Nursing leaders share strategies for reducing documentation burden

By Kat Jercich for Healthcare IT News

The root causes of nursing burnout are varied – as are potential solutions for it.

However, given that nurses are frequently responsible for clinical documentation, it’s perhaps not surprising that reducing documentation burden is frequently cited as a key strategy for fighting burnout.

Whether it’s through more in-depth electronic health record training or by taking an outside-the-box look at workflows, nursing executives shared their ideas with Healthcare IT News for reducing documentation burden – and acknowledged the hurdles that remain in the way.

“Unfortunately, we haven’t experienced a relaxation of documentation requirements from payers and/or regulatory agencies, so any reduction in documentation carries a risk of denial of payment or not meeting regulatory requirements,” said Ellen Hansen, chief nursing and clinical services officer at Children’s of Mississippi, part of the University of Mississippi Medical Center.

Still, she said, her team is automating more documentation, such as by expanding barcode scanning and device integration into the electronic medical record so that vital signs and ventilator settings auto-populate.

At the same time, she continued, “access to capital [and] operational funds to complete the full integration is the main barrier.” Some officials pointed to specific software as being particularly helpful.

“SharePoint allows my colleagues and [me] to share documents, edit documents and save documents in one centralized location, reducing the burden of sending documents back and forth,” said Gwendolyn Oglesby-Odom, chief nursing officer at Chicago-headquartered Advocate Aurora Health.

“It’s a much more efficient way to share documents, and reduces the burden of individuals who would typically have to edit them and store them,” she added.

Although EHRs can sometimes make documentation burdens heavier, Lorenzo Suter, CEO at Dupont Hospital in Fort Wayne, Indiana, said his organization’s vendor has played a role in assisting with their needs.

“Our staff undergo extensive training in documentation in Cerner during their orientation,” he said. “The clinically trained Cerner educators provide them with useful tips to promote efficiency.”

In addition, Dupont adds a human element to the equation.

“We also have a nurse informaticist who rounds daily in each department in order to help the nurses improve their workflow processes and answer questions. This allows the nurses to have the support they need after their orientation,” said Suter, who chairs the IU Fort Wayne Nursing Advisory Board.

Meanwhile, the Cleveland Clinic is tackling the documentation challenge on two fronts, both of which involve some creative introspection, said Nelita Iuppa, associate chief nursing officer for informatics.

“This year, our Nursing Institute launched a project called Nursing Documentation Excellence in an effort to move away from the historic typecasts of electronic documentation to a more streamlined, positive and productive EMR experience,” Iuppa said.

“First, we are looking at clinical scenarios that are the most time-consuming and intensive for nursing, such as a new admission documentation to see if there is anything that can automatically be accounted for or if there is anything that patients can assist with now that many have access to their own patient record portals to enter personal updates that led up to their admission,” she explained.

“Second, we have been looking at how we use electronic records to review or audit a chart,” she continued.

“We believe a lot of opportunity exists to streamline the reports available and to modify them by specialty and unique patient clinical scenario, instead of a one-report-fits-all approach.

“As we address both the input process and how we retrieve information from the EMR, we believe we can help all of our nurses regain ease and enjoyment that comes with the documentation aspects of patient care,” she said.

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