Identifying and adapting interventions to reduce documentation burden and improve nurses' efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study.

BACKGROUND: Although EHR systems have become a critical part of clinical care, nurses are experiencing a growing burden due to documentation requirements, taking time away from other important clinical activities. There is a need to address the inefficiencies and challenges that nurses face when documenting in and using EHRs. The objective of this study is to engage nurses in generating ideas on how organizations can support and optimize nurses' experiences with their EHR systems, thereby improving efficiency and reducing EHR-related burden. This work will ensure the identified solutions are grounded in nurses' perspectives and experiences and will address their specific EHR-related needs. METHODS: This mixed methods study will consist of three phases. Phase 1 will evaluate the accuracy of the EHR system's analytics platform in capturing how nurses utilize the system in real-time for tasks such as documentation, chart review, and medication reconciliation. Phase 2 consists of a retrospective analysis of the nursing-specific analytics platform and focus groups with nurses to understand and contextualize their usage patterns. These focus groups will also be used to identify areas for improvement in the utilization of the EHR. Phase 3 will include focus groups with nurses to generate and adapt potential interventions to address the areas for improvement and assess the perceived relevance, feasibility, and impact of the potential interventions. DISCUSSION: This work will generate insights on addressing nurses' EHR-related burden and burnout. By understanding and contextualizing inefficiencies and current practices, opportunities to improve EHR systems for nursing professional practice will be identified. The study findings will inform the co-design and implementation of interventions that will support adoption and impact. Future work will include the evaluation of the developed interventions, and research on scaling and disseminating the interventions for use in different organizations, EHR systems, and jurisdictions in Canada.

Understanding Mental Health Service User Experiences of Restraint Through Debriefing: A Qualitative Analysis.

OBJECTIVE: To examine debriefing data to understand experiences before, during, and after a restraint (seclusion, chemical, and physical) event from the perspective of inpatients at a large urban mental health and addiction hospital. METHOD: Audits were conducted on a purposeful sample of inpatient charts containing post-restraint event inpatient debrief forms (n = 55). Qualitative data from the forms were analyzed thematically. RESULTS: Loss of autonomy and related anger, conflict with staff and other inpatients, and unmet needs were the most common factors precipitating restraint events. Inpatients often reported that increased communication with staff could have prevented restraint. Inpatients described having had various negative emotional states and responses during restraint events, including fear and rejection. Post-restraint, inpatients often desired to leave the unit for fresh air or to engage in leisure activities. CONCLUSIONS: To our knowledge, our study is the first to use debriefing form data to explore mental health inpatients' experiences of restraint. Inpatients view restraint negatively and do not experience it as a therapeutic intervention. Debriefing, guided by a form, is useful for understanding the inpatient's experience of restraint, and should be used to re-establish the therapeutic relationship and to inform plans of care. In addition, individual and collective inpatient perspectives should inform alternatives to restraint.

Predictors of Patient-Initiated Discharge From an Inpatient Withdrawal Management Service: A Sex-Based Study.

OBJECTIVES: The purpose of this study was to examine sex-stratified independent predictors of patient-initiated discharge from an inpatient withdrawal management service and to determine whether those predictors differed by sex. METHODS: This study compared people who had self-initiated versus planned discharges and used sex-stratified generalized estimating equations models to identify independent predictors of patient-initiated discharge. Predictors examined included age, ethnicity, substance of concern, tobacco use, mental health comorbidities, day of discharge, referral source, children, and social assistance funds. RESULTS: Among females, there were 722 discharges, 116 of which were patient initiated. Among females, increasing age was associated with lower odds of patient-initiated discharge (OR = 0.97, 95% CI [0.95, 0.98]). Racialized females were nearly 2 times more likely to experience patient-initiated discharge compared with White females (OR = 1.8, 95% CI [1.09, 3.00]). Compared with weekdays, weekends were associated with over 4 times the odds of patient-initiated discharge (OR = 4.77, 95% CI [2.66, 8.56]). Having one or more mental health comorbidities was associated with lower odds of patient-initiated discharge compared with having no mental health comorbidities (OR = 0.51, 95% CI [0.32, 0.82]). Among males, there were 1,244 discharges, 185 of which were patient initiated. Among males, increasing age was associated with decreased odds of patient-initiated discharge (OR = 0.97, 95% CI [0.95, 0.98]). Compared with weekdays, weekends were associated with nearly 15 times the odds of patient-initiated discharge (OR = 14.9, 95% CI [9.11, 24.3]). CONCLUSIONS: Males and females have shared and unique predictors of patient-initiated discharge. Future studies should continue to examine the influence of sex and gender on engagement with addictions care.

A Pilot Implementation and Evaluation of Speech Recognition Technology for Nurses and Health Disciplines.

This pilot study addresses the pervasive issue of burnout among nurses and health disciplines, often exacerbated by the use of electronic health record (EHR) systems. Recognizing the potential of dictation to alleviate documentation burden, the study focuses on the adoption of speech recognition technology (SRT) in a large Canadian urban mental health and addiction teaching hospital. Clinicians who participated in the pilot provided feedback on their experiences via a survey, and analytics data were examined to measure usage and adoption patterns. Preliminary feedback reveals a subset of participants rapidly embracing the technology, reporting decreased documentation times and increased efficiency. However, some clinicians experienced challenges related to initial setup time and the effort of adjusting to a novel documentation approach.

Initial Findings of a Mixed-Methods Study to Reduce Nursing Documentation-Related Burden.

Amidst the current healthcare workforce crisis, nurses continue to experience burnout, with one contributor being the growing amount of required documentation and other electronic health record (EHR) tasks that must be completed. This study aims to identify ways in which nurses can be better supported through consideration for the burden that EHR systems may present due to increasing documentation requirements and areas of inefficient use. This study leverages nursing engagement to ensure the needs of nurses are identified and EHR efficiency is improved. Practical strategies and EHR system improvements will be proposed based on the recommendations and guidance of nursing staff.

Pre-implementation perceptions of clinicians regarding a patient portal in inpatient addictions settings: A qualitative descriptive study.

BACKGROUND: Patient portals have been implemented in many organizations to support patient engagement and empowerment. However, their use in inpatient mental health and addiction settings is relatively new and has not been extensively studied. To address this gap, this study explored clinician perspectives of implementing a patient portal in inpatient addiction settings. METHODS: The study followed qualitative descriptive methodology and used the Consolidated Framework for Implementation Research (CFIR) to guide the research. Interviews were conducted with clinicians working in an inpatient addictions service at a large mental health and addictions teaching hospital in Toronto, Canada. Data analysis was performed using directed content analysis and the CFIR domains. RESULTS: Twelve clinicians participated in semi-structured interviews. Participants included prescribers (such as physicians and nurse practitioners), registered nurses, allied health clinicians, and leadership. Participants had positive attitudes toward the patient portal, believing it would benefit patients and support consistency in healthcare. However, they also expressed reservations about its relevance and value during short inpatient admissions. Clinicians perceived the patient portal as compatible with existing workflows, enhancing patient empowerment and facilitating access to medical documentation. Concerns were raised about potential negative impacts on therapeutic rapport, particularly if patients disagreed with or were upset by the contents of their notes. Adaptations to the portal, such as improving documentation templates and providing detailed medication information, were suggested. Participants also highlighted advantages of the portal, including secure communication and access to laboratory results. CONCLUSIONS: Clinicians generally had positive attitudes toward implementing a patient portal. However, concerns about maintaining therapeutic rapport and the relevance of information to patients were identified, and adaptations were suggested to improve the utility of a portal in the context of short inpatient stays. The findings provide insights into clinician perspectives and can inform the implementation of patient portals in inpatient addiction settings.

Utilizing an Informatics Engagement Strategy as an Approach to Sustain and Retain the Nursing Workforce.

The purpose of this paper is to describe a nursing informatics engagement strategy at an academic teaching hospital in Canada aimed at sustaining and retaining the nursing workforce by (1) enhancing nursing engagement and leadership in informatics decision making; (2) improving nurses' experiences using the electronic health record (EHR) by creating a process of rapid handling of technology issues; (3) leveraging data about nurses' EHR system use to identify opportunities to further streamline documentation; and (4) enhancing and optimizing informatics education/training and communication strategies. The nursing informatics strategy aims to improve engagement among nursing staff, as well as decrease the burden of using the EHR as a way of addressing possible causes of burnout.

Predictors of and reasons for early discharge from inpatient withdrawal management settings: A scoping review.

ISSUES: Early discharges, also known as 'against medical advice' discharges, frequently occur in inpatient withdrawal management settings and can result in negative outcomes for patients. The purpose of this scoping review is to identify what is known about predictors of and reasons for the early discharge among adults accessing inpatient withdrawal management settings. APPROACH: MEDLINE, CINAHL, PsycINFO, ASSIA and EMBASE were searched, resulting in 2587 articles for screening. Title and abstract screening and full-text review were completed by two independent reviewers. Results were synthesised in quantitative and qualitative formats. KEY FINDINGS: Sixty-two studies were included in this scoping review. All studies focused on predictors of early discharge, except one which only described reasons for the early discharge. Forty-eight percent of studies involved retrospective review of health records data. The most frequently examined variables were demographics. Variables related to the treatment setting, such as referral source and treatment received, were examined less frequently but were more consistently associated with early discharge compared to demographics. Only six studies described patient reasons for the early discharge, which were retrieved via clinical documentation. The most common reasons for early discharge were dissatisfaction with treatment and family issues. IMPLICATIONS AND CONCLUSIONS: Most demographic variables do not consistently predict early discharge, and reasons for early discharge are not well understood. Future studies should focus on the predictive value of non-patient-level variables, or conduct analyses to account for predictors of early discharge among different subgroups of people (e.g. by gender or ethnicity). Qualitative research exploring patient perspectives is needed.

Increasing capacity to address the physical health needs of patients in a mental health and addictions hospital.

PURPOSE: This paper describes the strategy and outcomes of a quality improvement initiative focused on building the capacity of nurses at a mental health and addictions teaching hospital to provide an improved standard of physical health care. Education was provided via a series of e-learning modules and interactive workshops. To reinforce the education and enhance practice change, improvements were made to electronic documentation templates and organizational standards. Further, the organization provided increased access to physical health equipment, a mobile application to support assessments and a reference card for lanyards. CONCLUSIONS: Nurses identified increased confidence in performing physical assessments, and documentation improved with standards and automated forced functionality in the electronic health record. Ultimately, the organization successfully implemented a multifaceted strategy to improve physical healthcare services for people with mental health and substance use concerns. PRACTICE IMPLICATIONS: Organizational investment can lead to sustainable changes in nursing confidence and increased physical health assessment completion.

A systematic review of sex differences in treatment outcomes among people with opioid use disorder receiving buprenorphine maintenance versus other treatment conditions.

BACKGROUND: Opioid use disorder is a major health concern in North America. Currently, buprenorphine is one of the most common pharmacological interventions used to treat opioid use disorder. Despite increasing prevalence of opioid use disorder among females, little is known about sex considerations in relation to treatment with buprenorphine. METHODS: CINAHL, PsycINFO, EMBASE, PubMed/MEDLINE and Cochrane Central were searched for randomized controlled trials examining buprenorphine maintenance versus other medication-assisted treatment, placebo, or withdrawal management to determine if there were any sex differences in treatment outcomes reported. RESULTS: This review included 25 studies and found that only 52% included information related to sex differences in treatment outcomes or discussed any sex considerations in their studies. Of the 6,466 patients represented by these studies, only 26% were female. Of the studies conducting sex-specific analyses, seven studies examined treatment retention, five examined opioid use, two examined other substance use and one examined sexual risk behaviours. However, due to mixed findings, small sample sizes, and inability to conduct meta-analyses, no conclusive statements can be made about sex differences in these outcomes. None of the studies described sex differences in quality of life, legal involvement or mental and physical health. CONCLUSIONS: Low numbers of females have been included in randomized controlled trials examining buprenorphine compared to males. While sex differences in treatment outcomes were identified in this review, further research is needed in order to add to these findings. Future studies should include greater numbers of female participants and conduct sex-specific analyses.