Keywords

Electronic health records, Documentation, Home health nursing, Simulation training

 

Authors

  1. Husson, Nancy M. DNP, RN, CHSE
  2. Trangenstein, Patricia A. PhD, RN-BC
  3. Ketel, Christian DNP, APRN

Abstract

Home care nurses are expected to document their care delivery while in the patients' homes. Point of care documentation ensures that information in the EHR is accurate, timely, and accessible to all care team members. Standard training emphasized the features and functions of the different tabs within the electronic record. Managers and nurses reported standard training was not effective. The purpose of this project was to perform a post-implementation evaluation of the incorporation of point of care documentation, using case study scenarios, into the EHR training to determine if there was improved timeliness of documentation by new home care nurses. Quantitative data showed no statistical difference between the pre-implementation and post-implementation participants on completion of documentation within 24 hours from the small sample groups. Quantitative data from training evaluations showed a positive impact on learners' confidence and willingness to complete point of care documentation. Qualitative results showed participants viewed scenario-based training as interactive, meaningful, and indicative of a change in practice to include point of care documentation in the patients' home. The results suggest continued evaluation of the use of scenario-based education with point of care documentation as a format for more effective EHR training.