Caregivers Time Utilization Before and After the Introduction of an Electronic Nursing Documentation System in a Residential Aged Care Facility

Abstract

Background: Despite increasing research interest in caregivers' interaction with technology, there has been no attempt to investigate how the introduction of an electronic nursing documentation system in a residential aged care facility may affect caregivers' use of their time.

Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training

“…Staff perceptions of the influence of HIT on workflow were mixed: In some studies, staff described processes as more streamlined, 6,9,19,24,40,41 and in others, processes were more cumbersome. 7,16,18,25,27,30,32,42-44 In the quasi-experimental studies, staff in the intervention groups were more likely to report that documentation times and completeness improved. 8,41,42 In the studies that used direct observation and process mapping of workflows, the number of steps and the time to complete tasks were either reduced or the same with the new HIT system.…”

“…9,17,19,24,25,27 Of the studies that described training, many reported single sessions for nursing staff ranging from 30 minutes to 1 day, and single sessions for CNAs or personal care assistants (PCAs) of only 20 to 30 minutes. 9,19,21,24,29-31 In one of the few studies in which staff reported satisfaction with training, they received more training than what was typically reported: multiple days for nurses and full days for CNAs. 8 For new hires, training was often described as ad hoc, provided by other staff when available.…”

“…8 For new hires, training was often described as ad hoc, provided by other staff when available. 24,30,32 Four studies described a “train-the-trainer” process, in which a few individuals typically received a 1-week training with the software vendor and then provided additional support to staff during implementation. 19,21,24,33 Staff repeatedly identified the need for ongoing training and opportunities to practice.…”

“…8,41,42 In the studies that used direct observation and process mapping of workflows, the number of steps and the time to complete tasks were either reduced or the same with the new HIT system. 24,29-31,45 The studies with longer follow-up periods noted that staff efficiency decreased in the initial months following adoption, but that most processes had returned to baseline efficiency by 12 to 24 months. 2,25,27,29,30 In some cases, this reflected greater familiarity with the HIT system, 2 and in others, workflows were no more efficient because the staff had developed work-arounds or reverted to paper.…”

“…24,29-31,45 The studies with longer follow-up periods noted that staff efficiency decreased in the initial months following adoption, but that most processes had returned to baseline efficiency by 12 to 24 months. 2,25,27,29,30 In some cases, this reflected greater familiarity with the HIT system, 2 and in others, workflows were no more efficient because the staff had developed work-arounds or reverted to paper. 24 Two studies concluded that evaluation and redesign of workflows should occur in the planning phase, prior to HIT implementation.…”