Improving Nursing Care Quality and Safety through Electronic Medical Record Performance Management

Purpose:
To monitor and improve the quality and safety of nursing care in a free standing pediatric academic medical center through implementation of a new electronic medical record (EMR) system that replaced existing electronic and paper nursing care documentation processes.

Significance:
A report distributed to all nursing leaders weekly helped identify opportunities for improvement & inform data driven action planning for quality & safety issues (e.g. pain assessments, plan of care addressing skin & fall risks, bar code scanning of patient & meds, timely medication administration.

Strategy and Implementation:
Nursing leaders identified 13 key practice metrics that reflected nursing sensitive areas of quality & safe care. There was urgency to evaluate impact of new nursing documentation work flows & new EMR functionality (e.g. critical care area moving from paper to electronic documentation & best practice alerts to cue nurses to act on assessments). A report was developed in Excel that included color cues indicating level of meeting goals. Departments could view their performance compared to others & house wide results. After educating leaders on the metrics and sharing daily results, they were asked to share improvement actions. The report was enhanced to include run charts & weekly medians. Two months later a unit comparison by cluster (MedSurg, Critical Care, Psych) report was shared to help areas choose two metrics for active improvement. Failures were analyzed by area using detail data that was provided by analysts that informed who, what, & why documentation was noncompliant.

Evaluation:
Test of significance examining the weekly baseline compared to 3 to 4 month performance revealed 6 improvements: pain assessed on admission, appropriate & timely initiation of fall plan of care, patients & meds bar code scanned, meds given as ordered, safe day shift hand-off communications.

Implications for Practice:
Improvements in nursing documentation practices & optimization of the EMR were achieved through these data driven strategies. Disseminating results via Shared Governance Councils to staff, supported measurable increases in compliance with practice standards that impact patient care quality & safety.