Enhancing Documentation in the EHR to Reflect Nursing Workload in Acute Care Settings

Background: Despite extensive research on nursing workload since the 1930s, no standardized definition exists. However, it is crucial to consider the nurse-patient ratios as workload increases with the number of patients, adversely affecting both patient care and nurse morale. The University of Utah Hospital uses an application called Kronos OptiLink to generate workload and patient acuity based on admissions, discharges, transfers, and patient acuity. However, many nurses believe the calculated acuity is inaccurate, resulting in a lack of confidence in the application. As a solution, evaluating the workload associated with patient care tasks such as managing lines, drains, and airways can help generate a more accurate workload score and create a balanced patient assignment to achieve satisfaction with the application. Methods: This project was conducted at the University of Utah Hospital in two acute care units. The study aims to identify and enumerate the workload associated with lines, drains, and airways (LDAs) interventions to improve LDA documentation and create a balanced patient assignment. The project includes auditing patients' charts, conducting a survey on staffing assignments, workload, and LDA management, and proposing improvements to LDA documentation. The study also aims to generate a workload score for each LDA task for better workload assessment and management. The ultimate goal is to improve workflow for nurses and provide better patient care. Results: Chart auditing revealed that LDAs did not require consistent upgrades, but the amount of free text published when charting on LDAs was an issue. The survey response yielded only four participants, but the focus group revealed included workload scoring for different LDAs and the associated tasks. Conclusions: Quantifying patient workload through healthcare applications is helpful for leadership staff, but nurses' perspectives are crucial for success. Consistent review of nursing documentation in the electronic health record is essential to measure workload accurately.