Nursing Information Management Assessment Form

Nursing Information Management Assessment Form
Use this form to assess nursing information management practices, workflow quality, system use, and improvement needs.
Respondent Profile
Job Title / Role in Nursing
Nursing Unit / Department
Years of Nursing Experience
Work Setting / Facility Type
Current Information Management Practices
Primary documentation method/system used
Other
How often are patient charts updated?
Handoff/reporting process used
Other
Typical sources of patient information
Other
Assessment of Data Quality and Workflow
Rate the quality of nursing records
Rows Very Low Low Moderate High Very High
Accuracy
Completeness
Timeliness
Accessibility
Consistency
How often do these issues occur in nursing records?
Rows Never Rarely Sometimes Often Very Often
Duplicate entries
Missing data
Delayed entry
Unclear or hard-to-read records
How severe is the workflow impact of these issues?
Rows No Impact Minor Moderate Major Critical
Duplicate entries
Missing data
Delayed entry
Unclear or hard-to-read records
Which data quality problem is most common in your nursing records?
Other
Which workflow areas are most affected by data quality issues?
Other
System Use and Access
System name or type
Access method
Other
Frequency of use
Overall usability rating

1
2
3
4
5
6
7
8
9
10
1 is Poor, 10 is Excellent
Training, Support, and Improvement Needs
Have you completed training on the current information system?
Preferred training format
Top improvement priorities
Other
How confident are you in using the information system for your daily work?
Should be Empty:

Select theme:

Rows	Very Low	Low	Moderate	High	Very High
Accuracy
Completeness
Timeliness
Accessibility
Consistency

Rows	Never	Rarely	Sometimes	Often	Very Often
Duplicate entries
Missing data
Delayed entry
Unclear or hard-to-read records

Rows	No Impact	Minor	Moderate	Major	Critical
Duplicate entries
Missing data
Delayed entry
Unclear or hard-to-read records

Nursing Information Management Assessment Form

Respondent Profile

Current Information Management Practices

Assessment of Data Quality and Workflow

System Use and Access

Training, Support, and Improvement Needs