Beyond the Narrative Note: Nurses Using Speech Recognition Technology for Discrete Data Entry

Introduction: Clinical documentation presents a significant time burden for nurses, detracts from patient care, and may contribute to clinician burnout. Acute care nurses spend 19 to 35% of a 12-hour shift documenting in flowsheets (Collins et al., 2018). Speech recognition (SR) technology has increased in prevalence as a solution for physicians to improve their documentation efficiency. Because nursing documentation primarily consists of discrete data entry into flowsheets, SR technology has not been widely implemented for nurses (Blackley et al., 2019). At our organization, we developed a method for acute care nurses to navigate the EHR and document common assessment findings and interventions using the step-by-step voice command function of an SR application.

Methods: Step-by-step voice commands are macroinstructions that execute a series of keystrokes and text entries using a single voice command. We consulted our acute care bedside nurses to help us identify the most common sets of flowsheet documentation that they enter each shift. We then devised a way to enter this documentation in the EHR using only text entry and hotkeys. We assigned the steps to a single voice command, so that a nurse can simply say, for example, "Chart normal IV," instead of making several clicks around a flowsheet. We developed a foundation of common documentation voice commands and offered a 1.5-hour class to teach inpatient nurses how to use the SR technology and develop their own custom step-by-step commands. Our organization previously implemented SR technology for providers, so the application and microphones were already available at clinical workstations. To prevent misuse of this technology, we provided guidelines for usage and made class attendance a requirement for nurses to access to the SR application.

Learning outcomes: Collins et al. (2018) urged informaticists to address the increasing documentation burden for nurses through technology innovations. Voice commands allow nurses to quickly document common data sets; one voice command can eliminate up to 60 clicks. When we demonstrated the SR technology and promoted training, nurses were enthusiastic and willing to attend a class to gain access to the technology. Our SR technology for nurses program has been in effect for 9 months and is growing in popularity; registration for the classes is typically at capacity. To date, 142 nurses have completed the training and several have created their own custom voice commands. Based on requests and feedback from nursing staff, we began offering an advanced SR technology class, which trains users to create custom commands that can be added to our foundation of voice commands. This has resulted in increased staff engagement and an opportunity for nurses to contribute to informatics initiatives for their specialties. We are working with our EHR vendor and the SR vendor to extract data that will allow us to quantify time spent in nursing flowsheets pre and post implementation of SR technology and metrics for command usage. We plan on piloting EHR-integrated mobile devices which will enable nurses to use SR documentation independently of computer workstations.