There were common themes in the literature. For example, each reported that they were responding to documentation burden as a nurse dissatisfier. All expressed how they examined the problem and associated issues. Most reported their assessment involved metrics such as click, query, and screen counts. Others reported metrics related to time to complete a screen or function such as the admission assessment. Never did we find anyone describing their assessment of the nurse's documentation level of effort as good or expected.
A common tactic to combat documentation burden in the literature was to develop guidelines for reviewing EHR queries requests. As we examined our facility we noticed a trend to have queries added in reaction to practice issues. It seemed we were attempting to teach nursing or somehow control for bad actors by adding a query to "guide" the user. We realized that is not the purpose of an EHR and we had unwittingly contributed to our documentation burden with this practice.
We decided to develop guidelines of our own to inform and review both new and existing EHR queries. Queries requests would need to be evaluated against guidelines. The draft guidelines our clinical informatics group put forth are:
- Assume that nurses are ethically and clinically competent
- Collect data that inform clinical care and supports nursing workflow efficiencies (nursing care planning, clinical decision making or nursing outcomes).
- Construct data and queries to support evidence-based practice
- Automatic data capture whenever possible for bedside devices (Cardiac monitors, ventilators, IV pumps, etc)
- Required by mandatory regulations
I would be interested if anyone would be willing to share their guidelines or wish to comment on our draft.
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