMR, creating computer tag reminders, and auditing in real-time by charge nurses would increase compliance with the policy. Based on this input, Shared Governance developed a 1-page education sheet informing staff of the hospital’s policy and instructing them to add “Belongings” to their favorites in the EMR. The sheet was emailed to staff and posted in a centralized area. Staff signed a form confirming they completed the education and committed to following the policy. Charge RNs verified “Belongings” was added to staff favorites in the EMR and audited ED charts for belongings inventory prior to admissions, intervening as needed to ensure completion. Computer tags were placed on all ED monitors to reinforce education. ED RNs and technicians completed education during March 2023. The following month, all ED admission charts (n=345) were audited for four consecutive weeks and progress reports were posted weekly in the staff lounge.
Results: Compliance with the policy increased from 5% to 79% post-intervention.
Conclusions: Multifaceted intervention increased compliance with a policy requiring EMR documentation in the ED. Staff input led to the development of targeted education. Weekly progress reports kept staff engaged while they integrated belongings inventory EMR documentation into their workflow.
Implications for practice: Although there is evidence that belongings documentation education can reduce lost belongings, insufficient data was available to measure the impact of the intervention on lost belongings for this project. Further research is needed to determine the impact of belongings inventory documentation on patient and staff safety. Belongings inventory EMR documentation education will be included in ED orientation for future RNs and technicians, and ED chart audits will determine the rate of compliance. Education will be reinforced as needed. Inpatient units will determine their educational needs and implement targeted education. Regular chart audits will determine the impact of interventions on compliance with the hospital’s belongings inventory policy