EHRs stink!

Nurses General Nursing

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Specializes in LTC Rehab Med/Surg.

My small rural hospital has transferred to totally electronic charting. Implementation started about 3 months ago, and was completed about a month ago. I feel like my license is in jeopardy.

Med errors are shocking. Nothing critical, but an error is an error.

Nurse notes are inadequate simply because we have no time. I know. I know. It's my responsibility. No time / is no excuse. I need to take as much time as necessary to chart competently. The thing is charting is left til the end of the shift because everything else has to be done within time parameters. By the time I can chart, I'm physically and mentally used up.

Ancillary staff is entering VS, I & Os. CNAs are entering their own notes.

I don't have time to double check everybody elses' work because it takes 14 hrs to do my own.

I leave work and I absolutely know I've not covered my butt as I used to do with paper charting.

Management keeps saying "It'll get better". It will. It already has. But what about now?

Everyday for the last month I've left work feeling inadequate. The stress is almost unbearable. It's not

just me. We all look shell shocked at the end of the day. The last night I worked I literally did not eat anything for 12 straight hrs. Nobody has time for a lunch. Taking an hour, means adding one to the 14 you're already there. I liked my job. I liked where I worked. Now I just view it as a mine field I try to negotiate safely.

When can I expect sanity to return? Or will it?

Although I can sympathize completely, I don't understand about the med errors. And it is imperative that you somehow do most of your charting as you go along.

It will get better.

Best wishes!

Specializes in LTC Rehab Med/Surg.

Thanks for being positive. The med errors occur because the system still has lots of bugs. Orders get dropped for no reason. Times are changed on the Mar............who knows? BID gets to the computer, but it spits out only one time. Nurses have to enter their own orders into pharmacy, and to be honest, we are not on top of our game right now.

Specializes in Cardiac, PCU, Surg/Onc, LTC, Peds.

What specifically is keeping you from charting until the end of your shift? Using the EMR is way quicker than paper charting on 2 billion different forms. You HAVE to learn to chart as you go about your day.

Why the problem with med errors? Is it because they're tracked And caught better thru the EMR compared to paper charting?

Specializes in Emergency Dept. Trauma. Pediatrics.

I couldn't imagine paper charting. I love Electronic charting and I love Docs entering their own orders.

Specializes in Multi-disciplines.

Like the others said, chart as you go! Chart when it's fresh on your mind. You'll get a routine down.

Did your hospital not offer classes prior to the system going live? My most recent job just converted to a computerized medication administration, vs, and I&O's. The week that they went live, we were overstaffed for lower nurse/pt ratios, and nurses from other floors also came to help with the computers. (The computer systems went live by two floors at a time.) We are still doing paper documentation for physical assessments. I've worked in several computerized systems and they make my job so much easier.

Specializes in Certified Med/Surg tele, and other stuff.

I have to echo the others. It will get better.

Do you scan your meds? There should be no med errors if you do.

We have been slowly implementing a computerized order entry system and have had a nightmare of a time. Orders dropped by the computer or nobody can see them. Our system is so bad, they are going to a nicer system in a years time. I honestly can't wait, even though that means relearning a new system!

Specializes in Emergency, Trauma, Critical Care.

I think it depends on alot on the system. I worked with an incredible system that was quick and once I got the hang of it, it was so quick and easy to use. I felt so much more covered than I did when I was doing paper charting. SCM Eclipsys I think it was called?

Now I'm working at a hospital that is TRYING to implement a system...Medi-Tech. It's crap. We were supposed to start with it back in August, currently post poned indefinitely because every time we go live it crashes in about 2 hours. I miss my old system. People keep saying "it will get better, it will be great." I am one of the few who used another system, and all of us think it's going to be a living hell when we go live.

What specifically is keeping you from charting until the end of your shift? Using the EMR is way quicker than paper charting on 2 billion different forms. You HAVE to learn to chart as you go about your day.

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EHRs are not all quicker to chart with than paper. Our shift assessments use to literally take us 5 minutes to chart and we did it as soon as we left the room. The computer takes 10 minutes and that is if your patient has everything WNL. Heaven help you if they have a JP or chest tube or wounds. The EHR where I work now takes 10x longer to chart with than what it would if we using the paper charts.

I've worked in several different places and used several different EHRs and they are all crap, but we have to get use to it. The powers that be that haven't touched patients in years or never in their lives decided that this was for the best.

I feel your pain too.

I will echo the poster above. The paper charting was much faster. I could fill out the front and back flowsheet after assessing the patient and it took 5 minutes. No worries about slow computers, or system down or not enough computers to go around.

I have been adjusting to computer charting too.

There is no quick fix.

I learned to force myself to chart throughout the day because the thought of a backlog of charting to be done much later was more stressful than anything else.

Specializes in Emergency Dept. Trauma. Pediatrics.
I think it depends on alot on the system. I worked with an incredible system that was quick and once I got the hang of it, it was so quick and easy to use. I felt so much more covered than I did when I was doing paper charting. SCM Eclipsys I think it was called?

Now I'm working at a hospital that is TRYING to implement a system...Medi-Tech. It's crap. We were supposed to start with it back in August, currently post poned indefinitely because every time we go live it crashes in about 2 hours. I miss my old system. People keep saying "it will get better, it will be great." I am one of the few who used another system, and all of us think it's going to be a living hell when we go live.

Meditech was really good at our hospital here. I really liked it. Cerner was OK but I liked Meditech better.

Specializes in Oncology, Emergency.

Hate to say this ;) but it really gets better. The only problem is that many hospitals are rushing to implement the system lacking better implementation. I don't know what the rush is but i think its related to the new Health Legislation. I work for the biggest Healthcare in California and we use an Epic Based system tailored for the organization and have been Live for the last 3 years and loving it. But to get there the system was implemented in 2 phases. Phase I started in 2005-2008. In Phase the system was used to store medical information such as labs, imaging, EKG's and provider notes on ER and PCP visits. Nurses still had to chart on paper we used paper MAR's. MD's could do some charting but all orders were done on Paper. Phase II started in Mid 2008 where everything now was done on computer ; orders, labs, MAR and the cool part was scanning medications to ensure safety. By this time we were used to the system plus it took them 5 months of classes and test runs before we could go Live.And when we went live they had EPIC certified staff + IT work with us on the floor for another 2 months for support. Of course there were issues when we went live due to change but as of today we love the system and don't we hate it when there is a scheduled maintenance/update(which happens on nights) and we have to pull out the paper charts.

Back to your case...i have a per-diem in a rural hospital ER which just implemented the system a month ago to an EPIC system. They were using IBEX. Everybody is frustrated since they only scheduled nurses for 3 days(18 hrs) of training one month before implementation and they only had EPIC staff + IT staff for only 2 weeks and they were gone. As an experienced Epic user i am getting afraid of the situation where orders are missed or people don't know where to find orders. We are unable to scan medications and in many instances people over ride medications. The purpose of EHR is to encourage efficiency and safety. And the worst part is that they have not uploaded old records into the new system. So i understand your frustration. As a Super User i have some tricks of dealing with bugs:

- Have a white board or a book where people can write their concerns and problems with the system.

- Have processes created for the common tasks e.g administering medications, I & O's, Lines, Vitals, e.t.c

- Have a policy on what support personnel are supposed to chart in the system. For example the ED techs are able to chart vitals, make a note that an EKG was done and also enter the time, write a note about a splint placement e.t.c. Support staff should be discouraged from writing too much.

- Every bug encountered should be logged and forwarded to system support staff in the IT dep't/ Help Desk.

- Have weekly meetings between staff, management and super users to see if previous issues have been resolved.

And after that it should be easy. Once you know where to find what you want it becomes easy and there is increased efficiency and flow.

Pros of EHR's

- Increased efficiency and Safety.

- Better consolidation of information. Its easy for me to know more about patient condition and previous visits to department, mulch-disciplinary noted, easy access and compare data e.g labs(old and new) , visits, print old EKGS's, MD's can compare imaging, allergies all at one click where information has been verified and less easy to make a mistake.

- Centralization of care. Everyone involved in the care can access the charts and care continues; hated it those days everybody wanted the chart and there were delays.

Cons

- Makes critical thinking seem redundant; there are order sets to be followed and some department policies are overtaken. 3 years ago i could order Tylenol for a baby with fever in Triage , draw labs based on systems, could administer a nebulizer to someone wheezing or even order an X-ray for someone with ankle pain. Today i can't and have to wait for the MD to see them. I can do some stuff without waiting for an MD e.g EKG, SL with blood draw when its definite we need them but i will have to wait for the MD to order the labs plus i will have to ensure that he/she enters the orders. Of course the MD expects that you did all this but they have to ensure the entries are done.

- Nurses concentrate too much on the computer at the expense of the computers. MY argument is that you can always back chart what you have done. Just like they taught you in nursing school; first look at the patient.

Sorry about the long rant but i hope this helps and trust me it will get better

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