• Nursing Process Change with Task Reminder to Improve Inpatient Colonoscopies

      Kutch, Victoria; Gourley, Bridgitte (2022-05)
      Problem: At a community hospital in the mid-Atlantic region, a pattern of frequent cancellations and repeated colonoscopies were identified due to inadequate bowel preparations. Root causes of poor practice included a gap in protocols, missing documentation, poor communication, leadership changes, budget, and high patient ratios. Purpose: This project aimed to increase the quality of bowel preparation and decrease canceled and rescheduled procedures through a nurse process change with a task reminder. Methods: Three units were identified with frequent colonoscopy orders. Nursing staff were educated about administration standards and the evidence supporting adequate bowel preparation. The task reminders include start/stop times, percentage consumed, and additional feedback. Charts were audited over eight weeks. The staff received documentation feedback and education weekly. Results: Due to many COVID-19 related barriers, only 27 percent of nurses were educated. Five percent of the task reminders were placed in the drop boxes during the eight weeks. The run charts revealed an upward trend of successfully completed colonoscopies over eight weeks Conclusion: Evidence has shown that nurse facilitated bowel prep and increased education increases successful bowel prep and decreases adverse events. Task reminder submissions were minimal; however, many nurses were further educated about bowel preparation and the number of inadequate bowel preparations decreased. A future recommendation is to adopt this project in the medication administration record, which will allow for simpler and easier documentation by nursing staff.
    • Timed Reminders within the Electronic Health Record to Improve Pain Reassessment Documentation

      Noll, Rebecca L.; Bundy, Elaine Y. (2021-05)
      Problem & Purpose: Ineffective reassessment and documentation of a patient’s pain level can lead to physical and psychosocial impairments compromising the ability to participate in milieu activities among psychiatric inpatients. In a large community hospital’s inpatient psychiatric unit, pain reassessments were only completed 57% of the time. The purpose of this quality improvement project was to implement modifications to the pain assessment flowsheets in the electronic health record on an adult inpatient psychiatric unit to improve nurse adherence to reassessment and documentation of pain scores. Methods: Pain reassessment timed reminders were added into the electronic health record flowsheets and tracked over a 13-week period on an inpatient psychiatric unit in a large community hospital. An algorithm of the unit’s pain management policy was developed laying out step by step guidance for pain reassessment timelines and medication management. Twenty staff nurses from a unit with a 19-bed patient capacity participated in this quality improvement project. Nurses received education on how to add timed reminders into the electronic health record flowsheets prior to project implementation. Pre and post implementation surveys were administered to evaluate how often nurses reassess and document pain levels within the appropriate timeframe. Weekly run charts were used to analyze and track data on nursing staff compliance rates. Results: Data collected in the weekly audits reflected a 20% improvement in pain reassessment overall at the conclusion of the project timeline. A displayed pain assessment algorithm helped to boost reassessment documentation rates by 10% initially. The next week reassessment documentation decreased by 22% after posting names of individual nursing staff adherence rates. Documentation adherence rates increased within two weeks by 20% after posting a certificate of achievement displaying nursing staff achieving 100% weekly pain reassessment documentation. Conclusion: The use of timed reminders embedded into electronic health record flowsheets, a pain management algorithm, and recognition of staff with 100% documentation compliance contributed to improvement in pain reassessment documentation practices. Implications for practice included timely documentation of pain reassessments improving pain management among psychiatric inpatients.