Navigating the Complexities of Nursing Documentation When Patients Have Access to the Content: A Qualitative Study.

AIM: To explore how Danish registered nurses (RNs) in hospitals experience documenting nursing care in electronic patient records when the content is accessible to patients. METHODS: In a qualitative research design, data were generated in six focus groups conducted in late 2022 and early 2023, comprising 31 RNs employed in inpatient wards at a university hospital in Denmark. Subsequently, qualitative content analysis was applied to the gathered data. RESULTS: The findings include three themes: (1) weighing one's words, (2) building trust or triggering conflicts and (3) risking loss of knowledge. Together, these three themes illustrate the complexities that RNs navigate when patients have access to the content of nursing documentation. CONCLUSION: Patients' access to nursing documentation requires RNs to navigate a complex interplay of factors, including awareness of language-use, influence on the nurse-patient-relative relationships, and the risk of losing essential knowledge. Therefore, although patients' access to nursing documentation can induce a positive change in terms of strengthening the professional focus on documentation, it can also result in changes in documentation practices in ways that may compromise nursing documentation as a working tool. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The findings emphasize an urgent need to explore and discuss how sensitive nursing observations can be shared in a safe and appropriate way when patients have access to the documentation. Furthermore, to prevent misunderstandings and conflicts with patients, it is essential to focus on and prioritize patient involvement in nursing documentation. IMPACT: RNs navigate complex practices when patients have direct online access to nursing documentation content. It is crucial to clarify which content nursing documentation should entail and how sensitive nursing observations can be shared in a safe and appropriate way. REPORTING: The COREQ checklist was used for reporting.

Improving Blood Transfusion Request Form Documentation: A Quality Improvement Project.

BACKGROUND: The transfusion quality improvement project (QIP) serves as a valuable tool for assessing and educating individuals who request blood components. The World Health Organization (WHO) recommends that each institution utilize a blood transfusion request form to ensure the effective conveyance of patient information to the hospital's blood bank. This QIP aimed to implement a transfusion request form and measure compliance with its use. METHODS: A prospective study was conducted at Al Managil Teaching Hospital, Sudan, from May 1 to August 3, 2024, to address the lack of standardized transfusion request forms. The study included three cycles involving pre-intervention analysis, two phases of intervention with training sessions, and post-intervention evaluations. The interventions focused on developing and implementing a new transfusion request form, training clinical physicians, and reinforcing the form's use. Data from 100 randomly selected transfusion request forms were analyzed for completeness and adherence. RESULTS: The study showed significant improvements in the completeness of transfusion request forms across three cycles. In the first cycle, no data were collected, highlighting the absence of standardized forms. During the second cycle, with the introduction of the new form, the completion rates varied: some fields, such as patient information and clinical details, were fully completed in 50 cases (100%), while critical clinical parameters, such as current hemoglobin (Hb) and platelet (PLT) levels, were completed in only four requests (8%). By the third cycle, there was a substantial increase in completion rates across all domains. For example, patient information fields achieved 100% completion in 50 cases, and clinical parameters saw significant improvement, with current Hb and PLT levels documented in 48 cases (96%). The mean percentage completion increased from 68.1% in the second cycle to 97.9% in the third cycle, demonstrating the effectiveness of the interventions and training sessions. Minor decreases were observed in health insurance documentation and certain clinical details, indicating areas for further improvement. CONCLUSION: The systematic implementation and iterative evaluation of transfusion request forms significantly enhanced documentation completeness.

Adherence to Evidence-Based Guidelines and Implications When Designing Electronic Documentation for Urinary Catheters.

AIM: The aim of this study was to investigate the point prevalence and the rate of adherence to evidence-based guidelines for patients who had indwelling urinary catheters in three Australian acute care hospitals. DESIGN: A cross-sectional observational design was used. METHODS: A multisite cross-sectional observational design was utilised in three acute hospitals across Australia. Data were collected from each site in a single day directly from observation of the patient, the bedside notes and medical records. The data collected included observations of clinical care and scrutiny of the documentation of the insertion details and catheter care using best practice guidelines. RESULTS: Of the 1730 patients audited, 47% were female. The mean point prevalence of catheters in situ across three sites was 12.9%. Correct documentation compliance was reported to be, on average, 40%. Documentation was significantly better when a template was available to guide information recorded: this was regardless of whether it was hard copy or electronic. Overall, clinical care compliance with best practices was 77%. Of note for improvement was the fixing of the urinary catheter to the thigh in highly dependent patients. CONCLUSION: It was identified that there is a need for improvement across all three sites: specifically regarding securement of the urinary catheter to the patient's thigh within the ICU. In addition, it was identified that there is a need for documentation of the urine bag change in ward areas. Documentation may be improved by incorporating templates into healthcare documentation systems in the future. Further work is needed to ensure nurses are aware of the adverse effects of urinary catheters and thus, the need to adhere to best practice guidelines. PATIENT OR PUBLIC CONTRIBUTION: There has been no patient or public contribution. REPORTING METHOD: We have adhered to the STROBE guidelines for reporting.

The Utility and Implications of Ambient Scribes in Primary Care.

Ambient scribe technology, utilizing large language models, represents an opportunity for addressing several current pain points in the delivery of primary care. We explore the evolution of ambient scribes and their current use in primary care. We discuss the suitability of primary care for ambient scribe integration, considering the varied nature of patient presentations and the emphasis on comprehensive care. We also propose the stages of maturation in the use of ambient scribes in primary care and their impact on care delivery. Finally, we call for focused research on safety, bias, patient impact, and privacy in ambient scribe technology, emphasizing the need for early training and education of health care providers in artificial intelligence and digital health tools.

Enhancing laboratory biosafety management: a comprehensive strategy from theory to practice.

Objective: This study examines biosafety management practices in a psychiatric hospital's laboratory in China, focusing on how outdated information technology impacts the hospital's ability to respond to public health emergencies. The goal is to enhance the hospital's emergency response capabilities by updating risk assessments, biosafety manuals, and implementing a comprehensive quality management system alongside a specialized infection control system for significant respiratory diseases. Methods: We utilized an integrated research approach, expanding the scope of risk assessments, updating the biosafety manual according to the latest international standards, and implementing a quality management system. A specialized infection control system for significant respiratory diseases was introduced to improve emergency response capabilities. Results: Updated risk assessments and a new biosafety manual have significantly improved the identification and management of biosafety threats. Implementing new quality management and infection control systems has enhanced response efficiency and operational standardization. Conclusion: The measures taken have strengthened the biosafety management and emergency response capabilities of the laboratory department, highlighting the importance of information technology in biosafety management and recommending similar strategies for other institutions.

Occupational Therapy Assessment Tools for Children and Adolescents in Iran: A Scoping Review.

Background: Assessment tools are essential in occupational therapy for providing client-centered care, clinical decision-making, evidence-based documentation, and defining expected outcomes. This study investigated available occupational therapy assessment tools for children and adolescents in Iran. Methods: A comprehensive search was conducted in MEDLINE, PubMed Central, Web of Science, Embase, Scopus, SID, Magiran, and Google Scholar from their inception until May 24, 2022. Two reviewers screened records and applied inclusion criteria focused on peer-reviewed articles in English or Persian, covering children and adolescents aged 0-18 years old in Iran. The methodological quality of each study and the evidence quality of each measurement tool was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias Checklist, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results: A review of 66 articles published between 2010 and 2021, identified 51 assessment tools. The majority of tools (70.7%) targeted typically developing children and those with cerebral palsy, with limited options for adolescents (n=5) and infants (n=1). These tools primarily focused on assessing body functions (47.06%), particularly sensory-motor functions. While numerous tools demonstrated good reliability (66.67%) and significant content validity (31.37%), there was a paucity of high-quality evidence supporting other psychometric properties. Conclusion: This study identified 51 occupational therapy assessment tools for Iranian children and adolescents. However, the present research identified some concerning trends, such as lack of tools available for specific populations, an overreliance on translated tools, and a predominant focus on body functions. Moreover, there were concerns about the methodological quality of studies using these tools.

Use of an ambient artificial intelligence tool to improve quality of clinical documentation.

Background: Electronic health records (EHRs) have contributed to increased workloads for clinicians. Ambient artificial intelligence (AI) tools offer potential solutions, aiming to streamline clinical documentation and alleviate cognitive strain on healthcare providers. Objective: To assess the clinical utility of an ambient AI tool in enhancing consultation experience and the completion of clinical documentation. Methods: Outpatient consultations were simulated with actors and clinicians, comparing the AI tool against standard EHR practices. Documentation was assessed by the Sheffield Assessment Instrument for Letters (SAIL). Clinician experience was measured through questionnaires and the NASA Task Load Index. Results: AI-produced documentation achieved higher SAIL scores, with consultations 26.3% shorter on average, without impacting patient interaction time. Clinicians reported an enhanced experience and reduced task load. Conclusions: The AI tool significantly improved documentation quality and operational efficiency in simulated consultations. Clinicians recognised its potential to improve note-taking processes, indicating promise for integration into healthcare practices.

A Study at Wad Madani, Sudan: Are We Documenting Acute Ankle Fractures Effectively?

BACKGROUND: Medical records are essential documents that outline a patient's medical history and current health status. It involves maintaining records that include assessments of patient outcomes, care plans, and interventions necessary to meet patient needs. A patient's medical record encompasses details about their condition, as documented by healthcare professionals, including clinical assessments, evaluations, and professional opinions related to the delivery of care. METHODS:  This retrospective study aimed to evaluate the adequacy of our documentation for acute ankle fractures in accordance with the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines, encompassing a total of 41 cases. The research was conducted at the Gezira Center for Orthopedic Surgery and Traumatology (GCOST) in Wad Madani, Sudan, from May 12 to July 12, 2022. RESULTS: Of the 41 recorded notes for acute ankle fractures, 26 (63.4%) were documented by medical officers and 15 (36.6%) by orthopaedic trainees. Most fractures (25 cases, 61%) occurred in individuals aged 18-40 years, and the gender distribution showed that males accounted for most fractures, with 29 cases (70.7%). Additionally, all patients (100%) had a documented cause of injury. Skin integrity was noted in 38 patients (92.7%). Vascular examination was documented in 18 patients (43.9%), while neurological examination was recorded in 16 patients (39%). CONCLUSION: Although the cause of ankle fractures was reported in all patients, the neurovascular examination was insufficiently documented, compromising patient care and failing to meet national standards, as highlighted in our study. We recommend implementing the BOAST guidelines to ensure proper documentation and essential assessments.

Nurses' understanding of the necessity of core items recommended by the latest Utstein resuscitation registry template for in-hospital cardiac arrest: A cross-sectional study.

Background: It is essential for nurses, who are more likely to be first responders to cardiac arrest patients in hospitals, to understand the items that should be recorded when a cardiac arrest occurs to record the event accurately. We aimed to assess Japanese nurses' understanding of the necessity of recording core items, as defined in the Utstein-style reporting template. Methods: We conducted a cross-sectional study using an anonymous, self-administered online questionnaire survey at Kyoto University Hospital. In addition to nurses' understanding of the necessity of recording Utstein core items, we collected data on years of experience as a nurse, experiences of encountering in-hospital cardiac arrest (IHCA), and understanding and confidence in performing basic life support. Results: Of 1,202 eligible nurses, 492 participated, among whom 5.3% were aware of the Utstein-style reporting template. None of the items were considered "necessary" by all respondents. A documentation form listing the items to be recorded was requested by 86% of the respondents, and 82% reported having difficulties due to a lack of opportunities to learn how to write resuscitation documentation. Conclusion: We found that nurses lacked an understanding of the Utstein-style reporting template, which is critical for effective management and reporting of IHCA. Detailed and accurate documentation is crucial for improving outcomes in patients with IHCA. Effective education for nurses and development of a recording system are challenges that must be addressed in the future.

Assessment of the quality of oral squamous cell carcinoma clinical records in oral surgery with Surgical Tool for Auditing Records (STAR) scoring.

BACKGROUND: The Surgical Tool for Auditing Records scoring system [STAR] focuses on surgical record auditing with promising outcomes. It offers a structured approach to evaluating the quality of surgical notes. AIMS AND OBJECTIVES: This study aimed to assess the effectiveness of the STAR in evaluating oral surgical records and identifying areas for improvement in documentation practices. MATERIALS AND METHODS: The data was obtained from the Dental Information Archival Software (DIAS) of our institution. The sample size was determined using G*Power 3.1.9.4 software. Fifty consecutive oral surgery clinical records of oral squamous cell carcinoma patients were evaluated using STAR. Each record was reviewed for adherence to documentation standards including Initial Assessment (10 points), Follow-up Entries (8 points), Consent Documentation (7 points), Anesthesia Report (7 points), Surgical Log (9 points), and Discharge Synopsis (9 points). compiling a total STAR score (50 points). The data was tabulated in Google Sheets. The descriptive statistics with inter-observer agreement and the mean score were recorded. RESULTS: We observed that each of the 50 records received a score of 49/50 points on the STAR. Deductions were necessary in the Operative record section due to the lack of information regarding the sutures used. CONCLUSION: To summarize, this study emphasizes the effectiveness of the STAR scoring system in evaluating the quality of oral surgical records. Identifying deficiencies, particularly in documenting operative details, can improve the completeness and accuracy of patient records. It can ultimately enhance patient care and facilitate better communication among healthcare professionals.

Electronic health record system use and documentation burden of acute and critical care nurse clinicians: a mixed-methods study.

OBJECTIVES: Examine electronic health record (EHR) use and factors contributing to documentation burden in acute and critical care nurses. MATERIALS AND METHODS: A mixed-methods design was used guided by Unified Theory of Acceptance and Use of Technology. Key EHR components included, Flowsheets, Medication Administration Records (MAR), Care Plan, Notes, and Navigators. We first identified 5 units with the highest documentation burden in 1 university hospital through EHR log file analyses. Four nurses per unit were recruited and engaged in interviews and surveys designed to examine their perceptions of ease of use and usefulness of the 5 EHR components. A combination of inductive/deductive coding was used for qualitative data analysis. RESULTS: Nurses acknowledged the importance of documentation for patient care, yet perceived the required documentation as burdensome with levels varying across the 5 components. Factors contributing to burden included non-EHR issues (patient-to-nurse staffing ratios; patient acuity; suboptimal time management) and EHR usability issues related to design/features. Flowsheets, Care Plan, and Navigators were found to be below acceptable usability and contributed to more burden compared to MAR and Notes. The most troublesome EHR usability issues were data redundancy, poor workflow navigation, and cumbersome data entry based on unit type. DISCUSSION: Overall, we used quantitative and qualitative data to highlight challenges with current nursing documentation features in the EHR that contribute to documentation burden. Differences in perceived usability across the EHR documentation components were driven by multiple factors, such as non-alignment with workflows and amount of duplication of prior data entries. Nurses offered several recommendations for improving the EHR, including minimizing redundant or excessive data entry requirements, providing visual cues (eg, clear error messages, highlighting areas where missing or incorrect information are), and integrating decision support. CONCLUSION: Our study generated evidence for nurse EHR use and specific documentation usability issues contributing to burden. Findings can inform the development of solutions for enhancing multi-component EHR usability that accommodates the unique workflow of nurses. Documentation strategies designed to improve nurse working conditions should include non-EHR factors as they also contribute to documentation burden.

Chaperone in breast examination: a comprehensive systematic review of patient and clinician perspectives, and documentation.

BACKGROUND: The General Medical Council (GMC) has made it mandatory to have a chaperone present during intimate examinations, including breast exams, highlighting the importance of medicolegal protection for both patients and clinicians. AIMS: The use of chaperones during breast examinations is logical, especially in an increasingly litigious society. This review aims to summarize current information regarding patients' and clinicians' perspectives on chaperone use in breast examination. METHODS: A PRISMA-compliant search was conducted in electronic databases from inception until April 2023 for qualitative literature on patients' and clinicians' perspectives on chaperone use in breast examination. The inclusion criteria focused on studies related to breast examinations, excluding other intimate examinations. An inductive thematic analysis was performed in three domains: physician-associated factors, patient-associated factors, and chaperone documentation. RESULTS: Ten studies were included after screening 939 articles. For breast examination, the presence of male and older surgeons, nurse availability, rural settings, and patients' psychiatric comorbidities increased the likelihood of chaperone use during consultations. Medico-legal concerns were prominent for male physicians, while female physicians highlighted the need for technical support. Logistical issues were a common hindrance. The gender of physicians was important for patients, but there was conflicting evidence regarding patient preferences for chaperones and their purpose. Poor documentation was generally observed despite quality improvement projects. CONCLUSION: This study emphasizes the vital role of chaperones in clinical practice, urging a precise definition and targeted resolution for implementation challenges. Patient preferences highlight the need for a personalized approach, and increased awareness among healthcare professionals is essential.

Languages other than English in a pediatric ED: Documentation, extended stays, and revisits.

OBJECTIVE: Given the increasing proportion of patients and caregivers who use languages other than English (LOE) at our institution and across the U.S, we evaluated key workflow and outcome measures in our emergency department (ED) for patients and caregivers who use LOE. METHODS: This was a retrospective, cross-sectional study of patients and caregivers who presented to a free-standing urban pediatric facility. We used electronic health record data (EHR) and interpreter usage log data for our analysis of language documentation, length of stay, and ED revisits. We assessed ED revisits within 72-h using a multivariable logistic regression model adjusting for whether a primary care provider (PCP) was listed in the EHR, whether discharge was close to or on the weekend, and insurance status. We restricted our analysis to low-acuity patient encounters (Emergency Severity Index (ESI) scores of 4 and 5) to limit confounding factors related to higher ESI scores. RESULTS: We found that one in five patients and caregivers who use LOE had incorrect documentation of their language needs in the EHR. Using interpreter usage data to most accurately capture encounters using LOE, we found that patient encounters using LOE had a 38-min longer length of stay (LOS) and twice the odds of a 72-h ED revisit compared to encounters using English. CONCLUSION: These results highlight the need for better language documentation and understanding of factors contributing to extended stays and increased revisits for pediatric patients and caregivers who use LOE.

Impact of the I-DECIDED Tool to Improve Peripheral Intravenous Catheter Care in Paediatrics: Interrupted Time-Series Study.

AIM: To determine whether the I-DECIDED assessment and decision tool enhances peripheral intravenous catheter assessment, care and decision-making in paediatrics. DESIGN: Quasi-experimental, interrupted time-series study. METHODS: An interrupted time-series study was conducted in a paediatric inpatient unit at a public teaching hospital in Brazil. The participants were patients aged less than 15 years old with a peripheral intravenous catheter, and their parents or guardians. Data were collected between January and July 2023, encompassing six time points, three pre-intervention and three post-intervention. Evaluation data were based on the I-DECIDED tool, including idle devices, dressings, complications, patient/family awareness, hand hygiene, disinfection and documentation. RESULTS: We conducted 585 peripheral intravenous catheter observations, with 289 in the pre-intervention phase and 296 in the post-intervention phase, inserted in 65 hospitalised children, 30 in the pre-intervention phase and 35 in the post-intervention phase. After the intervention, reductions were observed in the number of idle catheters, substandard dressings and complications. Patients and family members reported an increase in device assessment, hand hygiene and peripheral intravenous catheter disinfection. Additionally, there was an increase in documentation of decision-making performed by nurses and nursing technicians/assistants. CONCLUSION: Implementation of the I-DECIDED assessment and decision tool in a paediatric unit significantly improved the assessment, care and decision-making regarding peripheral intravenous catheters. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Opportunity to enhance practice standards, elevate the quality of care provided to paediatric patients, contribute to improved patient outcomes, advance evidence-based practice in vascular access management and enhance patient experience through increased involvement in care. IMPACT: To influence clinical practice and healthcare policies aimed at improving peripheral intravenous catheter care and patient safety in paediatric settings. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution to the design of this study.

Didactic Instruction's Impact on Medicolegal Quality of Radiation Oncology Resident Physician Documentation.

Effective documentation serves as a cornerstone for communication and patient care, especially in radiation oncology (RO). Studies have shown room for improvement in documentation practices, and although documentation guidelines exist, it is uncertain if RO physicians are aware of or adhere to them. We aimed to assess RO resident physicians' medicolegal knowledge and the impact of an educational intervention on documentation practices. Grading rubrics for consultation and progress notes were created using guidelines, comprising of a fundamental score and total score. Residents from two institutions attended a didactic seminar on medicolegal documentation. Pre- and post-seminar, an electronic anonymous survey was used to assess resident knowledge and perspectives and random resident consultation and progress notes were scored. Mean documentation and survey item scores from pre- and post-seminar were compared. Fourteen resident physicians participated and completed surveys, and 48 consultation notes and 40 progress notes were analyzed. No participant had prior education specific to RO documentation, nor were any aware of available resources. Post-seminar, participants' medicolegal documentation knowledge significantly increased (86.61% vs. 95.54%, p = 0.001), as did the fundamental score (83.64% vs 89.29%, p = 0.041) and total scores of consultation notes (69.82% vs. 78.98%, p = 0.001) and total score of progress notes (55% vs. 75.19%, p < 0.001). Our seminar significantly enhanced residents' medicolegal knowledge and quality of documentation, and surveys revealed a lack of speciality specific documentation education. This combined with findings from other studies and participant opinions suggest that resident physicians would benefit from such training during residency.

Live software documentation of design pattern instances.

Background: Approaches to documenting the software patterns of a system can support intentionally and manually documenting them or automatically extracting them from the source code. Some of the approaches that we review do not maintain proximity between code and documentation. Others do not update the documentation after the code is changed. All of them present a low level of liveness. Approach: This work proposes an approach to improve the understandability of a software system by documenting the design patterns it uses. We regard the creation and the documentation of software as part of the same process and attempt to streamline the two activities. We achieve this by increasing the feedback about the pattern instances present in the code, during development-i.e., by increasing liveness. Moreover, our approach maintains proximity between code and documentation and allows us to visualize the pattern instances under the same environment. We developed a prototype-DesignPatternDoc-for IntelliJ IDEA that continuously identifies pattern instances in the code, suggests them to the developer, generates the respective pattern-instance documentation, and enables live editing and visualization of that documentation. Results: To evaluate this approach, we conducted a controlled experiment with 21 novice developers. We asked participants to complete three tasks that involved understanding and evolving small software systems-up to six classes and 100 lines of code-and recorded the duration and the number of context switches. The results show that our approach helps developers spend less time understanding and documenting a software system when compared to using tools with a lower degree of liveness. Additionally, embedding documentation in the IDE and maintaining it close to the source code reduces context switching significantly.

Improving the quality of nursing care through standardized nursing languages: Call to action across European countries.

BACKGROUND: Standardized Nursing Languages (SNLs) have enabled nursing assessments and care to be better documented and visible in electronic health records (EHRs). However, its implementation is challenging and heterogeneous across clinical settings. This study aimed to demonstrate the challenges experienced by members of a European nursing organization, ACENDIO, in implementing SNLs in documentation systems across countries and offer recommendations about its use. MATERIAL AND METHODS: The study was executed in two phases. First, an online survey was distributed among ACENDIO members. Second, members participated in two expert panels. Discussions were recorded, and thematic analysis was performed to formulate challenges and recommendations on the use of SNLs. RESULTS: The findings highlight that nurses across Europe are faced with several issues with current documentation systems in clinical settings, limited education on SNLs, and challenges in research on SNLs. Nurses, managers, vendors, educators and researchers should work closely together to face the challenges in the implementation of SNLs in electronic documentation systems. CONCLUSION: To fully utilize the beneficial effects of the use of SNLs, the call to action is to develop comprehensive collaborations of nursing practice, education, and research.

Electronic Discharge Summaries: Perspectives on National Implementation from Clinicians in Hospital and Primary Care.

This paper describes clinicians' views on the structure and content of an electronic discharge summary (EDS). A sample EDS template was developed by building on existing Australian guidelines to illustrate some of the proposed elements required for a high-quality clinical document. Surveys were widely disseminated to gather feedback and perspectives of hospital and primary care clinicians. A pragmatic approach to this study was underpinned by a strong evidence base and informed by implementation science methods. Key themes were identified, including variability in workflow and clinical needs, digital maturity, and digital health literacy of the clinical workforce. Understanding different workflows and priorities between hospital and primary care clinicians was a significant barrier to implementing a high-quality EDS. The strong consensus for change from both hospital and primary care clinicians, however, signaled the workforce's readiness as a potential enabler of high-quality EDS documentation.

Impact of the COVID-19 Pandemic on Pennsylvania School Nurse Management of Student Immunization Requirements.

School nurses play a significant role in the coordination of school-entry immunization requirements across the United States. The COVID-19 pandemic changed the school landscape and introduced additional responsibilities to a school nurse's workload. We conducted a cross-sectional survey with n = 110 Pennsylvania school nurses to explore the impact of the COVID-19 pandemic on school-entry immunization compliance management. Qualitative and quantitative data indicated increased difficulty obtaining school-entry immunization data (n = 52) and reduced school-level enforcement of immunization compliance (n = 30). We also observed increases in the percentage of students enrolled with an immunization exemption in Kindergarten, 7th, and 12th grades between the 2019-2020 and 2020-2021 school years. However, few respondents (15%) offered school-located immunization clinics (SLIC) for school-entry-required immunizations. While the benefits of SLICs are documented, the capacity required to execute recommended actions may be limited among school nurses-particularly post-COVID-19 pandemic. School nurses may need additional support to address these gaps.

Written Mobility Communication in Acute Care Medical Wards: An Observational Study of Physical Therapists' and Nurses' Documentation Practice.

OBJECTIVE: Low inpatient mobility is associated with poor hospital outcomes. Poor communication between clinicians has been identified as a barrier to improving mobility. Understanding how mobility is communicated within the multi-disciplinary team may help inform strategies to improve inpatient mobility. The aim of this study was to describe written mobility communication by physical therapists and nurses in acute care medical wards. METHODS: This cross-sectional observational study was conducted across 4 hospitals in an Australian health service. A survey of physical therapists and nurses identified preferred sources and content of written mobility communication. An audit described and compared written mobility communication in the most strongly preferred documentation sources. Findings were described and compared graphically between discipline and site. RESULTS: Questionnaires were completed by 85 physical therapists and 150 nurses. Twenty-two sources of documentation about mobility were identified. Preferences for sources and content varied between disciplines. Physical therapists nominated several preferred information sources and sought and documented broader mobility content. Nurses often sought nursing documents which focused on current mobility assistance and aids, with limited communication of mobility level or mobility goals. Audits of 104 patient records found that content varied between sources and sites, and content was variably missing or inconsistent between sources. CONCLUSION: Written mobility communication focused on mobility assistance and aids, rather than mobility levels or mobility goals, with poor completion and inconsistency within documentation. More complete and consistent documentation might improve progressive mobilization of hospital inpatients. IMPACT STATEMENT: Physical therapists and nurses seek and document different content in a wide range of locations, leading to incomplete and inconsistent written documentation.Understanding and resolving these practice differences offers potential to improve mobility communication and practice.