How a Time Discrepancy Changed Nursing Practice

Monday, 31 October 2011

Denise P. Cedeno, BS, RN, PCCN
Seton 1 Telemetry, Our Lady of Lourdes Memorial Hospital, Inc, Binghamton, NY

Learning Objective 1: Describe how quality improvement facilitates nursing practice.

Learning Objective 2: Explain how evidence-based practice improves patient outcomes.

During a routine audit, we identified an opportunity for improvement related to documentation of time. The auditor asked, “How can blood be picked up from the Blood Bank at 8:00 am and the transfusion started at the same time?”  Focusing on transfusions, a chart audit revealed multiple documentation discrepancies, especially related to time. A survey of staff showed that some wore watches, but most did not. Others used their cell phones or the clocks in patients’ rooms, which were not synchronized. 

A quality improvement study was conducted over two weeks to answer the question, “What time is it?” The unit’s atomic clock was used as the benchmark. Baseline data showed that 64% of staff answered incorrectly, and 36% correctly. Staff with the wrong time had no watch, while those with the right time did have a watch. All staff then was asked to synchronize their watch or other time piece with the atomic clock in the nursing station at the beginning of each shift and a poster was placed in the nursing station to reinforce this education. 

At the end of two weeks, 44% of staff still answered incorrectly, but 56% answered correctly and 60% of staff now uses a watch synchronized with the atomic clock to document time. The accuracy of time is important not only for transfusions, but also for all time sensitive documentation. This simple quality improvement project has grown into a hospital-wide initiative to improve the accuracy of documentation and eliminate discrepancies.