Dealing With Trauma Flow Sheet Documentation Problems

Over the years, I’ve commented a number of times on paper vs electronic trauma flow sheet. For those of you who somehow missed it, let me recap. Don’t use an electronic trauma flow sheet yet if you can possibly avoid it!

I look at the flow sheet as having two phases, input and output. The input phase occurs as data is being recorded on the sheet, hopefully in real time as events occur during the trauma resuscitation and its aftermath. The output phase consists of a human reviewing the completed flow sheet and analyzing the events and timing for performance improvement (PI) purposes.

The electronic trauma flow sheet has major problems in both phases. But the good, old-fashioned paper sheet isn’t perfect either. It is subject to problems during the input phase. The most common issue is incomplete documentation. I’ve seen so many trauma programs with ongoing issues in this area, and they struggle to find ways to improve or eliminate the missing data.

Here are a few tips you should consider:

  • Make sure your paper flow sheet is well-designed. Data items should not be scattered randomly over several pages. Primary survey items should be grouped together. Medications must have their own block. Diagnostic tests performed (not ordered) should be in the same area. Make sure that the narrative block that typically has vital signs and free-form text about what is happening is large enough, with enough room to write comfortably. There are so many good trauma flow sheets out there already. Borrow a few to see if your program can adopt some of the organizational concepts found on them.
  • Identify the commonly incomplete items at your program, then redesign the flow sheet to cluster them together in one prominent spot on it. Common missed items include patient temperature, time of diagnostic tests, and admitting destination  and time the patient leaves the emergency department.
  • If you have only a few problem data points and don’t want to totally redesign your form, manually highlight those blocks with an old-fashioned highlighting pen. This only works if you are highlighting a few items. Any more than two or three, and the scribe will start to ignore all of them. The fancy colored blocks will draw the eye and remind them to ask for the data.
  • Perform an accuracy review of the sheet soon after the resuscitation, ideally before the end of the nursing shift. And since the scribes are typically emergency nurses, it should be their responsibility. Not the trauma program’s. The ED nurses should take responsibility for their own work, and develop their own program to self-correct any deficiencies.

Do you have any suggestions or best practices that have worked for you? Please comment or tweet!

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