Research Article

Improving Nursing Documentation of STAT Medication Orders: A Quasi-Experimental Study in a Tertiary Care Hospital

Atiq Ur Rehman, Samina Iqbal Kanji, Rufina Soomro, Laila Aziz Rahimi, Mehtab Khan, Surriya Lazar, Khurram Wilson, Ali Muhammad, Anwar Ali Khan and Syed Mustansir Hussain Zaidi

Liaquat National Hospital and Medical College, Karachi, Pakistan

Submission:April 04, 2025; Published: June 12, 2025

*Corresponding author: Rufina Soomro Liaquat National Hospital, stadium Road. Karachi. Pakistan.

How to cite this article: Atiq Ur Rehman, Samina Iqbal Kanji, Rufina Soomro, Laila Aziz Rahimi, Mehtab K, et al. Improving Nursing Documentation of STAT Medication Orders: A Quasi-Experimental Study in a Tertiary Care Hospital. JOJ Nurse Health Care. 2025; 14(1): 555877.DOI:10.19080/JOJNHC.2025.14.555877

Abstract

Background: This study investigates inconsistencies in STAT medication documentation in a paper-based system, despite the timely availability of drugs, and identifies barriers to accurate record-keeping. Non-compliance with guidelines among medical and nursing teams highlights obstacles to accurate documentation.
Objective: To assess nursing documentation practices for STAT orders in a tertiary care hospital, one of the largest private healthcare facilities in Karachi, Pakistan, and evaluate the impact of an educational intervention.
Method: A quasi-experimental study was conducted to analyze nursing documentation practices before and after an educational intervention. Documentation was categorized as complete (all steps followed) or incomplete (at least one step missing).
Results: Among 200 nurses, 173 (86.5%) were diploma holders (GN), with 109 (54.5%) having ≤5 years of experience. Pre-intervention documentation accuracy was 69.1%, improving to 97% post-intervention. Completeness increased from 90% to 99%, with signature, date, and time documentation reaching 100%. Incorrect records (30.9%) were fully corrected (p < 0.001). GN nurses improved from 69.1% to 100%, while BScN and BSN nurses maintained high accuracy.
Conclusion: Educational interventions significantly improved STAT medication documentation accuracy in paper-based systems, benefiting healthcare organizations. Future research should explore long-term effects and broader applicability in various healthcare settings.

Keywords: STAT medication orders, nursing documentation, quasi-experimental study, paper-based systems, patient safety.

Introduction

Healthcare delivery is akin to a well-coordinated performance, where every aspect plays a crucial role in patient care. A medication order may be verbal, written, or electronic, directing the dispensing and administration of medication for specific medical indications. , , , STAT orders, derived from the Latin “statim,” meaning “immediately,” require urgent administration in response to acute symptoms and address urgent patient needs. Unlike scheduled or PRN orders, STAT orders demand immediate documentation to ensure patient safety and compliance with legal and regulatory standards.

However, the documentation of these orders often faces challenges, such as inaccuracies or delays, posing risks to patient safety and treatment efficacy. , , Understanding the significance of addressing these challenges, there is a critical need to examine stat order documentation practices, particularly among nursing staff. This exploration is vital for improving documentation accuracy, facilitating seamless communication, and ultimately enhancing patient care outcomes.

In the study setting, STAT medications are available in ward floor stock, eliminating delays in administration. However, a critical issue remains incomplete and inconsistent documentation. Nursing staff are required to document essential parameters—status (administered/done), date, time, and signature. Despite established guidelines, frequent deviations occur, posing risks to patient safety.

McNemar test was applied.
*Statistically Significant at p<0.05

Literature reviews, though limited, demonstrate the positive impact of certain interventions on improving the STAT ordering process. For instance, flagging STAT orders and establishing guidelines and even having a dedicated phone line between pharmacy and nursing stations for STAT orders.

Given limited literature on pre-and post-intervention documentation compliance, a pilot study was conducted.

The study aims to assess STAT order nursing documentation in a tertiary care hospital, identify documentation gaps, and propose corrective measures through an educational intervention.

Objective:

To evaluate the impact of an educational intervention on the completeness of STAT medication order documentation by nursing staff, following a predefined guideline (Standard Operating Procedure).

Methodology:

This quasi-experimental study was conducted at a tertiary care hospital in Karachi, Pakistan, over several months. Approval was obtained from the research ethics committee. Due to the lack of available literature regarding the pre-and post-educational intervention of stat order documentation, a pilot study of 19 subjects was conducted and based on pilot study findings (preintervention compliance of 57% and post-intervention 78%), a sample size of 106 STAT orders was determined using WHO software (95% confidence level, power = 90%).

Inclusion Criteria:

• Registered nursing staff from non-critical care areas.

Exclusion Criteria:

• Intensive care units and emergency departments.
• Non-registered nursing staff, including aides and technicians.

A STAT order was defined as “an urgent medication order requiring immediate administration. The documentation was evaluated based on adherence to four key parameters: status, date, time, and nurse’s signature. Data was collected from patient treatment sheets before and after the intervention using a standardized tool. SPSS version 25 was used for analysis, with McNemar’s test applied to compare pre- and post-intervention results (p-value ≤ 0.05).

Results:

Among the 200 participating nurses, 86.5% were General Nurses (GN), 9% held a Bachelor of Science in Nursing (BScN), and 4.5% had a BSN degree. Regarding experience, 54.5% had ≤5 years of experience, while 45.5% had >5 years.

Post-intervention, documentation accuracy significantly improved from 67% to 97%. Status documentation improved from 90% to 99%, signatures from 96.5% to 100%, dates from 92.5% to 100%, and times from 87.5% to 98% (p < 0.001).

GN nurses improved from 67.1% to 100% (p < 0.001), while BScN and BSN nurses showed high initial compliance with minor increases. Nurses with ≤5 years of experience improved from 79.8% to 100%, and those with >5 years from 55.3% to 100% (p < 0.001).

Discussion:

The importance of structured documentation and training is well established, and our findings align with previous research emphasizing structured training in improving medication safety Abdelaziz et al [1]and Maulana emphasized enhanced documentation along with incident reporting increases patient safety . Similar improvement has been observed with automated dispensing machines and computerized order systems Shulman et al [2], yet this study demonstrates that training alone can significantly improve compliance in paper-based systems improving accuracy from 67% to 97%.[3]

Verbal STAT orders remain a source of error and potential to compromise patient safety and their complexity increases the risk of miscommunication but this study shows that standardization mitigates risks. Although electronic documentation has shown some advantages [4] , but there are challenges in adaptation and training, and one has to decide which system is better . Our study demonstrates that with proper training paper-based documentation can achieve a comparable level of accuracy [5]. Our results also align with Ross [6], who emphasized the role of clear standing orders in reducing documentation errors.

Our study also supports the need for clear protocols for “asneed” or urgent medication documentation. Gordon identified risks related to PRN orders, and emphasized the importance of precise opioid documentation [7], reflects similar to our structured SOPbased format. Sarki et al highlighted that standard protocols can reduce insulin-related errors through systematic documentation that is supported our study. Reduced turnaround time for STAT medications improves therapeutic outcomes and staff satisfaction findings echoes with our findings [8]. Patients’ safety and quality is important and drug administration protocols should be practiced and monitored . For this proper guideline should be implemented to improve nursing documentation Continuous monitoring is critical, as compliance improves with real-time data tracking. A principle our study embraced of increasing patient safety by proper documentation and monitoring of STAT orders [9],

While electronic documentation may be an ideal long-term goal, this research highlights the effectiveness of structured training within resource-limited, paper-based systems. [10] Future research should examine the sustainability of these improvements across multiple institutions and investigate the transition to electronic documentation to further optimize compliance.

Conclusion & Recommendations:

A structured educational intervention significantly improved STAT medication documentation, with compliance rising from 67% to 97%. Healthcare institutions relying on paper-based documentation should implement similar training strategies to enhance accuracy and patient safety.

Future Research:

• Long-term impact analysis of educational interventions.
• Feasibility of transitioning from paper-based to electronic documentation.

Ethical Considerations:

• Participant confidentiality was maintained.
• Informed consent was obtained from all nursing staff.
• Data was securely stored and accessible only to authorized researchers.

Significance of the Study: This study contributes to improving nursing documentation practices, ultimately enhancing patient care, legal compliance, and communication within healthcare teams.

Observation and Result

In this study, a sample size totaling 50 to 70 participants was included, and a questionnaire focusing on the awareness of healthcare services was distributed. The responses gathered are as follows (Tables 1-4):

The survey results provide intriguing insights into the healthcare behaviors, preferences, and satisfaction levels among young adults aged 18-50 within the community. Notably, the demographic breakdown revealed a predominantly young adult population, with males slightly outnumbering females, constituting 60.3% and 38.4% of the participants, respectively. This demographic composition reflects a substantial representation of the youth demographic, offering a pertinent glimpse into this specific age group’s healthcare engagement.

Of particular interest is the high rate of healthcare utilization observed among the surveyed participants, with an overwhelming 90.4% reporting visits to healthcare providers within the past year. This finding underscores the significance of healthcare services in the lives of young adults, indicating a proactive approach to managing their health and seeking medical attention when needed.

Further analysis of the types of healthcare services accessed by the participants reveals diverse patterns of healthcare utilization. Half of the respondents opted for hospitals or clinics, highlighting the significance of primary care settings in meeting young adults’ healthcare needs. Additionally, a notable proportion utilized pharmacy services (22%), consulted specialists (11%), or accessed a combination of these services (16.4%). This diversity in healthcare utilization suggests a multifaceted approach to managing health concerns, with individuals seeking services tailored to their specific needs and preferences. The satisfaction levels among the surveyed participants reflect a generally positive outlook towards the healthcare services received. A substantial 61.6% expressed satisfaction, with an additional 28% indicating a high level of satisfaction. While a minority remained neutral (9.6%), the overall satisfaction rates underscore the effectiveness of healthcare services in meeting the expectations and needs of young adults within the community.

Moreover, the survey findings highlight a commendable level of awareness regarding preventive healthcare services among the respondents, with 76.7% indicating awareness of available preventive healthcare services in their area. This awareness underscores a proactive approach to healthcare management, with young adults recognizing the importance of preventive measures in maintaining their well-being and health. The survey results offer valuable insights into the healthcare engagement, preferences, and satisfaction levels among young adults aged 18-20 within the community. The findings underscore the significance of healthcare services in the lives of young adults, revealing patterns of utilization, satisfaction levels, and awareness of preventive healthcare services. These insights provide a foundation for informed decision-making and targeted interventions aimed at enhancing healthcare access, quality, and satisfaction among young adults in the community.

Conclusion

The active engagement of young adults in seeking and utilizing healthcare services within their community is a promising indicator of a proactive approach to health management. Hospitals and clinics serving as the primary destinations for these individuals suggest a level of accessibility and trust in the local healthcare infrastructure. The high satisfaction rates among these young adults signify that the services provided meet their expectations and likely address their healthcare needs effectively. This satisfaction is crucial for maintaining a positive attitude towards healthcare and encouraging continued utilization of services when needed

The elevated awareness about preventive healthcare services among young adults is particularly encouraging. It indicates that public health messages are effectively reaching this demographic, potentially through targeted campaigns, educational initiatives, or digital platforms tailored to their preferences. By being proactive about their health through preventive measures, these individuals are laying the groundwork for better long-term health outcomes. This trend not only benefits the individuals themselves but also contributes to the overall health and well-being of the community. As young adults take advantage of preventive services, they are likely to reduce the burden on healthcare systems by preventing or mitigating the onset of illnesses and chronic conditions. Furthermore, the success of these efforts reflects positively on healthcare providers and stakeholders within the community. It underscores their commitment to delivering accessible, highquality healthcare services and their ability to engage effectively with the younger demographic. Overall, the active participation of young adults in healthcare services, coupled with high satisfaction and a focus on prevention, bodes well for the community’s health awareness and future health outcomes. It highlights the importance of continued investment in preventive healthcare initiatives and underscores the potential for positive change when individuals are empowered to take control of their health [1-16].

Contribution to SDG

i. Promotion to healthcare awareness.

ii. SDG (Sustainable Development Goal) No: SDG 3.

iii. Reason/s: The reason why it’s SDG 3 is because this goal specifically targets health issues.

iv. It aims to ensure everyone has access to good healthcare services and promotes well-being for all at every stage of life. Your project aligns perfectly with this goal!.

References

1. Abdelaziz H, Richardson S, Walsh K, Nodzon J, Schwartz B (2016) Evaluation of STAT medication ordering process in a community hospital. Pharm Pact (Granada) 14(2): 647.
2. Shulman R, Singer M, Goldstone J, Bellingan G (2005) Medication errors: a prospective cohort study of hand-written and computerized physician order entry in the intensive care unit. Crit Care 9(5): R516-21.
3. Wakefield DS, Wakefield BJ (2009) Are verbal orders a threat to patient safety? Qual Saf Health Care. 18(3):165-168.
4. Wakefield DS, Ward MM, Groath D, Schwichtenberg T, Magdits L, et al. (2008) Complexity of medicatin-related verbal orders. Am J Med Qual 23(1): 7-17.
5. Niaz Khani Z, Pirnejad H, van der Sijs H, Aarts J (2011) Evaluating the medication process in the context of CPOE use: the significance of working around the system. Int J Med Inform 80(7): 490-506.
6. Ross J (1998) Clarity needed on standing orders. Nursing New Zealand 4(5):11.
7. Abdelaziz H, Richardson S, Walsh K, Nodzon J, Schwartz B (2016) Evaluation of STAT medication ordering process in a community hospital. Pharm Pract 14(2): 647.
8. Gordon DB, Dahl J, Phillips P, Frandsen J, Cowley C, et al. (2004) American Society for Pain Management Nursing, American Pain Society. The use of "as-needed" range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Society for Pain Management Nursing and the American ain Society. Pain Manag Nurse 5(2):53-8.
9. Donihi AC, DiNardo MM, DeVita MA, Korytkowski MT (2006) Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin. Qual Saf Health Care 15(2): 89-91.
10. Tiersten D (1983) The "stat" problem. Clin Lab Med 3(3): 499-507.