Electronic charting- administration time out of compliance

Specialties Geriatric

Published

Specializes in New Critical care NP, Critical care, Med-surg, LTC.

We're currently paper charting but I was recently told we'll be going to electronic and that really worries me. I'm still new, relatively slow, and last night I was passing 4pm meds at 7:10pm (I've got 30 residents, probably 25 on each of my two med passes). How do you do it if you're electronic charting and you're out of the med window? At this rate that would make me even slower because if I've got someone with a 4pm and 6pm, I can't really combine them unless I'm on the dot of 5pm. UGH!

Are there facilities with electronic charting that don't have the same time constraints? Or maybe it would be up to the management how they deal with those that are out of compliance? It is technically a med error to administer outside the hour before and after, correct? I just hope we don't have barcode scanning on top of it.

I've got enough stress there just learning the field, this will knock me for a loop!

Up Vote Up Vote ×

What system will you be using?

And EMAR makes med pass 1000x easier. Promise you it will go faster. And if we're late on ours it makes no notation as far as I've seen.

Up Vote Up Vote ×

If its late it will come up asking for a note to explain why it was administered late usually. Depends on your system. Do you have alot of people with meds scheduled at specific times rather than just pm or hs or such?

Up Vote Up Vote ×
Specializes in LTC.

When we went to EMAR, we changed our med pass times so we had a longer window to give them. With the exception of meds that absolutely need to be given at a certain time (eg: it's scheduled q 6 hrs, or if it needs to be given early in the AM before breakfast), meds are scheduled for AM Pass (0700-1100) Noon Pass (1100-1500) PM Pass (1500-1800) and HS Pass (1800-2300). So now instead of all the AM meds being scheduled at 0800 and are "late" if given after 0900, you have until 1100 to get them done.

Up Vote Up Vote ×
Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Thank you for the responses! I have no idea what system is intended for use, but I can see that some changes in our current system will have to be associated. We do currently have all meds with a scheduled time, so some residents have both 4pm and 6pm meds, but everyone gives those together during the first of the evening med passes. I'm obviously putting the cart way in front of the horse worrying about something that hasn't happened yet, and without knowing all the details. I'll just concentrate on getting more efficient at what I'm doing now and then any changes will just be what happens. ChrisRN24, good to hear that you think it makes the med pass faster- since my first one is usually almost three hours, anything gained there would be great!

Up Vote Up Vote ×
Specializes in LTC,Hospice/palliative care,acute care.

Once you learn the system you will see how much time you save,not just with the med pass but also re-ordering meds,order entry and documentation.You will actually have TIME to spend with a resident now and then.We have also been working hard on our unit to simplify the med pass for each shift as much as possible,it's usually the resident's request not to be awakened after 8pm so every doc has signed off on changing most q 12 meds to 9a and 5 p-our folks are pretty stable and if it means the difference between them accepting or refusing the med we can accomodate,same for the 4p and 6p meds unless it's contraindicated. You will LOVE the system after you are all trained and you get the glitches out...

Up Vote Up Vote ×
Specializes in ICU, CM, Geriatrics, Management.

E-Mars and e-charting are great for management. And often a nightmare for staff... everything nurses do and chart -- and when they do it -- can be readily scrutinized by sups.

A malicious management can use the system to discipline staff they don't "like"... for whatever reason.

Stay united with your peers, and vigilant to unreasonable policies & uses of the e-system.

Up Vote Up Vote ×
When we went to EMAR, we changed our med pass times so we had a longer window to give them. With the exception of meds that absolutely need to be given at a certain time (eg: it's scheduled q 6 hrs, or if it needs to be given early in the AM before breakfast), meds are scheduled for AM Pass (0700-1100) Noon Pass (1100-1500) PM Pass (1500-1800) and HS Pass (1800-2300). So now instead of all the AM meds being scheduled at 0800 and are "late" if given after 0900, you have until 1100 to get them done.

This is basically what my facility is doing. I'm sure it's going to take some time and adjustment to get everything right, but overall I'm looking forward to it. Not so much because of the EMAR, but because having a computer on the med cart will save SO MUCH time running up and down the hall for charting. I'll have to find another way to get my exercise, though.

Up Vote Up Vote ×
Specializes in LTC,Hospice/palliative care,acute care.
E-Mars and e-charting are great for management. And often a nightmare for staff... everything nurses do and chart -- and when they do it -- can be readily scrutinized by sups.

A malicious management can use the system to discipline staff they don't "like"... for whatevereason.

Stay united with your peers, and vigilant to unreasonable policies & uses of the e-system.

On the other hand if you are doing exactly what you are supposed to be doing you won't have a problem.

-that's just my experince.Usually if a co-worker of mine if being dogged by someone they have deserved it. Some of the nurse's notes I have seen over the years are too ridiculous-these peole are gtting the education they need and deserve now that anyone can easily access the charts and do an audit.Seriously-if you can't write a freaking nurse's note you have a problem.

Up Vote Up Vote ×
Specializes in ICU, CM, Geriatrics, Management.
On the other hand if you are doing exactly what you are supposed to be doing you won't have a problem...

That's fine and dandy so long as everything that's being required of nurses is reasonably do-able within the time being allotted. Consider all the issues often encountered at different facilities: more acute patients, reduced staff, prohibited overtime, poor equipment, the scrounging for supplies, etc.

Up Vote Up Vote ×
On the other hand if you are doing exactly what you are supposed to be doing you won't have a problem.

-that's just my experince.Usually if a co-worker of mine if being dogged by someone they have deserved it. Some of the nurse's notes I have seen over the years are too ridiculous-these peole are gtting the education they need and deserve now that anyone can easily access the charts and do an audit.Seriously-if you can't write a freaking nurse's note you have a problem.

In the case of our system, it doesn't even take a manual audit. There's a report that can be run that shows meds signed outside of the administration window.

As long as management is sane, I tend to agree with you. Seeing actual admin times lets them see that a particular med pass is, in fact, impossible within the administration window when every single nurse who does it runs at least an hour late. Or that one particular nurse is consistently late and may need some intervention of some sort - before something goes seriously wrong or s/he quits from frustration.

It's when management isn't sane (or it's being judged by state/corporate totally out of context) and uses the fact that someone was two minutes late administering some colace as an excuse to fire them that it's an issue.

Up Vote Up Vote ×
Specializes in Geriatrics, Dialysis.

The system we are using doesn't seem to have a problem with meds checked off late, only if you need to give them early for some reason. Then it is "are you sure you want to document this.." for every pill.

Up Vote Up Vote ×
+ Add a Comment