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RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
The power of positivity in communications is a real force. Complete and thorough documentation during a trauma resuscitation continues to be a challenge for many trauma centers. At our Level 1 trauma center, feedback emails following resuscitation were previously sent only if a documentation deficiency was identified during trauma service’s review of a patient chart.
INTRODUCTION
Our team hypothesized that increased documentation compliance could be achieved with positive feedback to nurses who completed all required documentation. The potential for improvement on all trauma alerts and activations in a timely manner offered the opportunity for providing frequent feedback to emergency department (ED) nurses in real time, potentially facilitating more open communication between the trauma service and ED at our hospital.
OBJECTIVES
The plan was to send daily emails for every activation completed by ED nurses that offered feedback on the required trauma documentation elements, including temperature, heart rate, blood pressure, GCS, primary and secondary assessments, and trauma surgeon arrival. If there were no missed elements, everything was highlighted in green. If elements were missed, those elements were highlighted in red, and a list of required documentation was attached to the email for reference. Emails regarding deficiencies were educational and supportive. Each month’s data were summarized and broken down by category (e.g., BP, temp, GCS, primary/secondary assessments). Monthly reports were provided for comparison, as well as educational articles providing rationale to support the importance of these essential documentation elements. Nurses were encouraged to provide the trauma service with any feedback they had regarding the data or suggestions for change and improvement.
PROJECT DESIGN
Documentation compliance improved in the six months after instituting this new feedback technique (n=1,036 activations/emails), from 68% in the 2nd month to 84% in the 6th month. Manual BP was documented 78% of the time in the 2nd month and improved to 93% in the 6th month. This process of positive feedback also improved and allowed for increased open communication between ED staff, ED leadership, and trauma services. In addition, ED staff nurses provided suggestions for change at the bedside, such as increased discretion with activations and trauma physician assistant check-ins.
RESULTS
CONCLUSIONS
ED nurses are consistently burdened with high patient census, staffing shortages, and increasing documentation requirements. The benefits of this project are:
• Improved compliance for documentation standards in the ED
• Improved communication between ED staff and the trauma service
• Identification of process challenges to inform future improvement projects
The utilization of positive feedback drives performance improvement better than our previous standard of deficiency-based feedback alone.
REFERENCES
Bilyeu, P., Eastes, L. (2013). Use of Electronic Medical Record for Trauma Resuscitations: How Does This Impact Documentation Completeness? Journal of Trauma Nursing, 20(3),166-168.Heller-Wescot, T., O’Connor, T., Raposo, A. (2014). Improving Trauma Documentation in the Emergency Department. Journal of Trauma Nursing, 21(5), 238-243. Mayer, J., Mooney, B., Gundlapalli, A., Harbarth S., Stoddard, G., Rubin, M., … Samore, M. (2011). Dissemination and Sustainability of a Hospital-Wide Hand Hygiene Program Emphasizing Positive Reinforcement. Infection Control & Hospital Epidemiology, 32(1), 59-66.
CONTACT
Meghan Cangley RN, BSN, CENTrauma Quality Specialist
St. Anthony Hospital [email protected]
St. Anthony Hospital Lakewood, CO
Meghan Cangley BSN, RN, CEN Abigail Blackmore MSN, RN, TCRN Pamela Bourg PhD, RN, TCRN, FAEN
Positivity Impacts Documentation Completeness
68%
74%
89%
80%84%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Perfect Documentation
PERFECT DOCUMENTATION
August September October November December
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
August September October November December
Documentation Errors
Doc Fallouts Total Activations
RESULTS
SETTING
0%
5%
10%
15%
20%
25%
July August September October November December
Missing Documentation
No Manual BP No Primary/Secondary No Temp TS not arrived
St. Anthony Hospital is an urban ACS-verified Level 1 community trauma center.
