Although the aim of hospitalization is to treat acute and critical illness, a lot of time and expertise is spent protecting patients from complications. In an ideal world, health care teams would implement treatment plans that are based on reliable evidence and understand the connection between their actions and patient outcomes. In such a world, an efficient electronic health record would ease the work of documenting proactive care.

Unfortunately, we do not work in an ideal world. Sometimes we must select interventions without sufficient evidence. In addition, documentation is often cumbersome. The gap between the ideal and the real is evident in Pittman et al’s finding that even when nursing documentation demonstrated appropriate preventive care, hospital-acquired pressure injuries (HAPIs) still occurred. Using a valid and reliable tool as an objective measurement, the authors found that 41% of HAPIs in their study were unavoidable....

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