Background Charting systems with decision support have been developed to assist with medication charting, but many of the features of these programs are not properly used in their clinical application. An analysis of medication error reports at LDS Hospital revealed the occurrence of error that should have been detected and prevented by decision support features if real-time entry at the bedside had taken place.

Objective Increase the real-time, bedside charting behavior of nurses.

Design A quasi-experimental before and after design.

Setting Two forty-bed surgical units, one of which served as the study unit, the other as control unit.

Intervention The study unit received educational intervention about error avoidance through real-time bedside charting, and twelve weeks of monitoring and performance feedback.

Measurements The real-time and bedside charting rates for the study and control units were measured before and after the intervention.

Results Before the intervention on the study unit, the real-time charting rate was 59%, the bedside rate was 40%. At the conclusion of a twelve-week intervention period the real-time rate increased to 73%, the bedside rate increased to 63%. Post intervention rates were 75% after eight weeks and remained at 75% after one year. Equivalent control unit real-time rates varied from 53% to 57% and bedside rates varied from 34% to 44% during the same intervals.

Conclusions Targeted educational intervention and monitored feedback yielded measurable improvements in the effective use of the computerized medication charting system and must be an ongoing process.