Workflow Analysis: A Nursing Documentation Improvement for Highest Level of Mobility Project

A core function of the nursing informaticist is to conduct workflow analysis to identify the tasks and information necessary to achieve desired outcomes. Often, operational stakeholder’s requests functionality, such as tasks or required documentation, to improve documentation compliance in the electronic medical record (EMR). The NI must observe existing workflows related to the intervention and consult with the end users on perceived barriers and adaptations to the intervention. This level of analysis allows the NI to redesign, prioritize, and order the tasks associated with the intervention to confirm the desired workflow. Ideally, a workflow analysis is done prior to intervention.

In 2022, a pilot was performed at the flagship hospital for the Franciscan Missionaries of Our Lady Health System (FMOLHS) to implement the John Hopkins activity mobility program-highest level of mobility (AMP-HLM) assessment. Activity and mobility programs have been shown to improve patient outcomes. The Epic analyst built the AMP-HLM documentation path into the systems EMR software. Following the pilot project, which included education on the tool, the AMP-HLM was rolled out operationally housewide. The overall documentation compliance and workflow integration was low. In 2023, the system chief quality officer (CQO) asked for assistance in efforts to improve documentation compliance among nurse end users using features within the EMR to aid in efficiency and prompt staff on documentation. The initial request was to add a task for the nurse as a reminder to document.

A workflow analysis was conducted by nursing informaticists in fall 2023 on three units. Three redesign interventions were identified to improve nursing AMP-HLM documentation compliance: 1) add HLM and mobility goal (AMP) to Rover to allow concurrent documentation; 2) add row information and naming with value choices for AMP, i.e., total (full assistance needed) and none (no assistance needed); and 3) add row information on the mobility scale section (flowsheets) for HLM to indicate HLM charting type (pre or post). The before and after data showed improvement for the daily AMP and the twice a day HLM documentation. Pre-daily AM-PAC overall was 46% to 64% post and pre-BID HLM was 77% to 83% post. A second redesign of two features to color code and split rows was entered into production environment with pending outcomes.