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.