PubMed · 1919759
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M Knapp, J Hollander. Simplifying documentation: a nursing care plan format.. https://pubmed.ncbi.nlm.nih.gov/1919759/
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A continuous quality improvement (CQI) project focused on documentation within the Newborn Intensive Care Unit (NICU) at Primary Children's Medical Center. The task force developed and implemented an interdisciplinary patient care documentation system that reduces duplication, increases compliance, improves communication and is fiscally responsible.
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Greater efficiency and ease of use results when nurses use an admission assessment form that is integrated with patient care outcome standards. Steps in developing such a focus are described.