Improving Respiratory Therapy Compliance With Use of Secure Chat in Electronic Health Record

Background: The purpose and primary benefit of healthcare compliance is to improve patient care. Noncompliance leads to poor outcomes. Challenges to implementing a new process include education of staff, ability of staff to remember to implement the new process, and engaging staff to initiate process. Cuff inflation device education was provided in June and again in July for all patients with inflated cuffs in the PICU and CTICU. Despite repetitive education on the use and documentation of a cuff inflation device, respiratory therapists (RTs) continued to have poor compliance with implementation and documentation of the device with 23% compliance in June and 21% compliance in July. The purpose of this project was to determine if the use of real time follow-up through the electronic health record (EHR) chat feature would improve compliance with policy and documentation regarding cuff inflation device use. Methods: Every Tuesday/Friday live chart review at 0500 and 0900 from 08/2021 through 12/2021 followed by secure chat with RTs through the EHR. Assigned staff noncompliant with use of cuff inflation device/documentation on eligible patients were followed up with in real time through secure chat in EHR. Number of cuffed endotracheal tubes was identified through EHR report. Results: 253 cuffed endotracheal tubes in PICU/CTICU were identified between 7/1/2021 and 12/31/2021. Follow-ups required for non-compliance (n = 65). 95.4% (62/65) responded back via EHR secure chat within 20 min of receiving the chat message. 4.6% (3/65) responded back between 20 min and 2 hours (average = 1 hour). All situations requiring follow-ups were considered non-compliant. Compliance with use of cuff inflation device/documentation occurred during the same shift after return chat message. Average time to compliance was 1 hour from return chat message. Over the first few months the number compliant increased as follows: August = 23/56 (41.1% compliance), September = 36/58 (62.1% compliance), October = 39/46 (84.8% compliance), November = 49/52 (94.2% compliance), December = 41/41 (100% compliance). This represents an increase incompliance of 143.1% from August 2021 to December 2021 (P = .029) Conclusions: Over time the compliance with cuff inflation device and documentation went from 41.1% in August to 100% in December, a 143.1% increase in compliance, and 100% compliance in January. Real time use of chat to remind staff of policy requirements can increase compliance with equipment and documentation.