Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study

Bail, Kasia, Davey, Rachel, Currie, Marian, Gibson, Jo, Merrick, Eamon and Redley, Bernice 2020, Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study, Australian health review, vol. 44, no. 5, pp. 672-676, doi: 10.1071/AH18231.

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Title Implementation pilot of a novel electronic bedside nursing chart: a mixed-methods case study
Author(s) Bail, Kasia
Davey, Rachel
Currie, Marian
Gibson, Jo
Merrick, Eamon
Redley, BerniceORCID iD for Redley, Bernice
Journal name Australian health review
Volume number 44
Issue number 5
Start page 672
End page 676
Total pages 5
Publisher CSIRO Publishing
Place of publication Clayton, Vic.
Publication date 2020-09
ISSN 0156-5788
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
health services research
information management
performance and evaluation
Summary The aim of this study was to investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. The case study used multiple data sources captured within a real-life clinical ward context. Quantitative findings included significant reductions in nurse-reported missed care (P < 0.05) and increased mean time spent at the bedside (from 21 to 28min h−1; P < 0.0001); reductions in patient-reported missed care and nurses’ walking distances were not significant. Qualitative themes included: (1) inconsistent expectations (perceptions about potential vs actual functionality and benefits of the technology); (2) decisional conflict between managers and end-user nurses (discordance between governance decisions and clinical operations; 30% of beds were closed and six of the eight trained nurse ‘super-users’ were moved from the pilot ward); and (3) workflow effects (ergonomic set-up of the digital interface). This study highlights the complex challenges of implementing and examining the effects of technology to support nursing care. Shared understanding of the technology goals and project scope in relation to nursing care and flexible and adaptive project and contingency planning are fundamental considerations. Complexity, unpredictability and uncertainty of ‘usual business’ are common confounders in acute hospital settings.What is known about the topic?Although much has been written about the implementation of electronic records into hospital systems, there is little research evaluating the effect of information technology systems that support the complex clinical decision making and documentation required to meet nurse and patient needs at the point of care.What does this paper add?This study highlights the potential to reduce missed care through better nursing workflow. Contributing factors to low nurse adoption of new technology have been identified, including inconsistent expectations and goals for the design of systems to support quality nursing care, incongruous decision making in design, adaptation and implementation processes and constrained physical workability in relation to nursing workflow.What are the implications for practitioners?The design of information systems to support nursing work requires a shared understanding of ‘good practice’ for high-quality nursing care that is consistent with theories of nursing practice, best evidence and professional practice standards. Recognition of effective and ineffective sociotechnical interactions that occur during complex nursing processes can help avoid ‘disruption without benefit’ and ‘amplification of errors already in the system’ during acute care technology implementation. Ongoing dynamic input from individuals and groups with different expertise and perspectives, as well as iterative, generative processes for moving towards a shared goal, are critical for effective and efficient implementation.
Language eng
DOI 10.1071/AH18231
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
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Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
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