Date of Conferral



Doctor of Nursing Practice (DNP)




Eileen Fowler


Clinical documentation is an essential quality element that is often not adequately completed. Current data demonstrate that 32% of home health claims do not meet the requirements for federal reimbursement. Rogers's diffusion of innovation was used as a conceptual framework to guide this quality improvement project which determined whether home health nurses with education and chart audit experience demonstrate increased documentation compliance relative to nurses with education only. After completing a 1-hour education program on documentation, a convenience sample of home health nurses (n = 8) was divided between a chart-audit group (n = 4) and a no-chart-audit group (n = 4). Each nurse in the chart-audit group reviewed 4 charts for adequacy of documentation related to pain assessment, homebound status, and skilled nursing notes. Charts of all nurses who attended the education program were independently assessed for documentation compliance 3 weeks after they completed the chart audit session. Based on Fisher's exact test analysis, no significant difference in adequacy of documentation was noted between nurses who conducted chart audits and those who did not; however, all nurses in the audit group had adequate documentation compliance for pain, homebound status, and skilled nursing notes. Nurses with > 4 years in nursing charted more adequately than nurses with -?¤ 4 years in nursing, and nurses with -?¤ 4 years in homecare were found to chart more adequately than nurses with > 4 years in homecare. Staff participation in chart audits, as a quality improvement strategy, may improve compliance with documentation requirements.