TY - JOUR
T1 - Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study
AU - Bail, Kasia
AU - Davey, Rachel
AU - Currie, Marian
AU - Gibson, Jo
AU - Merrick, Eamon
AU - Redley, Bernice
PY - 2020
Y1 - 2020
N2 - 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 28 min 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.
AB - 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 28 min 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.
KW - eHealth
KW - health services research
KW - hospitals
KW - information management
KW - performance and evaluation
UR - https://www.mendeley.com/catalogue/62183f67-ed86-344e-adba-40ba9e486dd6/
U2 - 10.1071/AH18231
DO - 10.1071/AH18231
M3 - Special issue
C2 - 32933642
VL - 44
SP - 672
EP - 676
JO - Australia Health Review
JF - Australia Health Review
SN - 1743-8462
IS - 5
ER -