Computer linking

[4fill]

I have been an RN for several decades, and have been up and down the pecking order of positions in large metropolitan hospitals. I have always had my heart in ICU.

Currently I am working in a small rural hospital as staff ICU. Our hospital, and 3 others (plus a pharmacy to cover after hours orders) have just linked electronically with a computer system (MediTech). Now all four hospitals can exchange medical and financial information to make transferring between institutions smoother. I am very uncomfortable with the set up; not the day to day use. Though it's not nurse friendly I can work with it. (No choice)

I have several concerns:

(1.) Accuracy, narrative is not encouraged

(2.) time delays inherent in the system though in a court of law I'm sure all entities would cover themselves. Culpability of an off campus, 3rd party pharmacy hasn't been explained. They are a stand in pharmacy for 48 hospitals. The next step in the modernization is that the MD's will have access to clinical test results and be able to put in orders from any computer anywhere.

For the first time in my career I have purchased professional Liability Insurance (AACN -$114 with 2 million / 4 Million in coverage).

Am I just paranoid or is computer charting a positive. I know that if I were an "ambulance chasing medical lawyer" I would look hard at hospitals using computers. We have already been told that capturing charges is more difficult in a computer system.

An aside questions: Do MD malpractice insurance rates increase with a computer system

[MegNeoNurse]

I have always had computer charting, we were trained in this is nursing school. Our legal classes even discussed aspects of best charting practice in reference to computer charting. So I am speaking from a biased background. I've always been told never to double chart (e.g. Annotating that lung sounds are clear and equal bilat and also selection this option in the respiratory flow sheet) as this increases risk of inconsistencies and errors. Some nurses do not annotate at all for this purpose. If you have a charting system that is made for inpatient and specifically ICU you can get away with this. The unit I work in charts by exception: initial assessment fully charted, the subsequent assessments only chart changes. This was new practice for me from the unit I came from where we charted a full assessment every time.I am unaware of the increase in liability in computer charting vs paper charting. The institutions I've worked in are a large healthcare system with 5 different hospitals and many clinics in the city, and a large teaching hospital.Hope this input helps.

[gogrady]

I was trained in computer. Started my first job in paper and went through the process of switching to computer. Its a pain at first and there will be a lot of mistakes throughout the process but it is far better in my opinion that attempting to decipher a Docs hand writing or having to read off results to a doc when he can access them at home. Working night shift I still haven't been able to convince IS to open a secure SMS with doctors but I think this is something that we will see in the near future. Overall this is long overdue. We live in the 21st century. We need faster more accessible care. The generation of Neanderthals (mostly old docs who don't want to have to learn a new system) who refuse to change because "this is the way we've always done it" are a small minority. Unfortunately the squeaky wheel tends to get the most attention and slow down the machine as a whole. On the bright side these are mostly old docs and they will be phasing out one way or the other. I see the change as a good thing. As Winston Churchill once said, "To change is to improve. To change often is to be perfect."