Transforming the Advocate Nurse Experience
Being able to spend more time with your patient and less time documenting in the electronic health record (EHR) is every nurse’s goal, but over the years the EHR had become the “go-to” solution to fix every issue, thus adding more documentation requirements. And the result? Nurses spend more time and more clicks in the EHR and less time connecting with their patients.
Combatting that kind of disconnect is the wisdom behind One Patient Experience (OPE). As part of the drive to create a uniform experience, last fall Advocate Health Care rolled out a new approach to eliminate unnecessary aspects of patient charting. The OPE project was a true partnership with Nursing Practice, Nursing Clinical Informatics and the CareConnection team.
The OPE team included system clinical practice specialist Pat Juarez, MS, APN, CCNS, CCRN-K, director Cheryl Hager, MSN, RN, NEA-BC, ONP, manager for Nursing Clinical Informatics Jeff Redican, RN, Kris Siuciak, BSN, RN, MBA, and Julie Winchester, BSN, RN, as well as the Cerner CareConnection team and staff nurse experts from across Advocate. Their mission was to streamline the patient assessment charting process so nurses could do what they were trained to do: spend quality time with their patients.
Every site had its own assessment procedure and nurses were spending too much time documenting. The Electronic Medical Record has greatly eased the now seemingly ancient practice of keeping handwritten charts, Juarez explained, “but it has made things very complicated. Going from paper to electronic, we let people do it their own way. Now, being more of an integrated health care system, we need to have a streamlined approach.”
So she engaged with nursing experts across the system to find out why they did what they did, then reached a consensus to develop a procedure that would best serve patients.
“Many of our patients are in with one or two problems,” Juarez said, “and the rest of their body systems are normal. But the nurses were documenting all normal body functions as well. Our goal was to reduce the number of clicks in medical records, and that’s how we measured our success.”
The answer was to de-emphasize those normal sections in assessment charts. “We were going to eliminate all of that within defined limits,” Juarez said. “Now we only document abnormal assessments.” The result is that abnormal findings are more obvious in the chart. Patients continue to get a documented full-body assessment upon admission and at every shift change, she explained. In more urgent cases, such as in the Intensive Care Unit, the assessment occurs more often.
A second issue involved the copy and paste function. Trying to save time, nurses would copy and paste a previous assessment factor into the new assessment, but mistakes were being made, and pertinent changes were being missed, Juarez said. Out went the copy-and-paste function.
Bottom line: The new approach works. Average charting time at admission has dropped eight percent. The average number of mouse clicks at admission has decreased 20 percent. The average active time on the computer per patient per day in the assessment section has decreased in seven out of 10 body systems. Estimation of time spent documenting per shift has fallen.
Essentially, the nurses now have more time to connect with their patients.