PDF(Pubmed)
Abstract：
BACKGROUND: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project.
OBJECTIVE: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system.
METHODS: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change.
RESULTS: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month.
CONCLUSIONS: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems.
OBJECTIVE: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system.
METHODS: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change.
RESULTS: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month.
CONCLUSIONS: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems.
摘要：
背景：9加号之旅（J9）是一种综合生殖，母性,新生儿,以降低海地农村孕产妇和新生儿发病率和死亡率为核心的目标。为了这个计划的最大有效性，必须使数据系统具有最高的质量。OpenMRS,电子病历（EMR）系统，自2013年以来一直在三级转诊医院工作，米雷巴莱斯理工大学，在海地，并已扩展为J9数据收集和报告。J9计划月度报告显示，工作人员执行双重图表的时间和能力有限，这导致报告不完整和不一致。对EMR数据输入质量的初步评估表明，在此质量改进项目开始时，只有18％（58/325）的J9产前检查以电子方式记录。
目的：本研究旨在从2020年11月至2021年9月，J9员工在EMR中将门诊产前护理的电子文档从18％（58/325）提高到85％。这个质量改进项目团队遇到的经验可以帮助其他人改进电子数据收集，以及在新兴的医疗保健系统中从纸质文件向电子文件的过渡。
方法：采取持续质量改进策略作为改进Mirebalais大学EMR数据收集的最佳方法。该团队使用了几种持续质量改进工具来进行此项目：（1）使用Ishikawa和Pareto图进行根本原因分析，(2)基线评价测量，和（3）计划-做-研究-行动改进周期，以记录增量变化和每个变化的结果。
结果：在2020年11月质量改进项目开始时，产前就诊的基线数据输入为18％（58/325）。10个月的改进策略导致EMR在每个月的护理点记录的平均89％（272/304）的产前检查。
结论：这个质量改进项目团队遇到的经验可以有助于在新兴的医疗保健系统中从纸质文档过渡到电子文档。成功的关键是拥有强大而敬业的护理领导，从纸质数据过渡到电子数据，并激励护理人员进行数据收集，以提高数据质量，因此，关于患者预后的报告。让护理团队密切参与EMR和质量改进流程的设计和实施，确保长期成功，同时将护士作为患者护理系统中的关键变革推动者。
目的：本研究旨在从2020年11月至2021年9月，J9员工在EMR中将门诊产前护理的电子文档从18％（58/325）提高到85％。这个质量改进项目团队遇到的经验可以帮助其他人改进电子数据收集，以及在新兴的医疗保健系统中从纸质文件向电子文件的过渡。
方法：采取持续质量改进策略作为改进Mirebalais大学EMR数据收集的最佳方法。该团队使用了几种持续质量改进工具来进行此项目：（1）使用Ishikawa和Pareto图进行根本原因分析，(2)基线评价测量，和（3）计划-做-研究-行动改进周期，以记录增量变化和每个变化的结果。
结果：在2020年11月质量改进项目开始时，产前就诊的基线数据输入为18％（58/325）。10个月的改进策略导致EMR在每个月的护理点记录的平均89％（272/304）的产前检查。
结论：这个质量改进项目团队遇到的经验可以有助于在新兴的医疗保健系统中从纸质文档过渡到电子文档。成功的关键是拥有强大而敬业的护理领导，从纸质数据过渡到电子数据，并激励护理人员进行数据收集，以提高数据质量，因此，关于患者预后的报告。让护理团队密切参与EMR和质量改进流程的设计和实施，确保长期成功，同时将护士作为患者护理系统中的关键变革推动者。
