NHS Grampian has unveiled new, streamlined patient admission paperwork.
The two-sided document – which has been based on feedback from patients and staff – is called the Nursing Admission Assessment Record and replaces the previous 18-page document.
It is now used for all in-patients, with the exception of mental health and learning disability services and maternity services.
Caroline Hiscox, acting director of nursing, midwifery and allied health professionals, said: “Record keeping is an essential part of professional practice.
“This ensures that essential information is captured and communicated to enhance the quality of care that we deliver.
“The problem identified by the nursing teams in Grampian was the requirement to document information was compromising the quality of assessment and conversation they were having with patients and their families.
“It sought to collect so much statistical information about a patient that we were missing the person.
“Nurses throughout the organisation have freely admitted that completing the form was becoming a ‘tick box’ exercise.
“Nurses will still record the information required and will enhance this by using their professional judgment to inform what they discuss with the patient.
“It looks at the whole person, not just the condition or illness.
“We are dedicated to offering completely person-centred care. This new process, along with initiatives such as our Welcome Wards, is proof of our commitment to this.”
Senior charge nurse Fiona Carnegie was one of the team who developed the new document.
She said: “The difference this has made to my team is amazing.
“They feel empowered and can really understand the person they are looking after.
“Much of the information collected by the previous document is already available in patient records. Instead of spending time getting people to repeat the same facts and figures, my nurses have got to know their patients.”
Ms Hiscox added: “Removing the requirement for nurses to collect information which we often already hold on our system allows the time to focus on the most important question – asking the patient what matters most to them.
“This could be family, their work, their pets or an important occasion they want to get better for.”