To test the hypothesis that HANDS “big picture summary” can be implemented uniformly across diverse settings and result in positive RN and plan of care (POC) data outcomes across time.
In a longitudinal, multi-site, full test design, a representative convenience sample of 8 medical-surgical units from 4 hospitals (1 university, 2 large community, and 1 small community) in one Midwestern state implemented the HANDS intervention for 24 (4 units) or 12 (4 units) months.
1) RN outcomes - percentage completing training, satisfaction with standardized terminologies, perception of HANDS usefulness, POC submission compliance rate. 2) POC data outcomes – validity (rate of optional changes/episode); reliability of terms and ratings; and volume of standardized data generated.
100% of the RNs who worked on the 8 study units successfully completed the required standardized training; all units selected participated for the entire 12- or 24-month designated period; compliance rates for POC entry at every patient handoff were 78% to 92%; reliability coefficients for use of the standardized terms and ratings were moderately strong; the pattern of optional POC change per episode declined but remained reasonable across time; the nurses generated a database of 40,747 episodes of care.
Only RNs and medical-surgical units participated.
It is possible to effectively standardize the capture and visualization of useful “big picture” healthcare information across diverse settings. Findings offer a viable alternative to the current practice of introducing new health information layers that ultimately increase the complexity and inconsistency of information for front line users.
Keywords: continuity of care, plan of care, standardization, terminologies, electronic health record, interdisciplinary, nursing