Impact of using data from electronic protocols in nursing performance management: A qualitative interview study.

Joanna Hope,Paul E. Schmidt,Alejandra Recio‐Saucedo,Peter Griffiths,Gary B. Smith

doi:10.1111/jonm.12858

Abstract

AimTo explore the impact of using electronic data in performance management to improve nursing compliance with a protocol.BackgroundElectronic data are increasingly used to monitor protocol compliance but little is known about the impact on nurses’ practice in hospital wards.MethodSeventeen acute hospital nursing staff participated in semi‐structured interviews about compliance with an early warning score (EWS) protocol delivered by a bedside electronic handheld device.ResultsBefore electronic EWS data was used to monitor compliance, staff combined protocol‐led actions with clinical judgement. However, some observations were missed to reduce noise and disruption at night. After compliance monitoring was introduced, observations were sometimes covertly omitted using a loophole. Interviewees described a loss of autonomy but acknowledged the EWS system sometimes flagged unexpected patient deterioration.ConclusionsIntroducing automated electronic systems to support nursing tasks can decrease nursing burden but remove the ability to record legitimate reasons for missing observations. This can result in covert resistance that could reduce patient safety.Implications for nursing managementProviding the ability to log legitimate reasons for missing observations would allow nurses to balance professional judgement with the use of electronic data in performance management of protocol compliance.

Highlights

Omissions in nursing care are increasingly recommended as nursing quality measures (Griffiths et al, 2018; VanFosson, Jones, & Yoder, 2016)
We explore the use of early warning score (EWS) protocols embedded within bedside electronic handheld devices
As this study has shown, it is important to approach the imposition of digital surveillance targets critically, and to understand reasons for passive resistance. This can help to avoid the use of covert strategies, which can undermine the purpose of using digital data in performance management by creating false readings

Summary

Introduction

Omissions in nursing care are increasingly recommended as nursing quality measures (Griffiths et al, 2018; VanFosson, Jones, & Yoder, 2016). | 1683 electronic devices the resulting data create new ways of measuring nursing omissions. Time‐stamped electronic data collected during these calls are used to compare nurse response times and numbers of en‐ quiries resolved within the time required by their protocol (Pope et al, 2017; Prichard, Turnbull, Halford, & Pope, 2014; Ruston, 2006). The data in this study derives from a wider study exploring why diur‐ nal variation in vital signs observations persisted in the study hospital following the introduction of a EWS protocol embedded within bed‐ side handheld devices. When the due time is reached, an amber clock icon appears This turns red if an observation is overdue by 30% past the scheduled interval. A summary for all patients is visible on linked software on ward computers and tablets

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