Paper-light working in nursing.

Abstract

There is no doubt that most nurses in 2014 will be working in a health organisation where they will be using some part of an electronic patient record (EPR) to support ‘paper-light’ approaches to safe, effective and person-centred care. Nurses moving forward in the ‘new world’ of information technology (IT) and computers was a foreign concept in the 1970s, 1980s and even the 1990s. With the fast-moving technology since then have we, as nurses, been able to keep step? EPR is a term used for a collection of information held in any system throughout an organisation. The system does not have to have been developed by or for the EPR programme. Nor does it need to have been developed specifically to enhance EPR—it merely has to provide information that will be viewed as part of the combined electronic record of a patient’s encounter(s) within the organisation. Most NHS organisations across the UK are redesigning patient pathways across primary, secondary and social care. These redesign programmes have involved a significant nursing contribution and we should challenge our organisations and ourselves to commit to at least 80% of the nursing record being electronic across primary and secondary care. A research study in North America (Institute of Medicine, 2001) identified that with EPR/paper-light working the challenges are many and the learning curve can be steep but in the end there are clear benefits. In my experiences nurses fully understand that better information will lead to improvements. Setting out the goals and expectations is key to successful implementation of nursing EPR—this is about using data to improve patient care and experiences. Involving frontline nurses and employing a nurse to work directly with IT colleagues can be beneficial for both design and implementation. EPR can maximise efficient working practices, reduce variation and improve the availability of appropriate information for nursing and the multidisciplinary team. Some of the points to remember when implementing EPR in health organisations are: ■ Clarify the vision, objectives and milestones of an EPR project ■ Review principles of future ambulatory care and inpatient admissions process ■ Map end-to-end patient journey ‘as-is’ today ■ Develop a future process vision ■ Identify gaps between ‘as is’ and ‘future’ journeys ■ Agree next steps to attain validation from the teams and how to collate changes and data requirements consistently. Newfield (2006) has said that without careful documentation standardisation, elements of the objective of retrieving data will be compromised. Marilyn Chow argues that ‘Good analytics need the most discrete data Rory Farrelly NHS Greater Glasgow and Clyde Director of Nursing Acute Services Division elements identified—not just the apples to apples but the pips to pips’ (Schwartz, 2012). When developing implementation plans, engaging clinical staff on how EPRs will operate across services linked with the pathways is crucial. Organisations must enlist the support of the health information and technology teams, organisational development teams, learning and education teams, higher education institutes and practice development teams. This will enable the teams to map out the pathways and then redesign the process to determine what will be done electronically. In my experience, up-front preparation is important. We still need to anticipate resistance at every point along the way and it will feel like a big challenge, but remember the opportunities EPR brings. There may be concerns over non-verbal language and interaction with our patients and their families/carers—for example, worrying about loss of eye contact because there is a perception that nurses spend more time inputting information into EPRs. In June 2008 the Royal College of Nursing (RCN) launched its e-Health Programme Policy Statement. Updated in 2010, this stresses that the content of electronic records must be SAFER: S – The systems and the way they are used conform to standards A – They are acceptable to our patients and their families/carers F – They are fit for purpose and practice E – There is evidence to support their introduction and use R – They must be risk managed. The content of electronic records must also represent faithfully the meaning intended by the person recording it and that meaning must be preserved (RCN, 2012) In my experience there are a number of strengths to working in a paper-light environment, such as legibility, suitability, reduction in variation and enhanced communication—all this has a positive impact on nursing documentation. As nurses I ask you to challenge yourself and your peers to grasp the opportunity of nursing EPRs and paper-light working in your working environments. With the development of voice-recognition software is there an opportunity for nurses to lead the way in using voice recognition to complete our documentation? We all have to start somewhere. BJN