Wednesday, March 8, 2017

Improving Practice and Reducing Risk Through Documentation: Why Not?

I have heard the criticism that we should not allow documentation to drive practice in healthcare. Why not?

A recent example is improving patient chlorhexidine bathing practice via documentation in the electronic medical record. Regular audits and consistent feedback lead to greater awareness, increased compliance with patient bathing and improved documentation. I recently came across this interesting publication titled Improving Nursing Documentation and Reducing Risk.  To quote the author, Patrica Duclos-Miller MSN,RN: " As professional nurses, we are held responsible for ensuring safe, quality patient care. The only proof of this is through nursing documentation."

Critics may argue that documenting the completion of a patient bath in the electronic medical record does not prove that the bath was done properly. This is true. However, direct observation of patient bathing is not feasible, at least not to scale. Also, patient skin calorimetry testing for chlorhexidine residual post bathing does not play out in reality. Documentation of chlorhexidine bathing in the electronic medical record satisfices, that is, it is a satisfactory and sufficient solution for a more realistic world, as I have previously discussed.

We must demand documentation solutions for things that truly matter, to minimize task burden and competing priorities. With respect to infection prevention and safety, top priorities include surgical and procedure time outs, central line checklist completion, daily review of urinary catheter need and chlorhexidine patient bathing.

In the end, these safety initiatives, no matter who burdensome they may be perceived, are the right thing to do.

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