NURSES' USE OF THE EHR SYSTEM TO DOCUMENT PATIENT SYMPTOMS IN ACUTE CARE SETTINGS

Aim: The specific aim of this presentation is to describe how Registered Nurses (RNs) use the electronic health record (EHR) system to document symptom assessment and management in acute care settings through a preliminary work system analysis of fourteen interviews with nurses.

Background: Symptom assessment and management is one of the essential activities of RNs in inpatient settings. Ineffective symptom assessment and management leads to sub-optimal patient outcomes. These activities can be improved through organizational and informatics interventions. However, effective design and implementation of informatics interventions depends on understanding existing work flows in acute care settings. This study was conducted as part of a broader project to develop nurse-sensitive patient-outcome metrics for quality improvement and operational decision-making.

Figure 1. The SEIPS model

Methods: We interviewed fourteen nurses who work at inpatient units of an academic hospital using semi-structured interviews. Interview questions pertained to work experience, patient care responsibilities, patient assessment, symptom management, and use of information technologies in the RNs work. For our preliminary analysis, we framed interview results according to the System Engineering Initiative in Patient Safety (SEIPS) model (Figure 1) developed by Carayon et al. The SEIPS model includes people, tasks, organization, technology and tools, and environment components.

Results: The people component includes the RNs, charge nurses, physicians, physical therapists, and patients. The task component includes symptom assessment, medication administration, documentation, and communication with other clinicians. Organization includes hospital policies and procedures. Technology and tools includes the EHR system, paper-based notes, medication scanners, and communications technology. These components interact with each other to form the nursing work system. For example, some RNs (people) prefer to complete charting (task) using the EHR (technology and tools) at the bed side while others conduct charting outside the patient room. Due to workload (organization), sometimes charting at the bed side is not possible and this can impact accuracy and completeness of patient documentation. EHR usability issues can also affect timeliness and accuracy of documentation.

Implications: Using the SEIPS model during a preliminary analysis we described the RNs work system related to patient symptom assessment and management in an acute care setting. This study contributes to practice by exploring the relationship between the components of the RNs work system which should inform the design of future informatics and organizational interventions.