Whalen Madeleine, Maliszewski Barbara, Gardner Heather, Smyth Sharon
Evidence-Based Practice Program Coordinator, Johns Hopkins Health System, Baltimore, MD, USA.
Nursing Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.
Worldviews Evid Based Nurs. 2021 Jun;18(3):170-179. doi: 10.1111/wvn.12492. Epub 2021 Jan 29.
As more hospitals transition to electronic health records (EHR) and rely on technology to inform practice, what is done with that information is increasingly important. Performance report cards for physicians and nurses are not new, yet there is little recent evidence on nurse-specific audit and feedback.
The aim of the project was to conduct an evidence-based practice (EBP) review to answer the question, "Does implementing an individualized audit and feedback report tool for nurses improve compliance, adherence, and/or performance of nursing tasks?".
Evidence was gathered from several databases. Reviewers read and appraised articles that answered the EBP question using the Johns Hopkins Nursing EBP Model. Data were then collated to synthesize and generate recommendations.
Of the initial 613 unique articles, eight (two research and six quality improvement) were included. Six articles demonstrated improvements while two did not. Articles analyzed nursing documentation (n = 3), tasks or skills (n = 2), and best practice compliance (n = 3). One manuscript utilized an EHR-generated report; all others were completed by hand. Overall, there was not consistent and compelling evidence to support individualized audit and feedback report tools in nursing. However, several themes emerged related to sustainability, timing of feedback, audit, and feedback in the context of quality improvement, and the methods of acquiring and distributing data.
The ubiquity and ease of the EHR make providing automated feedback to nurses tempting, yet it is not supported by the literature. More implementation science research is needed to explore audit and feedback reports in nursing. This article adds to the literature by highlighting a significant lack of consistent and compelling positive results from the well-established quality improvement strategy of audit and feedback in the nursing population. The absence of good data is as telling as its presence.
随着越来越多的医院转向电子健康记录（EHR）并依靠技术来指导实践，如何处理这些信息变得越来越重要。医生和护士的绩效报告卡并非新鲜事物，但近期关于护士特定的审核与反馈的证据却很少。
该项目的目的是进行一项循证实践（EBP）综述，以回答“为护士实施个性化审核与反馈报告工具是否能提高护理任务的依从性、坚持性和/或绩效？”这一问题。
从多个数据库收集证据。评审人员阅读并评估使用约翰霍普金斯护理循证实践模型回答循证实践问题的文章。然后对数据进行整理，以综合并生成建议。
在最初的613篇独特文章中，纳入了8篇（2篇研究性文章和6篇质量改进文章）。6篇文章显示有改进，2篇则没有。文章分析了护理记录（n = 3）、任务或技能（n = 2）以及最佳实践依从性（n = 3）。一篇手稿使用了电子健康记录生成的报告；其他所有报告均为手工完成。总体而言，没有一致且有说服力的证据支持在护理中使用个性化审核与反馈报告工具。然而，出现了几个与可持续性、反馈时机、质量改进背景下的审核与反馈以及获取和分发数据的方法相关的主题。
电子健康记录的普遍性和易用性使得向护士提供自动反馈很有吸引力，但文献并未支持这一点。需要更多的实施科学研究来探索护理中的审核与反馈报告。本文通过强调在护理人群中，既定的质量改进策略审核与反馈缺乏一致且有说服力的积极结果，为文献增添了内容。没有好的数据与有好的数据一样能说明问题。
