Title : The “record closing”, a concept for the benefit of nursing thinking, clinical management and quality improvement for patients
The Nursing Direction of the “Centre Hospitalier de Luxembourg” organized a nursing research project around innovation in nursing practices for hospital service organizations: the record closing.
The purpose of this project is:
• To generate the self-criticism of the professional and make him or her responsible for the care of patients through the writings in the nursing files
• To move from the notion of nurse responsibility to the notion of nursing team responsibility
• To standardize care plans by clinical picture
• To develop a safety culture
• To anticipate skills, and be an actor in the training objectives of the team
• To drive towards multidisciplinary responsibility
• To validate that all the activities of the nursing project are well completed and that the set objectives are well achieved and thus ensure that the team has responded to the expectations and needs of the patient, to the promised quality.
• To capitalize on the differences detected in the record closing
To date, this project is a real asset and brings out many added values for the benefit of patients and the professional development of our teams.
It has enabled a professional transformation of our managers within our institution leading them to ensure and assume managerial responsibility but also to develop a local clinical management. The managerial position of the head of unit around this innovative project contributes to empower each team member individually and collectively in his self-criticism. It is conducive to ethical reflection, creativity and the development of professional talent.
It is also part of a quality improvement process and allows measuring the gap between the desired quality and the delivered quality and the difference in perception: lived quality and delivered quality.
The record closing is one of the key tools that helped to achieve the accreditation of our institution according to Joint Commission International standards.