Is everything computerised where you work?

Home Health Columnist / Guide · Jun 3, 2011

Our homecare agency has had electronic medical records and laptop computers since 2002. In the fall, able to get faxserver purchased and software to open documents as editable pdf files, so agency now going paperless.

Totally transformed my department, Central Intake into a quieter, less stressful environment since our onsite liaisons now fax electronically homecare referrals + inturn we snd out via computer to branch, they emial to admit staff ---haven't bought copy paper in 2 months!

Hospital system also 90% electronic with big implimentation of 100% electronic by end 2012.

merlee · Jun 3, 2011

Believe it or not, the manual sphyg is more accurate when used correctly! They should be about the same most of the time, but you may not always have an electronic cuff on hand.

Not everywhere you work will be computerized and high tech. Learn as much as you can, it is all good!!

CPT_Charlios · Jun 3, 2011

Where I work everything is computerize charting, which I believe save lots of time compared to paper charting. I dont think I can ever work in a place that does paper charting anymore. We chart everything on the computer to include; VS, I/O's, assessments, progress notes, etc. Information you need to know about a patient can be found in the computer chart i.e ; H/P, Labs, test results, etc. The only thing kept in our hard charts are EKG's,*Living wills,*and consent forms.

Most hospital, in fact I think all hospitals use automatice b/p. But, using a sphyg to measure b/p is a skill all nurses need to know. I will use a sphyg if I have a b/p that is extremely out of range. One important facet to know is to always use the right size cuff.

TiffyRN, BSN, PhD · Jun 3, 2011

who is doing big long care plans ?
What do you spend most of your time typing into the computer if you do spend a lot of time doing it?
Also we are learning how to use the sphyg to take blood pressures but some hospitals has the (more accurate in my opinion) automatic ones that detect it for you?
Im just curious about just how technological a world we live in (in the nursing world that is)

First: I think the only people doing big long care plans may be students (maybe LTC, seems like I've heard that). The care plans where I work take less than 5 minutes to have a minimally acceptable TJC acceptable care plan. If you want to get fancy you can use a whole lot of (approved) short cuts that are built-in to our program.

Second: I feel I spend much more time charting because now I am the nursing branch of the hospital and a big part of medical records. We used to just write numbers down at the bedside on the flowsheet (in NICU, not Med/Surg), then medical records would take all the papers and eventually microfiche them. Now I write them down, then transcribe them to the computer, no further handling or microfiche needed. Plus so many things that used to be just quick checkmarks on a flowsheet now require typing things out. Overall, I'm a big supporter of EMR if nothing else because it took the doctor's bad handwriting out of the equation.

Third: Please please please learn to do a manual blood pressure. I don't want to see the mayhem when you call a doctor for a random crazy high/low BP with an asymptomatic patient and it's only been done by a machine. The exception might be in my field (NICU) where it is impossible to auscultate BP's and we must use machine pressures though if there is serious suspicion of unstable BP that kid will get an arterial line of some sort. Machines are notoriously inaccurate. It may seem to you since you don't have much experience that they are more accurate but I'd trust a manual BP any day over a machine BP.

Fourth: How technical is our world, well that really depends. Supposedly in the US we are supposed to all be EMR very soon, but some institutions are dragging their feet. In the rest of the world (even if you are only counting industrialized nations only) there is still a lot of paper charting going on.

misscherie · Jun 3, 2011

Great, thanks guys! I shall keep practising the manual BP, good to know that in your experience its actually often more accurate. The placement I am doing at the moment in an aged care facility, there is no computer and all is kept in individual folders and I do prefer computer based so will be interesting to see where I end up and just wanted to see if it was often like here or not. Thanks again! :)

GLORIAmunchkin72 · Jun 3, 2011

"I will use a sphyg if I have a b/p that is extremely out of range. One important facet to know is to always use the right size cuff".

Occasionally I have to use a sphyg and can't always find the right cuff. Should you use children's cuff with elderly people with very, very thin upper arm?

K+MgSO4, BSN · Jun 3, 2011

Misscherie If you are doing a placement in aged care I am assuming that you are a first year. Most aged care facilities are computerised but public, acute hospitals are paper based in Australia. Integrated notes are handwritten, obs and drug charts. also some hospitals including the major trauma hospital that I work in still does hand written path orders and imaging orders. So give it more than one placement before you make up your mind.

Also a manual BP is often more accurate than an automatic. The first thing I would be asking you as your ANUM if you reported an abnormal BP to me is ask you did you do a manual?

1southernstudent · Jun 3, 2011

I too am a student and just wanted to add that all of the hospitals I've done clinicals in are on computers in varying degrees.

But it is always a good idea to be knowlegable in the "old fashioned" way of doing things. In an emergency the computers and electrical systems may be down or maybe one day you might decide to do a mission rotation in a third world country where there is no such equipment. There is nothing wrong with modern technology....as long as it's available, but we have to make sure that the world doesn't come to a screeching halt if it isn't. JMHO

classicdame, MSN, EdD · Jun 3, 2011

The Health Care Reform Act mandates electronic health records by 2014 for all hospitals. Our program takes the assessment and creates a care plan from that. Pretty cool. We use automated thermometers, BP machines, and many other things and they are great up to a point. What is missing is the BRAIN of a nurse who does the critical thinking and determines that the clinical picture does not match the readings on the equipment and then intervenes appropriately. Machines are tools only, even electronic "machines".

psu_213, BSN, RN · Jun 3, 2011

At my one job we had almost all paper charting. (lab orders and diet orders were entered into the OLD computer system). When we had to administer blood--blood bank would call up that the unit(s) of blood were ready and we entered a request into the computer system for the blood to be sent to the floor. Then we went to (basically) all computer charting, which I think is much, much better than computer charting for so many reasons. Well, when we went to computer charting, blood bank would call up that the unit(s) were ready and we had to tube down a paper req for them to send the blood to the floor. Go figure.

As for the automated blood pressure machines vs. taking a manual BP...there is still a lot of human element that goes into getting an accurate reading from the machine--correct cuff length, correct cuff width, correct placement of the cuff, etc., etc. Not that those aren't concerns for a manual BP (they are), but if there are any doubts about the "computer's" pressure, I will be taking it myself.

Catch22Personified · Jun 4, 2011

I'm in a LTC facility and everything is done on paper so its quite a nightmare. Does the Healthcare Reform Act actually affect LTC facilities with the electronic charting mandate?