title: Improving Effectiveness and Satisfaction of an Electronic Charting System in Taiwan.
abstract: OBJECTIVE
  An efficient but comprehensive documentation system is essential for reducing nursing workload and ensuring adequate time for direct patient care. A "focus" is a nursing diagnosis or patient problem. The purpose of this project is to review and revise the focuses in the electronic charting system and to develop new focuses for documentation of clinical pathways. In addition, this project evaluated the impact of these changes on time required for documentation and nurse satisfaction.
  
  
  BACKGROUND
  In 2012, a large hospital in Taiwan implemented a self-developed electronic charting system that had 217 focuses in the database. Staff reported low job satisfaction and too much time on documentation. Three major issues were identified, including repetitious and redundant documentation, incorrect templates, and an incomprehensive database.
  
  
  METHODS
  A clinical nurse specialist devised quality improvement project was implemented on one 50-bed surgical unit. Forty-one focuses were revised and 13 new focuses were developed for clinical pathways. The implementation of new focus templates enhanced evidence-based practice and prevented redundant documentation. Focus templates also incorporated nursing policies and/or patient education materials. Two outcome indicators, time spent documenting and nurse satisfaction, were evaluated 3 months after implementation.
  
  
  RESULTS
  Documentation time decreased by 60% (from 138.5 to 55.8 hours) per week. The median documentation time per patient per day decreased from 18.4 minutes to 9.3 minutes. Average scores for satisfaction in usability, content, functionality, and effectiveness were increased.
  
  
  CONCLUSIONS
  Evidence-based focus templates used for documentation can reduce documentation time and increase nurse satisfaction. Clinical nurse specialists play an important role in leading the development of quality improvement projects while improving work efficiency.
authors.affiliation: Author Affiliations: Clinical Nurse Specialist and Head Nurse (Dr Hsieh); Professional Registered Nurse (Ms Chien); Associate Director (Ms Chang); and Director (Ms Chen), National Cheng Kung University Hospital, Tainan, Taiwan ROC; Professor, Department of Anesthesia (Dr Henker); Associate Professor, Center for Nursing Research (Dr Ren); Assistant Professor, Acute and Tertiary Care Department, and Coordinator, Adult-Gero Clinical Nurse Specialist Area of Concentration (Dr Tuite), School of Nursing, University of Pittsburgh, Pennsylvania.
authors.forename: Hsiao-Yen
authors.initials: HY
authors.lastname: Hsieh
authors.forename: Richard
authors.initials: R
authors.lastname: Henker
authors.forename: Dianxu
authors.initials: D
authors.lastname: Ren
authors.forename: Wan-Yi
authors.initials: WY
authors.lastname: Chien
authors.forename: Jia-Ping
authors.initials: JP
authors.lastname: Chang
authors.forename: Lifan
authors.initials: L
authors.lastname: Chen
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Tuite
mesh_terms: D057286:Electronic Health Records; D006801:Humans; D007588:Job Satisfaction; D009737:Nursing Records; D009741:Nursing Staff, Hospital / Q000523:psychology*; D013624:Taiwan; D016526:Workload