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

Area of Science:

• Nursing informatics
• Healthcare management
• Patient safety

Background:

• Electronic data are increasingly utilized for monitoring healthcare protocol compliance.
• Limited understanding exists regarding the impact of electronic data on nursing practices in hospital settings.

Purpose of the Study:

• To investigate the effects of using electronic data for performance management on nursing adherence to protocols.
• To explore how electronic monitoring influences nurses' practices and decision-making.

Main Methods:

• Semi-structured interviews were conducted with 17 acute hospital nursing staff.
• The study focused on compliance with an early warning score (EWS) protocol delivered via a bedside electronic handheld device.

Main Results:

• Nurses previously balanced protocol adherence with clinical judgment, sometimes omitting observations at night.
• Introduction of electronic compliance monitoring led to covert omission of observations via loopholes, despite acknowledging the EWS's utility in detecting patient deterioration.
• Staff reported a loss of autonomy.

Conclusions:

• Automated electronic systems can reduce nursing workload but may hinder the recording of valid reasons for missed observations, potentially leading to covert resistance and reduced patient safety.
• Integrating functionality for logging legitimate reasons for missed observations is crucial for nurses to reconcile professional judgment with electronic performance management, thereby enhancing patient safety.