How to Optimize Integrated Patient Progress Notes: A Multidisciplinary Focus Group Study in Indonesia

Journal of Multidisciplinary Healthcare Dovepress open access to scientific and medical research Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 118.243.144.70 on 26-May-2020 For personal use only. Open Access Full Text Article ORIGINAL RESEARCH How to Optimize Integrated Patient Progress Notes: A Multidisciplinary Focus Group Study in Indonesia This article was published in the following Dove Press journal: Journal of Multidisciplinary Healthcare Hajjul Kamil 1 R Rachmah 1 Elly Wardani 1 Catrin Björvell 2 1 Nursing Leadership and Management Department, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia; 2Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Introduction: Hospitals in Indonesia are obligated to implement Integrated Patient Progress Notes (IPPNs), also known as the “Catatan Perkembangan Pasien Terintegrasi”. A progress note contains the entire interaction between patients and health professionals, including physicians, nurses, pharmacists, dietitians, and physiotherapists. However, since the first launch in 2012, obstacles and problems in completing this integrated documentation remains nationwide. Aim: The objective of this investigation was to identify health professional’s perspectives on obstacles and problems using IPPNs and facilitators that may optimize their use. Methods: Five focus group discussions (FGDs) involving 37 participants took place. All FGDs were recorded, translated, and transcribed verbatim. A thematic analysis was used to interpret the data. Results: The thematic analysis of the material revealed three main categories for each of the two topics; Topic 1. Perceived problems hindering integrated documentation: lack of supervision, competence, workload; topic 2: perceived strategies to optimize integrated documentation: organizational support, joint practices, integrating technology with IPPN. Conclusion: The results indicate that health professionals see the importance of using IPPNs but only if implemented with educational and organizational support and that the use of an electronic patient record may be more effective than a paper record. To continue the implementation of IPPNs, it is suggested that it is preceded by educational and organizational support. Keywords: integrated documentation, Indonesia, patient report, safety, service quality Introduction Correspondence: Elly Wardani Nursing Leadership and Management Department, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia Email 1 submit your manuscript | www.dovepress.com Journal of Multidisciplinary Healthcare 2020:13 1–8 DovePress © 2020 Kamil et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://doi.org/10.2147/JMDH.S229907 Powered by TCPDF (www.tcpdf.org) Introducing care coordination as a health reform means essentializing communication and increasing interactions between health professionals. Multiprofessional communication is necessary to avoid or at least minimize misinformation, maintain coordination, and improve care management.1 It is acknowledged that proper documentation in the patient’s health-care record has larger significance than simply recording the history. The patient’s health-care record is the main communication medium between health-care professionals, helping them to deliver a high quality of care. The importance of proper documentation in the health-care setting has been noted for centuries. Florence Nightingale mentioned how meticulous patient documentation is tightly linked to a high level of health-care quality. A collection of data and information that Nightingale analyzed at that time provided evidence linking cleanliness to the number of preventable deaths in health-care settings.2 Dovepress Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 118.243.144.70 on 26-May-2020 For personal use only. Kamil et al Although the importance of health-care documentation has been identified, communication problems across healthcare disciplines still exist. In 2005, Joint Commission International3 reported that 90% of unanticipated events not related to the patient’s illness that resulted in death or serious physical or psychological injury to the patient were due to breakdowns in communication between health-care professionals. It is difficult to deliver a high quality of care without a transparent, uniform system of health-care documentation; hence, this is one of the hospital accreditation criteria set out by the Hospital Accreditation Commission of Indonesia (Komisi Akreditasi Rumah Sakit [KARS]). Integrating health professionals’ patient progress notes were viewed as a solution to bridge this information gap, minimizing communication barriers between health-care providers and hence decreasing unexpected or accidental events.4 In response to this, KARS introduced the “Catatan Perkembangan Pasien Terintegrasi”, referred to here as the Integrated Patient Progress Note (IPPN). This was a manifestation of a patient-centered care initiative aimed at increasing the quality of documentation in general and to minimize communication barriers between health-care providers. IPPNs required health professionals to document patient progress notes on the same sheets in the same part of the patient’s health record. The IPPNs contained chronologic documentation of the entire interaction between the patient and health professionals, including physicians, nurses, pharmacists, dietitians, and physiotherapists. KARS obligated all hospitals to implement IPPNs in 2012. Efforts that have been made to optimize its implementation include socialization programs through training provided by KARS’s certified national surveyors, benchmarking of provincial hospitals against national health centers, or an assistance program whereby the surveyors assisting hospitals with the introduction of IPPNs and how to complete the form correctly.5,6 Despite all the hard work, the implementation has been a dynamic process involving multiple health-care teams.5,6 The aim of IPPNs was to synchronize care between providers, but the documentation still did not describe collaborative practices among health professionals. In an audit by Noorkasiani et al,7 the completion of the IPPN documentation was shown to be poor. For example, it was found that only 60% of the n (...truncated)