Institutional and Economic Influences on Quality of Nursing Documentation

Published In: Health Care Management Review, v. 19, no. 4, 1994, p. 9-19

Posted on RAND.org on December 31, 1993

by Louise Parker, Kenneth B. Wells, Joan L. Buchanan, Bernadette Benjamin

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Reports on the quality of nursing documentation for over 2,500 depressed, elderly Medicare patients hospitalized in one of 277 general hospitals, either prior to or after the implementation of the prospective payment system (PPS). Data came from the RAND Prospective Payment/Quality of Care Study. The article presents five conclusions of the documentation study: (1) Nursing documentation in hospital charts generally increased following the implementation of PPS. (2) Documentation of psychiatric phenomena was more thorough for patients who had spent at least one day in a psychiatric unit than for patients who had never been in a psychiatric unit. (3) Documentation of cognitive status was much more thorough for patients who had never been in a psychiatric unit. (4) Nursing staff levels had virtually no effect on the quality of documentation. (5) Across all time periods and hospitals, a low proportion of patients had relevant nursing notes. For example, on the first day of hospitalization for depression, 15 percent of pre-PPS and 32 percent of post-PPS patients had notes concerning suicidality. At discharge, nursing notes on cognitive status were present for less than 40 percent of pre-PPS patients and less than 50 percent of post-PPS patients. The authors state that unless standardized forms and tools are employed by nurses and hospitals, it is unlikely that nurse documentation of patient status will increase. However, further study is needed about how documentation relates to quality of care.

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