An Essential Clinical Dataset Intervention for Nursing Documentation of a Pediatric Admission History Database.

PURPOSE: The purpose of this study was to improve nursing documentation efficiencies and satisfaction of a pediatric admission history workflow. Secondary aims determined if defining essential data elements was associated with decreased pediatric admission history documentation time, increased dataset completion rate, and increased satisfaction. DESIGN AND METHODS: A quasi-experimental between-group difference comparison was conducted for a nurse-led quality improvement study that included implementation of a pediatric essential clinical dataset (ECD) tool for pre/post-intervention analysis of nursing admission history documentation time, dataset completion rate, and satisfaction. A survey was administered to nurses pre- and post-intervention to compare documentation satisfaction. RESULTS: Nursing admission history documentation time decreased by 1 min 31 s and the number of clicks decreased 38%. Dataset utilization increased 8% indicating improved nursing documentation of essential questions within a pediatric admission history form. Nursing documentation satisfaction with the pediatric admission history form was minimally impacted by the pediatric ECD study intervention. CONCLUSIONS: Defining what is essential for nurses to document positively influenced nursing documentation time, dataset completion rate, and satisfaction. PRACTICE IMPLICATIONS: The study contributed to EHR content standardization, optimization, and documentation efficiencies for nurses within a pediatric organization with implications for clinical and informatics collaboration to create real-world evidence, leveraging an intervention that decreased documentation burden and increased time for children and families.

Impact of High-Reliability Education on Adverse Event Reporting by Registered Nurses.

Adverse event reporting is one strategy to identify risks and improve patient safety, but, historically, adverse events are underreported by registered nurses (RNs) because of fear of retribution and blame. A program was provided on high reliability to examine whether education would impact RNs' willingness to report adverse events. Although the findings were not statistically significant, they demonstrated a positive impact on adverse event reporting and support the need to create a culture of high reliability.

Meet ANCC's New Executive Leaders.

In October 2016, the American Nurses Credentialing Center (ANCC) announced the appointment of Loressa Cole, DNP, MBA, RN, FACHE, NEA-BC, as its new executive director and executive vice president and Jeffrey Doucette, DNP, RN, CENP, FACHE, NEA-BC, LNHA, as its new vice president of the Magnet Recognition® and Pathway to Excellence® Programs. In this Magnet® Perspectives column, we learn more about these 2 dynamic leaders at the helm of ANCC.

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

Exploring the Human Experience in Health Care.

This is the first article in a new series from Press Ganey-a health care performance improvement organization-that will discuss the many facets of the human experience in health care. Using the latest national data, the series will explore the intersections of safety, reliability, experience, and service, and their impact on engagement, work culture, and nurse-sensitive outcomes. Each installment will be designed as a "deep dive" into the most recent thinking and evidence-based approaches to improvement of the patient experience with a particular focus on practical and implementable tactics in each of the above subject areas.

The mindful nurse leader: Improving processes and outcomes; restoring joy to nursing.

In this first installment of a three-part series on mindfulness, we describe a dynamic project aimed at elevating the importance of mindfulness, compassion, and presence as key competencies for professional nurses across the career span in all healthcare settings.

The mindful nurse leader: Advancing executive nurse leadership skills through participation in action learning.

In this second installment of a three-part series on mindfulness, we describe the process of producing video vignettes to illustrate how clinical nurses draw on the power of mindfulness to build their own resiliency while delivering compassionate care.

The mindful nurse leader: Key take-away: Go slow before you go fast.

The first and second articles in this three-part series on mindfulness described the production of the video "In the Moment: Stories of Mindfulness in Nursing" as part of the authors' Robert Wood Johnson Foundation Executive Nurse Fellowship program. In this final installment, we discuss our leadership approaches and lessons learned, both as a team and individuals.

Serving up uncommon service.

Differentiate between quality and service to improve patient and staff satisfaction.