AlayaCare App: 4- Linking Notes to their Shifts

AlayaCare is a software platform that is both browser based for the office staff, and with a mobile device app designed for use in the field by a team of nurses. An agency uses AlayaCare to complete its work: scheduling nurses, allowing nurses to document their work in real time, and then for the office team to coordinate payroll and claims based on the nurses work.

The app includes modules for recording vitals and documenting medication administration, as well as providing each agency the ability to fine tune shift notes, aka nurses notes, using its built in feature set.

The fields for some of the more crucial elements of a nurses note are added to the chart in other places, leveraging the electronic integration of the note to the larger chart, includeing links to specific shifts for which they provide care.

Examples: patient vitals recorded for the nurses note are accumulated into the patients chart, and can be viewed outside of the note using the VITALS module in the Care section of the shift. Similarly, Page 12 of the nurse’s note has one field, the Summary Narrative. As a written official record of the nurses shift, these narratives are also culled into a module called Progress Notes which allows all care team members access to the most up-to-date information about their patient from any shift.

The electronic “Nurses Note” in AlayaCare is a fully digital form that nurses complete for each shift. Notes are linked to the shifts electronically as they are completed, based on which shift the nurse has entered to complete the form..

When nurses first login, the current day’s schedule appears first; showing any shifts that are assigned for that day. The shifts appear as rectangular areas on the Schedule screen. Nurses must “tap through”, clicking on the rectangle for their days shift in order to do work there.

Nurses may review past shifts, preview upcoming shifts or start their current shift by selecting the shift entry that appears on the nurse’s schedule (the first screen to appear in the app, once logged in).

To move betwen shifts, the nurse must swipe within the Schedule view to move backward or forward in the schedule.

A Nurses Note is linked to the shift from which it is opened and submitted. If a nurse opens, edits and submits more than one note while entered into a single day’s shifts, all of those notes will be linked that that one shift.

When a nurse selects the FORMS module (from the tiled modeles in the CARE delivery section of the app), the nurse does so from within a designated and unique shift. This determines the link of the Nurses Note to the shift.

It is crucial, and cannot be understated, how important it is for a nurse to edit and save their notes from within the corresponding shift. Failure to do so will mislink the note, which may be challenged by state and federal authorities as a violation of established “real time” protocols..

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The Note covers the major measurements & recording practices for skilled nursing in the care of pediatric patients during their shifts.

To leave a note that is being edited or updated, then tosave it in draft mode and return to it later is a hallmark of a modern health care app. AlayaCare is built to facilitate the return to documenting after each medical administration or assessment. However navigating back and forth between modules can be confusing. Navigating between shifts requires additional steps.

When opening a saved draft, the Note always reopens on page 1. There is no way to easily jump to one section or another; a nurse must click “NEXT” in the lower right corner of the open note to move through the pages. This means that if the Summary Narrative is the last item to be completed, saving the write-up and continuing with new edits is cumbersome and frustrating for nurses.

To complete an unfinishd note AFTER a shift has passed, nurses must verify that they are viewing the patient’s chart from within the correct shift!.

It is critical for a nurse to remember is to save the note as a draft during the span of it’s being edited. When a tablet or smartphone running the AlayaCare app times out or goes to sleep, unsaved notes are lost. Period. There is no getting back data that is cleared from memory if it hasn’t been saved.

As med-sheets migrate from paper format to electronic documentation at Milestones in Home Care, nurses will need to be proficient in moving from the FORMS module to the MEDICATION module and back throughout the shift. Saving the draft note is part of this move from one module to the next.

Tech note: AlayaCare is working to include auto-save capabilities to the Progress Note and the Nurses Note form. We are constantly considering ways to help nurses complete their work more efficiently without compromising on precision in their documentation.

Acknowledging that nurses are challenged throughout their shift with complications both medical and technical, documentation sometimes has to be completed after a shift.

Sometimes there is simply not enough time to complete the written narrative or to update information during their shift, in which case, the note must be completed after the shift — ideally, as soon after the shift as is possible.

Nurses whose shifts are followed immediately by another shift, covered by another nurse, might need to reliquish the provided tablet on which the have started their documentation, but might not have finished. In these cases, synced data from the tablet will be readily available on their own smartphone or using a web browser from a laptop or desktop.

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If more than a day has passed before a nurse can complete their note, they MUST navigate to the correct day/date before they reopen the incomplete note. Failure to tap into the correct shift to complete a note will result in a mis-link.

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Again, a Nurses Note is linked to the shift from which it is opened and submitted. If a nurse opens, edits and submits a note for a previous shift, they must first navigate to that day/date and tap into the shift that corresponds to the note being completed. Otherwise, the note will be linked to the wrong shift.

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Saving a draft on the system — whether online or in offline mode — also records the timeing of those edits. This can help prove a nurse’s adherence to established protocols.

Tech note: AlayaCare is working to include auto-save capabilities to the Progress Note and the Nurses Note form. We are constantly considering ways to help nurses complete their work more efficiently without compromising on precision in their documentation.