3 PURPOSE OF THE STUDY
5.3 Nurses’ perceptions of information culture, information management
SAFETY OUTCOMES
RNs’ perceptions of information culture are described under the following categories:
information management practices (Figure 12), safety management and reporting (Figure 13), and information behaviors (Figure 14). Further, information management incidents are divided into the potential failures in information transfer (Figure 15) and documentation errors (Figure 16). Patient safety outcomes are described in Figure 17.
Figures 12-17 present frequencies of categories as percentages. Descriptive statistics of all variables are presented in Appendix 1.
The description of information management practices is presented in the Figure 12.
Almost half of RNs disagreed that working practices in their unit were based on un-written rules; however, 21% of them still agreed with the statement. Further, a smaller share of RNs stated that in their organization, the written guidelines for the use of electronic patient data (12%), the transfer of patient data between organizations (11%), and/or the electronic documentation of patient data (17%) did not exist. Regardless of the implementation of EPRs, 55% of the respondents agreed that handwritten patient records were used alongside the electronic system. Over half of the nurses stated that electronically documented patient data must be copied manually in patient records.
On the other hand, almost all of the RNs felt electronic patient data were available when needed, and that they had access to it when needed. However, 74% of the nurses perceived that electronic patient data was not easy to find in the system.
88
I have access to electronic databases that I need in patient care. (n=1072) I need to search for needed patient data in
electronic information systems. (n=1076) I have access to electronic patient data that I
need. (n=1079)
Electronic patient data are available when needed. (n=1074)
Once an electronically documented patient data are not manually copied in patient
records. (n=1053)
In this unit, handwritten patient records are not used alongside electronic patient records.
(n=1061)
Once an electronically documented patient data are not copied in other information
systems. (n=1053)
Once an electronically documented patient data are available for all health professionals.
(n=1074)
Important patient care information is often lost during shift changes. (n=1074) Things “fall between the cracks” when transferring patients from one unit to another.
(n=1077)
In this unit, we have uniform written guideline for the electronic documentation of patient
data. (n=1060)
In this unit, we have uniform written guideline for the transfer of patient data between
organizations. (n=1057)
In this unit, we have uniform written guideline for the use of electronic patient data.
(n=1055)
I need to search for the general guidelines of my organization. (n=1074) In this unit working practices are mainly based on unwritten procedures. (n=1060)
Agree Neither Disagree
Figure 12. Information management practices.
Figure 13 presents the results of safety management and reporting. The respondents found that adverse events and near-miss situation were reported (80%), and pre-vention of them was discussed (79%) in the most of the units, but they did not feel confident that patient safety was a top priority for the hospital management (36%).
Only 22% of RNs felt that hospital management tried to solve information manage-ment problems.
47 27
79 22
80
28 37
11 50
12
25 36
10 28
9
0 % 50 % 100 %
We are given feedback about changes put into place based on event reports. (n=1074)
The actions of hospital management show that patient safety is a top priority. (n=1076) In this unit, we discuss ways to prevent
recurrence of errors. (n=1076) Hospital management act to resolve problems relating to information management. (n=1055) In this unit, adverse event and near-miss
situations are reported. (n=1060)
Agree Neither Disagree
Figure 13. Safety management and reporting.
The nurses’ perceptions of information behaviors are described in Figure 14. In gen-eral, the majority of nurses were aware of clinical guidelines (77%) and general guide-lines (83%) in their organizations, and they knew how to report adverse events in pa-tient care (89%). They trusted the accuracy of papa-tient data in electronic records (81%), but one-third of the respondents did not use primarily electronic tools to document patient data. Only 60% of the respondents were found to receive the most current data from the electronic system.
78
Before caring a patient, I am acquainted with data documented by other professionals
(n=1068)
I utilize reports from electronic databases in my job. (n=1066)
I receive the most current patient data from electronic information systems. (n=1069)
I do mainly document patient data in electronic records. (n=1069) I trust to the accuracy of electronic patient
data. (n=1072)
I know how to report adverse events in patient care. (n=1067)
I am aware of general guidelines in my organization. (n=1063) I am aware of clinical guidelines used in my
organization. (n=1061)
Agree Neither Disagree
Figure 14. Information behaviors.
Figure 15 describes the potential failures in information transfer experienced by RNs.
Verbal (78%) and handwritten (44%) orders are monthly used in hospitals. The half of the nurses experienced delays in information transfer of changes in patient care at least monthly and the unavailability of patient data was a monthly problem for 42%
of the respondents.
Patient data were not available when I needed them. (N=1061) I received changes in patient´s care
regimen with delay. (N=1056) I have received handwritten orders.
(N=1065)
I have received verbal orders. (n=1063)
Never Seldom Monthly Weekly
Figure 15. Potential failures in information transfer.
The nurses’ perceptions of prevalence of documentation errors are shown in Figure 16. Over the half of nurses (54%) do not document patient data immediately weekly.
One third of the respondents forget neither to document patient data nor document inaccurate data. Most of the nurses perceive that they do not remember all details when documenting (26%), they forget to document the data (19%) or they document inaccurate data (6%) monthly or weekly. A total of 46% of the nurses reported that they have documented electronic patient data using someone else´s username, and 10% of the nurses have done it weekly.
54
I documented electronic patient data using someone else´s user name.
(N=1047)
I did not document patient data immediately. (N=1066) I forgot to document necessary patient
data. (N=1052)
I did not remember all details when documenting patient data. (N=1054)
I documented inaccurate data.
The frequency of patient safety outcomes is described in Figure 17. Most nurses be-lieve that missing (60%) or inaccurate data (58%) have never caused adverse events or near-miss situations in patient care, but 34% of them perceived that medication administration errors occur monthly or weekly. The nurses (66%) evaluated that com-plaints from patients or their families were seldom made.
60
Missing data have caused adverse event or a near-miss situation.
(N=1037)
Inaccurate data have caused adverse event or a near-miss situation.
(N=1042)
Medication administration errors.
(n=1072)
Complaints from patients or their families. (n=1054)
Never Seldom Monthly Weekly
Figure 17. Patient safety outcomes.
Nurses’ perceptions of information culture, information management incidents, and patient safety outcomes illustrated the situation in Finnish acute hospitals (n = 32).
These perceptions were utilized in the development of the model for connecting in-formation culture and patient safety, which is presented in the next section.