Date of Award

Summer 2023

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Dr. Jolie Wildinger

Preceptor

Dr. Cathy Byers

Mentor

Dr. Beverly Sims

Abstract

Background: Electronic health records (EHRs) are commonly used within healthcare systems across the United States. Although EHRs were developed to provide safe delivery of care, poor documentation quality remains a problem. Poor HER documentation can negatively affect many patients’ health outcomes.

Purpose: The purpose of the DNP project was to determine the degree to which using a simulated electronic documentation model to train nurses in an acute care unit would decrease documentation errors and missed care and decrease missed opportunities for patient education in EHRs.

Methods: The theoretical framework was underpinned by the Donabedian model, positing that factors associated with structure, process, and outcome should be evaluated to determine the quality of a healthcare system. The convenience sample of participants (n = 15) was full-time nursing staff assigned to an acute unit in an urban hospital. All the participants completed a training session using the documentation model pre-installed in the hospital's EHR system. All the participants completed structured chart reviews involving 19 documented items before, during, and after the intervention.

Results: Using the documentation model for eight weeks helped improve the quality of the nurses' structured chart reviews by a small degree, indicated by Cramer's V = 0.00 to 0.34. The target of 100% correct responses was not reached for 3/19 (15.8%) of the documented items.

Conclusion: Using a simulated electronic record model resulted in a small to moderate significance level, reducing documentation errors. More training sessions are required before 100% documentation quality can be achieved. Training sessions would be best if the simulated documentation model is used during new employee hospital orientation before staff is released to the assigned units.

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