Abstract:
Background: The widespread adoption of Electronic Patient Record (EPR) Systems in neonatal units has resulted in improved accuracy of documentation, more efficient storage and retrieval of patient data, and has the environmental benefit of reduced paper use. At a tertiary neonatal unit in London, UK, an electronic patient care record system was in use for daily clinical documentation. However, patient growth continued to be documented on paper growth charts. This quality improvement project (QIP) aimed to demonstrate that use of the electronic growth chart function on the EPR would not result in a deterioration in the quality of growth data.
Methods: The medical team were provided with written instructions on how to plot weight and head circumference (HC) using the EPR, and asked to do this as well as continue the normal practice of plotting on the paper growth chart once a week. Growth chart data was then analysed from a 4 week period for all babies who had been admitted for the duration of the study period. After further education and implementation of the use of electronic growth charts only, the growth data was analysed again 6 weeks later.
Results: 19 patients were included in the first audit cycle. Electronic growth charts had more data points plotted for weight than paper growth charts, in all cases (average 6.3 vs 3.4). Paper growth charts were more likely to have long intervals (>7 days) between data points for both weight and HC. 9 patients were included in the second audit cycle, which included electronic growth charts only. The number of data points for weight was the same as during the first audit period (average 6.3). The number of data points for HC was improved compared with the first audit period (average 2.7 vs 2.3). The greatest time interval between data points was improved for weight (average 7.1 days vs 7.5 days in the first audit cycle), but worse for HC (12.4 days vs 8 days in the first audit cycle).
Discussion: This QIP demonstrated that use of electronic growth charts was not inferior to the use of paper growth charts. What more, transitioning to electronic growth charts resulted in more growth data being plotted, more accurate plotting of growth parameters, and the unification of patient data. This leads to more precise digital records of weight for prescribing purposes, better availability of historic growth data post-discharge, and the ability to continue plotting growth data in the same place in the outpatient setting. Further education of the team is likely to result in more regular documentation of growth parameters such as HC. This work can be translated to other neonatal units where there is hybrid use of paper and electronic documentation systems.
