As part of a clinical nurse leader (CNL) capstone project, the primary investigator performed a gap analysis on hematology/oncology unit to determine the concerns staff had that prevented them from taking the best care they could of their patients. One opportunity that arose multiple times was that there was a lack of standardization when taking care of patients admitted with sickle cell disease (SCD).
One way that nurses can foster standardization of care is in the creation of smart notes (dot phrases) in the electronic health record, a relatively simple way to inform and guide care. In this project, a smart note was developed to guide nurses in writing their daily nursing notes for patients admitted with SCD. This smart note prompted nurses to answer a series of choices or yes/no questions and write an individualized note on the patient. This project was submitted to the Drexel University Institutional Review Board, protocol #2012008263, and was classified as “not human research determination.”
The primary investigator presented the smart note to nurses on the unit, who were shown how to toggle through choices. In addition, reminder stickers were placed on all nursing touchdown stations about how to access the smart note. The primary investigator ran reports from the EHR from February 1, 2020, through April 30, 2020, and from February 1, 2021, through April 30, 2021, to track the number of SCD ER visits and inpatient admissions. These reports contained information on the type of encounter (ER vs. inpatient), the admit date/time, the discharge date/time, admitting department, age, sex, admitting source (ER, outpatient clinic, or another facility), encounter diagnoses, admission diagnosis, inpatient readmission (yes or no), and inpatient/ER readmission (yes or no). These reports were exported as Excel spreadsheets so that the data could be sorted and tabulated more easily. In addition, reports were run to determine compliance in the utilization of smart notes by nurses.
The goal for this project was to see a 10% decrease in average LOS between 2020 and 20201; however, in comparing the same three-month time period in 2020 and 2021 for 7 Schiedt, the average LOS increased from 4.76 days to 5.05 days, representing a 6.09% increase, which did not support the hypothesis. It is difficult to draw specific conclusions from the study time period because during 2020 the COVID-19 pandemic began and health care systems were faced with incredible uncertainly, intense pressure on health care workers, and a lack of proper resources necessary to protect staff and treat patients. There were many variables that contributed to the overall results. However, staff and the primary nurse practitioner caring for this population appreciated its ease of use and amount of information that was included. Because standardizing care of patients with SCD was a major concern during the microsystem assessment, this first effort was deemed successful, and the use of the SCD smart note will be taught to other nurses who care for SCD patients in the hospital.