Streamline Charting for General Nursing Postpartum and Newborn Visits

Summary

Impact Statement:

St. Croix County Public Health nurses were concerned that the time needed to complete required paperwork was taking them away from serving postpartum mothers and newborn babies. To put clients first, they conducted a quality improvement initiative that reduced the time for documentation by 37%. This initiative resulted in changes that have since been adopted as part of the department’s standard policy and procedures for all postpartum and newborn clients.

Summary:

St. Croix County Public Health completed a quality improvement (QI) project focused on increasing efficiency of daily operations, specifically public health nurse (PHN) documentation time. The health department had recently transitioned into a Results Only Work Environment (ROWE). While examining the goals (desired results) of the General Postpartum/Newborn Home Visit Program, PHNs began questioning the program’s documentation process. Data were being entered into a system that was no longer used to measure outcomes, resulting in duplicate charting. The PHNs involved in the program organized as a QI team and set an aim statement with a goal to decrease PHN charting time for this program by 25%. The PHNs used a fishbone diagram to identify root causes and a new documentation process. This new process was found to reduce PHN documentation time by 37%. The health department adopted the proposed change and incorporated it into a new documentation policy and procedure.

Organization that conducted the QI initiative:

St. Croix County Department of Health and Human Services –Public Health

Citation:

Reyzer, S. Public Health Quality Improvement Exchange. Streamline Charting for General Nursing Postpartum and Newborn Visits. Fri, 03/29/2013 - 19:34. Available at https://phqix.org/content/streamline-charting-general-nursing-postpartum-and-newborn-visits. Accessed May 28, 2023.

Background and Aim

Planning and Execution Details

QI Implementation:

1. Get Started The issue (lengthy charting time and use of Secure Public Health Electronic Record Environment [SPHERE] for postpartum/newborn [PP/NB] home visits) was identified by public health nurses (PHNs) during case management meetings. Multiple PHNs were finding it challenging to "get everything done" and felt that charting seemed to take a long time. While implementing a Results Only Work Environment (ROWE), questions developed about why the documentation procedure continued to include SPHERE data entry as a requirement. Also, "increasing efficiency by decreasing duplication of charting" had been identified as a goal in our department strategic plan. PHNs identified that eliminating SPHERE data entry would reduce duplicate charting, and thus would likely save documentation time and increase PHN efficiency. 2. Assemble the Team At a nursing case management meeting, it was proposed that St. Croix County DHHS–Public Health consider a quality improvement (QI) project focusing on the general PP/NB documentation process in an effort to streamline the charting process. On January 17, 2012, the team assembled included the four PHNs who provided the service with team support from the nursing supervisor (QI core team member). One of the PHNs became the project leader. 3. Examine the Current Approach The team utilized the fishbone diagram to examine the current general PP/NB documentation process. Several root causes for a lengthy charting process were identified. As expected, SPHERE entry was identified as a cause of duplicate charting for the purpose of an electronic nursing note that could then be printed and put in the paper chart. Outcome data for the general PP/NB program had already shifted from SPHERE to a spreadsheet (ROWE-related process). It was verified that the referral spreadsheet included data for all necessary program measures if SPHERE was not used for data collection. 4. Identify Potential Solutions The team looked at the various root causes and explored the possible solutions. Some options to reduce documentation time, based on various processes, would have involved shifting responsibilities from PHNs to other staff. Eliminating SPHERE data entry seemed to be a more manageable solution to begin the QI effort. The solution still needed to include a process for completing the nursing note. It was determined that the PHNs could enter the nursing note in a Microsoft Word document and then print it. The team determined that those other solutions could be potential options for ongoing QI efforts to streamline charting. 5. Develop an Improvement Theory An aim statement was created. By March 31, PHNs will spend 25% less time completing documentation for general PP/NB clients. PHNs speculated that if SPHERE data entry was eliminated and the nursing progress note was completed through Microsoft Word (while continuing to print the note on sticky paper and paste in the chart), documentation time would decrease by 25%. Gathering baseline data for potential ongoing QI efforts to streamline charting was included in the plan. 6. Test the Theory for Improvement The initial step actually was to gather baseline data: how long it takes to enter data into SPHERE, create the nursing note in SPHERE, and print and paste in the chart (for mother and infant). The team leader created a charting time tracking form and entered all of the data. Each nurse on the team gathered baseline data for four clients (two mothers and two infants). Then the team moved into piloting the new process. Each nurse reported the time it took to do the nursing note using Microsoft Word (no SPHERE entry). While tracking that data, the team also reported how long it took them to complete all the other paper forms in the client's chart for all four clients.

Focus activities

Administration:

Data collection and management/Information Technology

Organizational effectiveness

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

Fishbone Diagram

Root cause analysis

QI Tool Documentation:

1-31-2012 Fishbone.xls

Initiative Dates:

2/1/12 to 5/11/12

Initiative Duration:

Less than 6 months

Supplemental Materials:

Sample of materials produced

Storyboard

Supplemental Files:

Attachment	Size
QI Storyboard Grant report 10-18-12.doc.doc	39.5 KB
Charting Time Tracking Form (2).docx	15.73 KB

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Submission Status:

Completed

Comments

This really gave our health

This really gave our health department some great insight as we are trying reduce documentation processes for this program as well. From state to state we differ a little in our program documentation requirements, but this provided us with a starting point that was very benficial.

Streamline Charting for General Nursing Postpartum and Newborn Visits

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

This really gave our health

QI Spotlight

quality improvement together.

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Streamline Charting for General Nursing Postpartum and Newborn Visits

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight