It is well known that nurses want to spend time with patients, but they are often frustrated over the amount of administration needs.
Adopting electronic health records can save valuable time spent on writing, filing and finding records, releasing more time for hands-on nursing. EHRs also improve the quality, safety and continuity of care. However, nurses need to be involved in the planning and implementation of new technology and it must be emphasised that not only the technology “doesn’t bite” but, it can actually help in their journey and enable a new level of patient care and experience.
Information can be found quickly and easily with EHRs, as it will be legible and structured. A single EHR, holding all a patient’s information, can be accessed anywhere – a vast improvement on paper-based records, which are often held in different places.
In addition, patients do not need to fill out forms and answer the same questions when they move to different parts of the health system – a position that does not inspire confidence.
Nursing documentation supports the continuity, quality and safety of patient care, and nurses are familiar with the phrase “it if isn’t recorded, it didn’t happen”. A well-designed, integrated system will help.
Electronic records at bedside
EHRs now take case notes to the point of care, and make information available to all clinical staff as soon as it is entered. If lab and imaging results are available immediately, this is a significant time-saver for nurses. Having current records at the bedside means nurses can promptly explain test results or other aspects of care to patients.
Records should be updated as near to an episode of care as possible and nurses are expected to record if their notes are made later on under the NMC code. If data is entered at the bedside, records are updated while they’re fresh in nurses’ minds, without the risk of details being forgotten later (managers must remember, though, that staff shortages, rapidly changing situations and emergencies can prevent instant updating).
The more time that passes between the nurse taking the notes and then inputting the data, the bigger the risk of the inputted data being a more generic summary, rather than an detailed account. Inputting handwritten notes also risks errors and can create duplication, an unrewarding waste of time for a caring nurse.
Nurses value EHRs and how they complement their work. Those who have gone back to paper records after using EHRs realise the latter are far more efficient.
The evolution of the EHR
Recent improvements include login by smart card, which allows all practitioners (including agency workers) to move between patients without having to log in and out each time – this can save a significant amount of time if a nurse is administering medication to 10 or 15 patients. Nurses have previously complained about time spent logging in and out.
Over the years, EHRs have evolved from being a record of data or a digital flow chart to a sophisticated clinical information and contact system.
Wireless handsets, integrated into the hospital system, allow nurses to contact colleagues on and or off site rapidly, making consultation with specialists or getting help on the ward a lot easier.
The patient’s bedside terminal includes a call bell; the system can recognise that a call could be for someone else so delivers the call (or request) to a more appropriate recipient instead of a highly skilled nurse who just happens to be at the nurse station. Again, this improves time management and care.
Patient data portability
If patients are moved, their records move with them. Anyone calling up their details, whether a practitioner or a switchboard operator putting through a call, will see where they are.
EHRs also affect nursing workflows and care processes. They improve coordination across multi-disciplinary care teams and support models of care such as care pathways and
clinical networks in a way that is not possible with paper records. In addition, they can be analysed retrospectively to identify outcomes, and for audit and research purposes.
Nurses must now embrace technology changes and how they can enable them to work in ways that may be different to current practice.
Time is needed to adapt to new systems. Smooth adoption can streamline clinical nursing activities, and user-friendly design and support during implementation facilitates this.
Mastery takes around 4-8 months from introduction, according to nursing professor Willa Fields. She explains that this is because nurses have a mental picture of how paper records work, so use them without thinking, and that once nurses have developed a mental picture of how EHRs work, they “zip right through it”.
A nurse who worked with paper records after using EHRs “realised just how much of an advantage even an imperfect EHR was”. Another recalled problems with paper records, which including time spent on looking for old records and restocking charts. Much time is wasted walking around to retrieve paper-based records, which is is hardly conducive to Productive Ward standards.
The EHR and what the nurse wants
Systems must to be designed around what nurses need. While nurses welcome EHRs, they are less satisfied with those that are cumbersome to use (Lavin et al, 2015).
Joyce Sensmeier, vice-president of informatics at the Health Information Management Systems Society, says “chief nursing officers must advocate for what is needed to make these systems right for nurses”.
Because EHRs can be easily adapted and hold a great deal of information, managers must consider carefully the addition of any extra fields, balancing benefits against time implications.
Making records available to patients will make them more involved in their healthcare; they will, for example, be able to highlight inconsistencies or omissions. With some models, it is is easy to copy and paste information, which means errors as well as facts can be perpetuated.
EHRs bring together practitioners, care, and documentation. The whole patient journey is tracked, from initial enquiry to hospital stay, discharge into the community and follow up, improving continuity of care.
In the community, integrated EHRs also free up time for district nurses, who can access and update records on wireless tablets during visits, obtaining the same benefits for care as their hospital counterparts. Some systems can analyse journeys to patients’ homes, which can be used to minimise driving time.
A good, integrated system enables nurses in different settings to spend more time with patients.
- Electronic healthcare records that can be used at the point of care improve the quality, safety and continuity of care and free up nursing time.
- They can also improve the nurses’ working environment, help to keep stress levels at bay, and enable enhanced quality of care and patient experience.
- Systems must to be designed around nursing requirements, and chief nursing officers should advocate for this.
- They can support new ways of working, and change communication with colleagues and patients.
- EHRs have evolved from being a data record to a sophisticated clinical information and contact system.
Learn why real-time patient admin affects not only the true cost of care, but nurses’ job satisfaction, patient experience, and quality of care. Download your free report The Modern Patient Experience: Where Care Matters now.