Improving Communication: The Effectiveness of the Electronic Kardex in Reducing Patient Falls

Purpose:
Looking for a new fall management strategy to add to our toolbox, the interdisciplinary team at Hudson Valley Hospital Center decided to upgrade our “electronic kardex”, the Patient Care Summary (PCS). The focus of this revision was on improving communication and promoting patient safety.

Significance:
Patient safety related to fall prevention has been a topic under review in every healthcare organization across the country. Nurses who serve on the frontlines could benefit from the use of technology in providing timely information on all aspects of a patients care.

Strategy and Implementation:
In 2010 the Nursing Informatics Council recognized that our electronic kardex, known as the Patient Care Summary (PCS), needed updating to capture real-time patient information in a succinct format. The final version of the new e-kardex was launched in early 2011. Included in that launch was an innovative idea to transfer documentation of adverse event information to the PCS. An adverse event could be a patient fall, rapid response, or a cardiac arrest. A nurse can select three types of notes to file in the patients electronic health record: 1) Education Note, 2) Progress Note, and 3) Significant Events Note. When the nurse transcribes information into the Significant Events Note (SEN), it will automatically flow over to the PCS. Success with implementation of the SEN was dependent on initial staff education and the continuous efforts of the Educators and Nurse Managers to reinforce the importance of selecting the correct type of note.

Evaluation:
Our overall fall rate prior to the implementation of the SEN as part of the PCS was 2.08. By the 1Q in 2012 our patient fall rate steadily trended downward to 1.12. Unit-based benchmarks from NDNQI have allowed us to identify trends in the majority of our critical-care and medical-surgical units.

Implications for Practice:
Vital information updated in real-time, raises awareness of patient experiences and reduces the chance that information will get lost during the hospitalization. This innovative process provides an excellent match between the use of technology and reduction of patient falls.