The Risk of Documentation

I’m a horribly, great nurse.

First, the great part. I’m a workhorse. Anyone who’s been a nurse knows that some nurses are team players, easy to get along with and do more nursing than complaining. I take heavier workloads, volunteer for new admissions, help other teams, and my subordinates love working with me. I don’t leave them hanging and I share tasks with them fairly.

My patients love me and more importantly, my patients recover and become healthier under my care. I educate, I console, I encourage my patients. I feed, I massage, I entertain, I crack jokes, I cry with my patients. I heal and I nurse people back to health. I’ve been a nurse for nearly five years now and I can proudly say that I’ve nursed nearly three thousand people back to health during some of the toughest times of their lives.

I make the lives of physicians easy. I know when to call at one in the morning and when to let them sleep. I highlight important trends or symptoms that they should reconsider and suggest treatments or medications that they were planning to order anyway but might have forgotten at the moment. I pride myself in being a great team player and the liaison between patient, provider and clinicians.

Yet despite all this, I'am a horrible nurse. I have little patience for documentation and it’s pervasion of the nursing profession, and healthcare for that matter. Managers always hark that “if it’s not documented it was not done” and in a legal sense they’re right. But I won’t be the first to say that documentation degrades my care and if the first rule is ‘Do No Harm’ then what is the real enemy?

Documentation is repetitive, inefficient, and incentivized to protect against lawsuits. If the incentive is to protect against lawsuits, then there is no denying the propensity for erroneous or conveniently incomplete data. It’s easy to paint a picture of health with the documentation systems used today - every clinician who has ever checked a mundane checkbox has done it. Is there not a better way?

If you want to disrupt healthcare, strip away the layers of accountability to only the core that allows for adequate patient protection and the ability for nurses, physicians and other clinicians to practice freely, efficiently, without fear of reprisal.

When nursing first adopted electronic health recording (EHR), it changed the workflow in very fundamental (mostly positive) ways. EHR software, however, has bloated to seemingly protect against every possible adverse event within a hospital. Madness is when nurses spend 65% of their time documenting to protect themselves against the 1% chance of a specific adverse event.

As health tech innovation comes to the forefront, technologists could do well be examining the incentives surrounding healthcare. Identify the ones masked to protect patients and identify who the real beneficiaries are. To disrupt healthcare we may have to shift risks and accountability or risk staying on our current path.


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