Impact of using data from electronic protocols in nursing performance management: A qualitative interview study

J Nurs Manag. 2019 Nov;27(8):1682-1690. doi: 10.1111/jonm.12858. Epub 2019 Oct 28.

Abstract

Aim: To explore the impact of using electronic data in performance management to improve nursing compliance with a protocol.

Background: Electronic data are increasingly used to monitor protocol compliance but little is known about the impact on nurses' practice in hospital wards.

Method: Seventeen acute hospital nursing staff participated in semi-structured interviews about compliance with an early warning score (EWS) protocol delivered by a bedside electronic handheld device.

Results: Before electronic EWS data was used to monitor compliance, staff combined protocol-led actions with clinical judgement. However, some observations were missed to reduce noise and disruption at night. After compliance monitoring was introduced, observations were sometimes covertly omitted using a loophole. Interviewees described a loss of autonomy but acknowledged the EWS system sometimes flagged unexpected patient deterioration.

Conclusions: Introducing automated electronic systems to support nursing tasks can decrease nursing burden but remove the ability to record legitimate reasons for missing observations. This can result in covert resistance that could reduce patient safety.

Implications for nursing management: Providing the ability to log legitimate reasons for missing observations would allow nurses to balance professional judgement with the use of electronic data in performance management of protocol compliance.

Keywords: early warning score; information management and technology; nursing quality; patient safety; performance management.

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel
  • Early Warning Score*
  • Equipment and Supplies / statistics & numerical data*
  • Female
  • Guideline Adherence / standards*
  • Guideline Adherence / statistics & numerical data
  • Humans
  • Interviews as Topic / methods
  • Male
  • Middle Aged
  • Nursing Staff / psychology
  • Nursing Staff / standards*
  • Nursing Staff / statistics & numerical data
  • Qualitative Research
  • Work Performance / standards*
  • Work Performance / statistics & numerical data