Insights into creation and use of prescribing documentation in the hospital medical record

RATIONALE, AIMS AND OBJECTIVES: Extraction of prescribing data from medical records is a common, albeit flawed, research method. Yet little is known about the processes that result in those data. This study explores the creation and use of prescribing documentation in the medical record, from the perspective of the hospital doctors who both create and use it. METHODS: Thirty-six hospital doctors were purposely selected for qualitative interviews, giving a maximum variability sample of grades of doctors across the range of major medical specialty areas and medical teams at a large teaching hospital in England. RESULTS: The findings suggest a number of reasons why hospital doctors fail to record prescribing decisions in the medical record. There was no set standard, record keeping was not formally taught and the hurried environment of the ward gave little time for documentation. The doctors also acknowledged that there was no need for completeness, as colleagues would be able to 'fill in the gaps' via an inferential process. Assumptions were made and although this was not seen as ideal, it was recognized as necessary if work was to be done efficiently. CONCLUSION: These results reinforce the suggestion that, despite the large number of potential users, the medical record is created for those with the right privileged knowledge. This has profound implications for those without that insider knowledge who are using medical records for research purposes. FUNDING: This work was funded by a North West Regional National Health Service Postdoctoral Fellowship.     

Training health care providers in the treatment of tobacco use and dependence: pre- and post-training results

Rationale  Health care providers have an extended reach into the population of tobacco users. Increasing the number and variety of health care providers that deliver the evidence-based, brief interventions for tobacco use prescribed by the Public Health Service Clinical Practice Guideline is likely to result in more tobacco users exposed to evidence-based treatments and more successful quit attempts. Effective training is key to increasing provider performance and proficiency in this regard.
Method  A 1-hour didactic training was delivered to 1286 health care providers (185 physicians, 359 nurses, 75 dental providers and 667 other health-related professions). Pre- and post-training tests assessed provider attitudes, knowledge and behaviours. Paired samples t -tests were used to compare pre- and post-test results. Analysis of variance was used to test for significant differences among professional groups.
Results  Prior to training, physicians engaged in more interventions and reported more knowledge and more positive attitudes towards treating tobacco use than the other professions. Post-training, differences among physicians, nurses and dental providers were minimal. All professions reported significantly more knowledge and more positive attitudes on nearly all measures.
Conclusions  A large potential benefit can be garnered from a brief, targeted, 1-hour training in the brief, evidence-based interventions for treating tobacco use and dependence. Increases in perceived knowledge and positive attitudes towards treatment among the professional groups suggest that trainees will perform interventions at higher frequency post-training. Overall gains were highest for dental providers and nurses.     

Telephone nurses’ use of a decision support system: An observational study

Telephone nurses give advice and support and make assessments based on verbal communication only. Web‐based decision support systems are often used to increase patient safety and make medically correct assessments. The aim of the present this study was to describe factors affecting the use of a decision support system and experiences with this system among telephone nurses in Swedish primary health care. Observations and semistructured interviews were conducted. Six registered nurses with at least 1 year of experience of telephone nursing participated. Field notes and interviews were analyzed by qualitative content analysis. The main findings of the present this study were factors that decrease the decision support system use or promote deviation from decision support system use, factors that are positive for decision support system use and the decision support system complicates the work. Underuse and deviations from decision support systems can be a safety risk, because decisions are based on too little information. Further research with observations of telephone nurses’ use of decision support systems is needed to develop both telephone nursing and decision support systems.     

Satisfaction of health‐care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates

The integration of electronic health records (EHRs) has shown promise in improving health‐care quality. In the United Arab Emirates, EHRs have been recently adopted to improve the quality and safety of patient care. A cross‐sectional survey of 680 health‐care providers (HCPs) was conducted to assess the satisfaction of HCPs in the United Arab Emirates with EHRs' impact on access/viewing, documentation and medication administration and to explore the barriers encountered in their use. Data were collected over 6 months from April to September 2014. High overall satisfaction with EHRs was reported by HCPs, suggesting their acceptance. Physicians reported the greatest overall satisfaction with EHRs, although nurses showed significantly higher satisfaction with the impact on medication administration compared with other HCPs. The most significant barriers reported by nurses were lack of belief in the value of EHRs for patients and lack of adequate computer skills. Given the large investment in technology, additional research is necessary to promote the full utilization of EHRs. Nurses need to be aware of the value of EHRs for patient care and be involved in all stages of EHR implementations to maximize its meaningful use for better clinical outcomes.     

Electronic medical record platform enhancements during COVID‐19 to support identify‐isolate‐inform strategy for initial detection and management of patients

Singapore was one of the earliest countries affected by COVID‐19, outside China. EDs in Singapore faced a surge of confirmed cases of COVID‐19 patients, which stretched their resources. Here we describe how we adopted strategic changes using the identify‐isolate‐inform tool to improve the evaluation, treatment and management of COVID‐19 patients. During this pandemic, information technology integration, modifications to the electronic medical record and essential enhancements to the dashboard were implemented in a timely manner to match the clinical needs. Considerations for an isolation facility within an ED are especially important for future outbreaks.     

Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2‐year follow‐up

Rational, aims and objectives Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability. Method A computer‐based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4‐week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE‐AIM framework was applied to assess and compare outcome according to strategy. Results A more positive outcome regarding reach, effectiveness, adoption and implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible. Conclusion After 24 months, the most positive outcomes regarding all RE‐AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.