Streamlining Electronic Medical Record (EMR) Documentation during COVID-19 Surge: Impact on Front-Line Nurses

Project description: Electronic documentation burden is well documented in the literature. During the initial COVID-19 surge period in 2020, this burden was elevated to a critical level. Front-line nurses working in a community hospital in the northeast region of the United States reported being overwhelmed with EMR documentation as they were caring for multiple patients who were rapidly deteriorating. Therefore, EMR documentation urgently needed to be streamlined to reduce the documentation burden among front-line clinical nurses. EMR documentation was streamlined strategically in seven critical areas to decrease the documentation burden experienced by nurses during the COVID-19 emergency.

Method: Streamlining the EMR during the COVID-19 surge was initiated by front-line nurses as they reported their concerns to the unit nurse managers. Nurse managers further reached out to nursing administration and, in collaboration with the informatics team, designed a streamlined EMR documentation targeting seven key areas which included patient profile, assessment and intervention, vitals and intake-output flow sheets, medication administration record, plan of care, progress notes, and patient education.

Analysis: A mixed-method study conducted on coping and adaptation of front-line nurses during COVID-19 surge collected data from open-ended questions focusing on nursing adaptations. Qualitative content analysis was conducted using Atlas-ti a qualitative analysis software on n=94 responses describing adaptations made by front-line nurses to cope with changes in the hospital environment imposed during the COVID-19 surge.

Results: Among n=94 responses that were content analyzed to understand adaptations that occurred, one of the major themes that emerged was “streamlined charting.” Some direct quotes as evidence are “Electronic charting was streamlined to make it less cumbersome,” “Charting was less and more concise,” “Less charting as taught to us by our nurse manager,” “most of the time there was so much to do for these patients we had to forget about the charting and adapt to the circumstances,” “we definitely had to adapt our usual focus on charting in the computer to more emergent tasks at the bedside.” This evidence suggests that streamlining EMR documentation may be essential in reducing the documentation burden experienced among front-line nurses during emergency situations, thus promoting positive coping behavior in a rapidly changing clinical environment.

References
1) Gesner, E., Gazarian, P., & Dykes, P. (2019). The burden and burnout in documenting patient care: an integrative literature review. MEDINFO 2019: Health and Wellbeing e-Networks for All, 1194-1198.
2) Harmon, C. S., Adams, S. A., & Davis, J. E. (2020). Nursing Cognitive-Overload and Electronic Documentation Burden: A Literature Review. Journal of Informatics Nursing, 5(3), 16-30.
3) Olivares Bøgeskov, B., & Grimshaw-Aagaard, S. L. S. (2019). Essential task or meaningless burden? Nurses’ perceptions of the value of documentation. Nordic Journal of Nursing Research, 39(1), 9-19.