Browse Theses

Missed nursing care results in poor patient and organizational outcomes. Ambulation is one of the most frequently reported types of missed nursing care and has been linked to increased inpatient falls, additional hospitalization costs, and a longer average length of stay. The need for nurses to prioritize care in the presence of inadequate staffing, task complexity, time pressure, and interruptions may be a contributing factor to missed nursing care, yet there has been inattention to interventions that support nurse decision-making in the presence of these factors. The purpose of this project was to implement an electronic nursing worklist reminder, a type of clinical decision support, to remind nurses to complete patient ambulation and evaluate the impact of the reminder on missed nursing care specific to ambulation and its documentation, patient falls rates, and nurse perception of missed ambulation and clinical decision support. Electronic nursing worklist reminders are a form of clinical decision support within the Electronic Health Record that may support nurse decision-making and reduce missed nursing care. An electronic nursing worklist reminder was added to the electronic health record on one general medicine unit to remind nurses to complete patient ambulation. Data on missed ambulation were collected pre- and post-intervention. Patient falls rates were compared and a survey designed to gather demographic data and evaluate RN perception of missed ambulation and clinical decision support was also administered. Analysis revealed an increase in patient ambulation, indicated by the presence of nursing documentation. There was no significant difference in patient falls rates. Nurses perceived significantly less missed ambulation on the unit overall, but no significant difference in individual completion of ambulation or perception of clinical decision support. Electronic nursing care reminders can reduce missed nursing care specific to ambulation, and potentially other types of missed nursing care. Patients in the hospital setting who are at risk for functional decline due to missed ambulation may benefit from an electronic nursing worklist reminder that reminds nurses to complete ambulation.