Kardexes yes or no?

barefootlady, ADN, RN · Jul 11, 2004

orders are entered into computer by UC, verified by RNC, copy of print out is placed into box of primary care RN for update. RN primary care nurse then enters new med or discontinues med on bedside MAR. Sounds like it should work well, but there are glitches. RN primary care nurse needs to develop a system of checking her box and Charge nurse needs to alert primary care nurse of BIG orders, like blood, pending tests that could effect med administrations. Hope this helps.

Jailhouse RN · Jul 11, 2004

With the all computer and bedside systems ther are too many hands in the pot and room for way too many errors.

nptobee · Jul 11, 2004

I'm a Unit Secretary. When a doc writes the order I transcribe it to either the medication or treatment Kardex. The order is faxed to pharmacy if it's for a med. I also have to enter the request for labs or procedures into the computer. The RN who has that patient that day then checks the Kardex and computer.

teeituptom, BSN, RN · Aug 5, 2004

Yall still have Kardexes

I thought they died out yrs ago

Pediatric Critical Care Columnist · Aug 5, 2004

we're still using kardexes. as one of my coworkers pointed out, they are a huge risk factor for med errors. 1) they're written in pencil. 2) they are not legal documents and are discarded when the patient is transferred out. 3) they are only as good as the nurse responsible for checking the orders. so many times the mar doesn't match the kardex. lots of our nurses are lacakdaisical about updating both kardex and mar. 4) our order sheets are a big part of the problem. they're not separated into med orders and general treatment orders. everything is written as it occurs to the doctor. weeding out the med orders is often a challenge. and our attendings have a habit of slipping in one or two more orders at the end of the orders written by the resident in rounds, then cosigning the whole list. these often get missed. we also have no mechanism for easily identifying orders that have changed, which in our environment is all the time!

plaintiff's lawyer: nurse nancy, can you tell me why you gave this dose of drug x to my client's mother on such-and-such a date?

nurse nancy: well you see, it was written that way in pencil on my kardex, and i just didn't notice that the mar said something different.

plaintiff's lawyer: and where is this kardex now?

nurse nancy: well, it was thrown out when mrs. y died. that's what we always do.

is anybody else alarmed by this???

a couple of weeks ago, another nurse recopied the now-soiled and all-but-unreadable kardex on a long-term patient, and asked me to check it for accuracy. the kid has been with us for ten weeks and is very unstable so has about a thousand order sheets. her chart has been thinned many times, a process whereby someone just pulls out a handful of order sheets, progress notes, nurses' notes and lab reports, slaps a rubber band around the pile and shoves it into a cabinet. we have no standard for rewriting current orders, so i spent a good hour sifting through the stacks of order sheets, and was unable to find any written order for two meds that had been being given for weeks. one, carvedilol, was mentioned in the progress notes only, and the other, aldactazide, had been given long term on the ward before she came to us but wasn't formally ordered in our unit. can you say lawsuit? this family isn't the most easygoing, either. i can see a big dust-up in the future over the whole system.

canadiannurse21 · Aug 5, 2004

Where I work, the physician writes an order on the "physicians order sheet" which is on the pt's chart; then that order is transcribed onto a medication kardex by a nurse, then has to be co-signed by another nurse before the medication is given. All meds that are given (IV, PO, IM, prn, stats, one-time-only's, etc) are on this medication kardex . Also, on night shifts, an RN goes through the chart, looks at all the orders written that day, makes sure they are all accurate and co-signed. There isn't very much room for error :) Some of the systems you guys are describing makes my skin crawl, especially with all the litigation these days :eek:

teeituptom, BSN, RN · Aug 6, 2004

they worked well in the olden days

however with computerized systems they are outdated

and Im an old fart

BeenThereDoneThat74, MSN, RN · Aug 22, 2004

We're still using Kardexes. As one of my coworkers pointed out, they are a huge risk factor for med errors. 1) They're written in pencil. 2) They are not legal documents and are discarded when the patient is transferred out. 3) They are only as good as the nurse responsible for checking the orders. So many times the MAR doesn't match the Kardex. Lots of our nurses are lacakdaisical about updating both Kardex and MAR. 4) Our order sheets are a big part of the problem. They're not separated into med orders and general treatment orders. Everything is written as it occurs to the doctor. Weeding out the med orders is often a challenge. AND our attendings have a habit of slipping in one or two more orders at the end of the orders written by the resident in rounds, then cosigning the whole list. These often get missed. We also have no mechanism for easily identifying orders that have changed, which in our environment is ALL THE TIME!
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I think they are the biggest waste of paper and pencil I've ever seen! One of my hosptals uses them religiously, but not everyonre updates them. The clerk puts the meds in (but not the times), nobody (myself included) updates them, then they get thrown out at discharge. Just another thing for us to check. If you've checked your MAR and your chart, you've found everything you need to know.