Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study

Abstract

The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P<0.05) and increased mean time spent at the bedside (from 21 to 28min h−1; P<0.0001); reductions in patient-reported missed care and nurses’ walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology); (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations; 30% of beds were closed and six of the eight trained nurse ‘super-users’ were moved from the pilot ward); and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of ‘usual business’ are common confounders in acute hospital settings. What is known about the topic?Although much has been written about the implementation of electronic records into hospital systems, there is little research evaluating the effect of information technology systems that support the complex clinical decision making and documentation required to meet nurse and patient needs at the point of care. What does this paper add?This study highlights the potential to reduce missed care through better nursing workflow. Contributing factors to low nurse adoption of new technology have been identified, including inconsistent expectations and goals for the design of systems to support quality nursing care, incongruous decision making in design, adaptation and implementation processes and constrained physical workability in relation to nursing workflow. What are the implications for practitioners?The design of information systems to support nursing work requires a shared understanding of ‘good practice’ for high-quality nursing care that is consistent with theories of nursing practice, best evidence and professional practice standards. Recognition of effective and ineffective sociotechnical interactions that occur during complex nursing processes can help avoid ‘disruption without benefit’ and ‘amplification of errors already in the system’ during acute care technology implementation. Ongoing dynamic input from individuals and groups with different expertise and perspectives, as well as iterative, generative processes for moving towards a shared goal, are critical for effective and efficient implementation.

Ten statements to support nurse leaders implement e‐health tools for nursing work in hospitals: A modified Delphi study

“…The national nursing informatics experts participating in this study unanimously agreed that implementing e‐health tools provides an important opportunity to reframe and enhance nursing workflows, increase nurse work quality and efficiency and ensure the focus of nursing care remains on the patient (Callen, 2016). However, they also reflected that both the design and implementation of many e‐health tools currently used in the Australian healthcare context may not support the goals of nurses providing hospital care (Bail et al, 2020). This indicates important challenges facing the future of e‐health tools for nursing in hospitals, and aligns with the purpose of this research to support nurse leaders to achieve success with e‐health tool implementation in hospitals.…”

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“…To date, only one study directly examined the effect of EHR implementation on UNC. Bail et al (2020) found that nurses spent more time at the bedside and nurse perceived UNC decreased following EHR implementation. No differences were noted in time spent on direct versus indirect care, time for hunting and gathering supplies and equipment, or time on system-related care.…”

Digital Nursing Technology to Achieve Job Satisfaction: A Systematic Review

“…They also simultaneously document bedside care, however, many nurses were not satisfied due to duplication of work and increased workload. In addition, they also recorded injuries related to posture and duration of time required to complete electronic forms on bedside touch screens, and negative comments contradicted by observational data [21]. Similarly, the statement by Leenan et al that there is still dissatisfaction in the use of electronic devices such as alarms due to system malfunctions, alarm frequency and dissonance with nurse measurements [22], and also found the low acceptance in the implementation of information systems, lack of training and support as inhibiting factors [23], [24].…”

“…This study discovered that there were 10 articles on ICT in nursing services such as the use of EHR [23], [24], [29]. It also includes HIT, ICT or implementing E-Health, and PAEHR [27], [19], [26], [20], [31], implementation of a novel electronic bedside nursing chart [21], while digital technology is also related to technology [30].…”