Improving Effectiveness and Satisfaction of an Electronic Charting System in Taiwan Hsiao-Yen Hsieh, DNP, RN n Richard Henker, PhD, RN, CRNA, FAAN n Dianxu Ren, MD, PhD n Wan-Yi Chien, BSN, RN n Jia-Ping Chang, MSN, RN n Lifan Chen, MSN, RN n Patricia K. Tuite, PhD, RN, CCNS Purpose/Objectives: An efficient but comprehensive documentation system is essential for reducing nursing workload and ensuring adequate time for direct patient care. A ‘‘focus’’ is a nursing diagnosis or patient problem. The purpose of this project is to review and revise the focuses in the electronic charting system and to develop new focuses for documentation of clinical pathways. In addition, this project evaluated the impact of these changes on time required for documentation and nurse satisfaction. Background/Rationale: In 2012, a large hospital in Taiwan implemented a self-developed electronic charting system that had 217 focuses in the database. Staff reported low job satisfaction and too much time on documentation. Three major issues were identified, including repetitious and redundant documentation, incorrect templates, and an incomprehensive database. Description: A clinical nurse specialist devised quality improvement project was implemented on one 50-bed surgical unit. Forty-one focuses were revised and 13 new focuses were developed for clinical pathways. The implementation of new focus templates enhanced evidence-based practice and prevented redundant documentation. Focus templates also incorporated nursing policies and/or patient education materials. Two outcome indicators, time spent documenting and nurse satisfaction, were evaluated 3 months after implementation. Outcomes: Documentation time decreased by 60% (from 138.5 to 55.8 hours) per week. The median documentation time per patient per day decreased from 18.4 minutes to 9.3 minutes. Average scores for satisfaction in usability, content, functionality, and effectiveness were increased. Conclusion: Evidence-based focus templates used for documentation can reduce documentation time and increase nurse satisfaction. Clinical nurse specialists play an important role in leading the development of quality improvement projects while improving work efficiency. KEY WORDS: clinical pathway, electronic nursing documentation, focus charting, satisfaction, time documentation A n accurate patient record is essential for ensuring clear documentation of the patient assessment and progress related to the implementation of care, pa- tient safety, and interdisciplinary communication. There are many nursing documentation frameworks that have been used for progress notes. Focus charting is one of the nursing documentation frameworks, which is similar to the ‘‘SOAP’’ note framework, and has been used inter- nationally. 1Y3 In the focus charting system, the ‘‘focus’’ is a nursing diagnosis that defines patient problems by sys- tematic assessment, and the process of care documented by the structure of data, action, response, and teaching (DAR or DART). 1,2 Focus charting is easily incorporated in- to the existing nursing process and helps to improve the standard of patient care and documentation. 2 Compared with paper-based records, electronic health records provide a more comprehensive patient assessment and improve the quality of documentation structure. 4 Whether the use of electronic record can improve patient Author Affiliations: Clinical Nurse Specialist and Head Nurse (Dr Hsieh); Professional Registered Nurse (Ms Chien); Associate Director (Ms Chang); and Director (Ms Chen), National Cheng Kung University Hospital, Tainan, Taiwan ROC; Professor, Department of Anesthesia (Dr Henker); Associate Professor, Center for Nursing Research (Dr Ren); Assistant Professor, Acute and Tertiary Care Department, and Coordinator, Adult-Gero Clinical Nurse Specialist Area of Concentration (Dr Tuite), School of Nursing, University of Pittsburgh, Pennsylvania. This research wad funded by National Cheng Kung University Hospital. The authors report no conflicts of interest. Correspondence: Hsiao-Yen Hsieh, DNP, RN, No. 138 Sheng Li Rd, Tainan, Taiwan 704, ROC (yan73921@hotmail.com). DOI: 10.1097/NUR.0000000000000250 Clinical Nurse Specialist A www.cns-journal.com E1 Clinical Nurse Specialist A Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved. Feature Article Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.