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HealthDecember 02, 2021

Decreasing nurse manager workloads and avoiding errors with automated documentation processes

By: Sarah Handzel, BSN, RN
Nurse managers around the world struggle with completing appropriate and error-free documentation as required by governmental regulations. Recently, the German Ministry of Health adopted a new regulation defining maximum nurse-patient ratios that must be met in some divisions of the hospital. The fulfillment of these ratios must be documented and reported.

If hospitals don’t meet the new requirement, they face financial penalties of up to €20,000, or approximately $22,469. As such, many nurse managers are burdened with increased documentation workloads — some nurse managers report spending up to 49% of their workday on deskwork. And on top of all that, the documentation regulation is subject to change each year. Any documentation process must be flexible and easy to update as a result.

A recent article in CIN: Computers, Informatics, Nursing explores the development and implementation of an automated documentation process for use by nurse managers. By developing a new automatic process, the authors hope to assess the use of business intelligence (BI) in nursing management documentation processes.

Process analysis leads to automated processes

First, a process analysis was carried out in a 650-bed German hospital. The results were then used to design and implement a new documentation and visualization system, including new load scripts and a new collection of dashboards. Load scripts define how data is imported into a specific data model, while dashboards display the model’s information in various ways.

The new regulation defines the output of the documentation process. It includes organizational information that cannot be changed by hospital users because it is used by governmental agencies to identify the hospital and its specific wards. However, based on the hospital’s staff and patient numbers, specific information must be input, such as:

  • The monthly average number of nurses and patients
  • Resulting nurse-patient ratios
  • The number of shifts in which the required limit was not met

Manually entering this information leads to several problems. First, it is a time-consuming process that takes away from the nursing manager’s resources. Also, the process itself is error-prone since many manual copying and calculation steps can quickly lead to numerical errors. Finally, the process itself does not scale. The more wards and hospital locations affected by the new regulation; the more work time is needed to complete necessary documentation.

Understanding the new data model

The new data model was derived from the regulation text and contains all information in the regulation itself. The following fields are included:

  • Base fields used to match entries from data sources, such as date, ward, location, shift, and division
  • Defined nurse-patient ratios and the maximum allowed portion of non-examined nurses, who receive less instruction and training compared to examined nurses
  • Others using formulas using various mathematical equations

The new system was found to be effective and useable as a one-click documentation and visualization system. It automatically read any inputted data and calculated the required documentation while filtering out any data that was unnecessary. The created dashboards then contain various data visualization components and can be used by nurse managers to analyze data that was previously loaded.

The authors note that, overall, this solution was cost-effective and could make use of existing information technology systems. The system reduced the workload needed to fulfill the new documentation requirements and resulted in less errors compared to manual data entry. The automated process was scalable and could easily adapt to changes in the regulation, making it an ideal solution for nurse managers and having a positive impact on the documentation process.

Explore how solutions from Lippincott can support nurse managers in team performance and impact patient outcomes.  

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Sarah Handzel, BSN, RN
Freelance Health and Medical Content Writer, Wolters Kluwer Health
Sarah has over nine years’ experience in various clinical areas, including surgery, endocrinology, family practice, and pharmaceuticals. She began writing professionally in 2016 as a way to use her medical knowledge beyond the bedside to help educate and inform healthcare consumers and providers.
  1. CIN: Computers, Informatics, Nursing: October 2021 - Volume 39 - Issue 10 - p 584-591 doi: 10.1097/CIN.0000000000000790
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