Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Joyce Brettner


Doctor of Nursing Practice


Purpose: A clinical documentation improvement (CDI) project was aimed at improving emergency department (ED) registered nurses (RN) and techs documentation of blood and urine specimen collection using electronic health record (EHR) specimen collection documentation (SCD) flowsheets.

Methods: ED RNs and techs were provided with SCD flowsheet CDI training using video, tip sheets, and in person support. The Plan Do Study Act (PDSA) framework was utilized to monitor iterative change over time and reinforce training. At baseline and during each of the three PDSA cycles, data was collected to evaluate blood and urine SCD. To reinforce documentation in the SCD flowsheet, the ED nurse manager communicated importance of accurate documentation, tip sheets were replenished in the ED, and in-person support continued.

Results: Of 46 participants, 37% viewed the training video and 70% received in-person support. Documentation in SCD flowsheets increased by 16% overall for blood and urine SCD; blood increased by 17% and urine by 15%. Although documentation in the SCD flowsheet increased, accuracy of documentation did not improve for blood collection whereas it did for urine collection.

Conclusion: SCD flowsheet CDI efforts improved documentation of blood and urine specimen collection in SCD flowsheets. Most participants indicated training methods were effective, especially in-person support. Feedback from participants about documentation indicated EHR enhancements to the SCD flowsheet would improve accuracy of blood collection documentation. Continued CDI in the ED has the potential to impact nursing practice through improved data collection. Improved data collection has implications for monitoring patient outcomes and increasing revenue.

Available for download on Saturday, July 27, 2024