Goswami Ipsita, Chansarn Panadda, Aldana Aguirre Jose, Taher Floura, Wilson Diane, Hahn Cecil, ElShahed Amr, Lee Kyong-Soon
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Neonatology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Pediatr Qual Saf. 2021 Aug 26;6(5):e461. doi: 10.1097/pq9.0000000000000461. eCollection 2021 Sep-Oct.
Neonates admitted to neurocritical care units frequently undergo continuous bedside cerebral function monitoring (CFM). Documentation of CFM findings that are complete and accurate can augment the quality of care through improved communication. We aimed to increase the compliance with and quality of CFM documentation in the electronic medical records by 50% in our neonatal intensive care unit over 6 months.
We used the Plan-Do-Study-Act methodology, process mapping, and fishbone analysis. We implemented interventions, including the development of standardized EMR templates, face-to-face reminders at staff meetings and clinical handover sessions, and teaching on CFM interpretation.
We evaluated 50 and 161 charts pre (August-October 2018) and postintervention (December 2018-July 2019), respectively. We improved compliance with documentation from 72% to 89% ( = 0.004); and the quality of documentation from 10% to 61% ( < 0.001). Multimodal reminders to document and educational sessions to increase familiarity with CFM interpretation effectively improved the quality of documentation.
We improved the compliance with and the quality of CFM documentation using targeted quality improvement interventions with case-focused educational sessions, reference tools, and standardized templates. Barriers to compliance with documentation were adverse effects on the workflow that changes in the EMR system may address. A significant challenge to sustainability was the high frequency of rotating trainees. We addressed this challenge by developing mandatory electronic teaching modules that include reminders to document and a case-focused teaching curriculum; to increase awareness of the importance of CFM documentation and increase confidence in CFM interpretation.
入住神经重症监护病房的新生儿经常接受床边连续脑功能监测（CFM）。完整准确地记录CFM结果可通过改善沟通来提高护理质量。我们的目标是在6个月内将新生儿重症监护病房电子病历中CFM记录的合规性和质量提高50%。
我们采用了计划-执行-研究-行动方法、流程映射和鱼骨分析。我们实施了干预措施，包括开发标准化的电子病历模板、在员工会议和临床交接班会议上面对面提醒，以及关于CFM解读的教学。
我们分别评估了干预前（2018年8月至10月）和干预后（2018年12月至2019年7月）的50份和161份病历。我们将记录的合规性从72%提高到了89%（P = 0.004）；记录质量从10%提高到了61%（P < 0.001）。记录的多模式提醒和提高对CFM解读熟悉程度的教育课程有效地提高了记录质量。
我们通过有针对性的质量改进干预措施，包括以病例为重点的教育课程、参考工具和标准化模板，提高了CFM记录的合规性和质量。记录合规性的障碍是电子病历系统变化可能解决的对工作流程的不利影响。可持续性的一个重大挑战是轮转实习生的频率很高。我们通过开发强制性的电子教学模块来应对这一挑战，这些模块包括记录提醒和以病例为重点的教学课程；以提高对CFM记录重要性的认识，并增强对CFM解读的信心。
