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Redesign of nursing workflow seeing success

Apr. 17, 2014, 9:19 AM

In 2008, Vanderbilt nurses participated in a nationwide survey to determine how they spent their time, and it revealed that only 16 percent was spent on direct patient care, while 28 percent was spent on documentation.

When Workflow Redesign efforts got underway in the fall, nursing documentation was a clear area for improvement.

“Through our focus groups, observations and feedback, we heard the need to optimize nursing documentation, including the time spent doing documentation, the duplication within documentation and the number of entry fields,” said Vickie Thompson, MSN, R.N., manager of Nursing Special Projects at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, who is leading the Vanderbilt-wide nursing documentation project.

They also saw the success of changes around Braden, a pressure ulcer assessment tool, and the falls tool at Children’s Hospital. These changes made the documentation more simple and convenient to complete.

“The work with Braden in the fall showed us this was a good opportunity to improve nursing workflow and something the nurses really wanted,” Thompson said.

The nursing documentation project team includes staff nurses from Vanderbilt University Hospital and Children’s Hospital inpatient and perioperative areas who are vetting ideas and giving feedback.

“I definitely feel like the workflow redesign leaders are listening to the nurses,” said Taylor Armstead, R.N., BSN, an 8 South nurse on the focus group. “Being involved with the documentation focus group allows me to understand the extensive process of making changes in our documentation system. I then can gladly report back to my co-workers that our suggestions are not just ‘lost in space.’”

Armstead said the small changes already made to documentation have improved nursing workflow, and she anticipates more successful changes in the future.

“Charting is a necessary task that is very tedious and time consuming. With these documentation changes, I believe this will allow us to be more efficient in our time, ultimately resulting in meeting the needs of our patients.”

The team is looking at implementing changes to documentation of ventilator-associated pneumonia (VAP), using a “bundles” approach to decrease the number of entry fields.

“VAP is a great example of the Credo value, ‘We continuously evaluate and improve our performance.’ The initial intervention got us the clinical results we wanted and during this rapid cycle wave there was an evaluation of the documentation to make it more efficient, further improving overall performance,” said Bill Fulkerson, associate hospital director, Professional Services.

Other documentation changes in the evaluation stage include:

• Handover forms.

• Admission forms.

• Documentation across the care continuum.

“We’re making all these changes while taking quality and safety requirements into account,” Thompson said. “The focus groups have been great at vetting our ideas and giving us additional ideas for quick wins or long-term projects. The nurses have been great to work with.”

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