Enhancing disaster preparedness of specialty nurses on a national scale

Purpose – The number of disasters has increased by 30 per cent worldwide in the past 30 years. Nurses constitute the largest clinical group within a hospital and their ability to respond to disasters is crucial to the provision of quality patient care. The purpose of this paper is to evaluate a four-year disaster preparedness partnership between two tertiary hospitals from the perspective of executive staff, senior clinical managers and specialist nurses. The national disaster response centre was situated in one hospital and the other hospital was located 3,500 km away. Design/methodology/approach – The intervention involved selected nurses working at the partner hospital to enable familiarisation with policies, procedures and layout in the event of a request for back-up in the event of a national disaster. A mixed-methods design was used to elicit the strengths and limitations of the partnership. Surveys, in-depth interviews and focus groups were used. Findings – In total, 67 participants provided evaluations including ten executive staff, 17 clinical management nurses and 38 nurses from the disaster response team. Improvements in some aspects of communication were recommended. The successful recruitment of highly skilled and committed nurses was a strength. A disaster exercise resulted in 79 per cent of nurses, able and willing to go immediately to the partner hospital for up to 14 days. Research limitations/implications – During the four year partnership, no actual disaster occurred that required support. This limited the ability to fully trial the partnership in an authentic manner. The disaster exercise, although helpful in trialling the processes and assessing nurse availability, it has some limitations. Originality/value – This innovative partnership successfully prepared specialist nurses from geographically distant hospitals for a disaster response. This together with a willingness to be deployed enhanced Australia’s capacity in the event of a disaster

The impact of an integrated electronic health record on nurse time at the bedside: A pre-post continuous time and motion study

Background Evidence about the effectiveness of electronic health records in improving nursing workload efficiency is uncertain. Aim To measure, compare and describe nurse time spent on patient care prior to, and following implementation of an integrated electronic health record roll-out using a standardised approach. Design Structured, continuous observation, pre-post time and motion design. Methods Continuous observations took place in general wards in surgical and medical divisions of a tertiary hospital in South East Queensland from November 2015 to July 2017. Trained nurse observers independently observed and recorded patient care provided by consenting direct-care nurses over the course of an entire clinical shift in surgical wards or during medication rounds in medical wards. Care activities were timed and coded into categories (direct care, indirect care, ward related activities, documentation, personal and miscellaneous activities), and additional elements that influence nursing care. Descriptive statistics including frequency, percentages and median duration were reported for care activities with differences between pre- and post-implementation reported. Findings Direct-care nurses (n = 51) were observed for the duration of an entire clinical shift or during a medication round with a total of 6209 activities observed in both divisions. Most nursing activities occurred at the patient’s bedside prior to and following the implementation of an integrated electronic health record. In the surgical division, direct care activities (such as assessing patient needs and preparing and administering ordered medications), and ward related activities (such as cleaning and clerical work) showed a significant decrease (p = <0.001), although both had significant increases in median duration. The number of indirect care activities (such as verbal reporting) also increased (p =  0.010), although there was a downward trend in their median duration (p =  0.015). Documentation (such as computer data entry) increased significantly in number of activities (p = <0.001), and median duration (p =  0.002). In the medical division, there were no significant changes in direct or indirect care or ward related activities or median time. However, documentation activities and associated median duration increased significantly (p = <0.001). Discussion There was a significant increase in median time for documentation activities within an 18-month period following roll-out. However, this increase occurred as a result of the integrated electronic health record roll-out. Pre-implementation training assisted nurse adaptation. Workflows may improve as clinicians become more familiar with the digital system. Conclusion While the move from paper-based patient records to an integrated electronic health record did not significantly change the amount of nurse time at the bedside, or for the preparation and administration of ordered medications, there was a clear and consistent trend of increased documentation time and activities following implementation of the electronic health record. This knowledge may assist nurse leaders when implementing electronic health records