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ACTIONS FOR POLICY AND IMPLEMENTATION

• Evaluation data from 260 residents, visitors and residential aged care staff over 2 years evaluated an aged care digital documentation system, co-designed with nurses and care workers
• Key findings indicated improved quality and efficiency. The quality of person focused documentation improved from 30% to 90%; nurses spent 6% less time searching for information, 15% less time on documentation and cut their walking distances per shift by 25%.
• The ACE digital documentation system led to reduced wasted time and more time on individualised care.

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Associate Professor Kasia Bail
Associate Professor Bernice Redley
Distinguished Professor Diane Gibson
 

Faculty of Health, University of Canberra

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RESEARCH CONTEXT

Documentation is often cited as the ‘least favorite’ task of staff in aged care, and can be compounded by duplication of items, inaccessible formats and locations, and the sense of doing more ‘paper-focused care’ rather than ‘person focused care’.  A recent study by the University of Canberra evaluating a new, co-designed aged care ecosystem (ACE) has found that using an implementation process which involved ground-level staff to create the system was highly valued by staff and residents. 

The independent mixed-method evaluation found ACE was easy for staff to learn, use and navigate, and resulted in less time spent on ‘waste’ activities such as searching for information or documenting. Nurses (RNs & ENs) spent a mean of 6% less time on ‘hunting and gathering’ activities and the distance they travelled (steps) per shift reduced by 25%. Care workers spent 10% less time multitasking which helps to reduce their cognitive load. Nurses spent less time on documentation: reduced from 20.4% of their time to 6.4%. With the additional reduction in time saved on ‘hunting and gathering, the mean time saved by nurses following implementation of ACE was approximately 20%, time reinvested into more time with residents.

While time spent on documentation decreased, the quality of documentation improved across legibility, completeness and accessibility. ACE implementation was associated with increases in completion of: resident assessments (68%-96%); documentation of the nursing process (55%-94%); resident-focussed goal setting (56%-88%), and nursing evaluations of care (31% to 88%). The overall quality of resident care increased, with staff reporting being able to spend more time with residents; more able to respond to individual resident needs; and better equipped able to manage the ‘delicacies of dignity’.  

Digital systems in aged care are often considered laborious, imprecise, counter-intuitive and lacking in person-focussed details. The improvement in both quality and completeness of documentation, coupled with time savings achieved by using ACE is an important advance on earlier forms of electronic-based health records for residential aged care. This new research found that staff from a variety of backgrounds and with different digital skill levels were able to use the new ACE with relatively short training thereby reducing a major cost barrier to uptake. The many positive findings highlighted by this evaluation, and their potential for genuine improvements in the residential aged system, are particularly significant in the context of the Royal Commission into Aged Care Quality and Safety, and the Federal Government response in the May Budget.

Acknowledgements to all research team members Eamon Merrick, Karen Strickland, Bridget Smith, Alicia Hind, Beatric Vann, Natasha Jojo, Catherine Paterson and the Jindalee staff especially Joana Fernando, Chris Lemon, and Pam Bondfield.

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