New hosptial computer systems pull nurses away from patient care - page 4

Hi all, Just want to know if any of you have been involved in a new computer roll out in your hospital where bedside paper charting is being eliminated and all done in the computer----eclypsis,... Read More

  1. by   lee1
    Quote from tfk0630
    We combine the computerized system for med administration and continuity of care, teaching, plan of care, restraints, and I&O with the ICU flowsheet. The combination works well, particularly when a patient is stepped-down to another unit.

    How does the ICU flowsheet work? Is it interfaced to the monitor or do the nurses have to put in ALL the data, thus making them keep 2 flowsheets???
  2. by   dorimar
    this is for lee1,

    I have charted on only one computer system in the ICU :MKESSON ( however while it worked, it went through a terrible "upgrade" that made it very cumbersome and terrible). The nice thing, is that your vitals are always in there no matter how busy you are ( the moniter is slaved into the computer system)and all you have to do is pick the ones you want to save when you have the time to do so. However, you have to be carefull as say.. your pleth is not on or the patient is not perfusing, so your pleth is not accurate and it reads 70 and you save all those sats without editing (many nurses are not careful), or you are using your proximal port to infuse so the transducer is off to the CVP and it reads 320 and you chart a CVP of 320 for 2 hours if you don't catch it. Also the downside is that many times the computer, moniter, and real time are ALL off and you are dealing with 3 different times-- when looking at a crucial rhythm strip, moniter vitals, and real time of say when the code was called and the code sheet charting etc. Also if you jot notes down for when you changed your drip titrations they may not correlate with when your computer vitas indicated you made the change. (ie your pressure dropped to 70 systolic you -look at your watch as you increase your pressor and write a note you plan to chart later in the computer- but the vitals at that time may be 100 systolic in the computer as the timeing is off by minutes sometimes) I am a stickler for charting and it can be a nightmare when you have a critical night. I found that many times i had to change my real time charting to adjust to whatever the computer said the vitals were at the time. While this may be do-able, it is not when there are rhythm stirps involved and they dont' match any of it (especially in a code when your are using a 4th timed piece of equipment-- the defibrillator moniter and strips-- not connected to the computer , but that clearly gives another DIFFERENT time). I have complained about all these time discrepencies repeatedly, but noone seems to deem it serious enough to address.
  3. by   Indy
    Quote from lee1
    Those of you who work in the ICUS when these new computer systems went live. Did you have interfaces from your monitoring system??? How did you computer chart all of the many IVs, drips, titrations, frequent VS???? How did you differeniate artifact, false VS readings??? Did you end up doing double charting just to remember what took place, say in a code situation or a plain old hectic hi acuity patient undergoing procedures simulataneously. What about field trips, say to CAT scan, MRI, etc.
    My facility is in the middle of switching to sunrise/eclypsis (however you spell that). So far we have lab work visible, order entry but not meds or pharmacy orders, and flowsheets for vitals and I/O. If you ask me it's being done arsebackwards. I didn't use the thing at all until we had to put orders into it, because the DOS based system worked just fine and I could actually use it faster with the keyboard 'cause I can type.

    I would love for them to have put in nurse notes and assessment sheets, admission assessments, etc. in first to force us to use the system. That way we'd already know how to work it when it came time for order entry, instead of all the double work we're doing. Our graphics flowsheets now have to be done twice. Paper for cranky physicians who don't use the system and computer for everyone else. I'm doing one or the other first and it's a PITA. Oh yes, and the list of crap you can put in as "nursing orders" is ridiculous. "Smile at pt. daily" isn't on there but it might as well be! You can do "conditional" orders, like what to do in case of an emergency. !! In case of an emergency, I am not looking in sunrise to see if I can do something or put it in the computer! I'm doing whatever needs to be done!

    And I've seen the paper ICU flowsheets that are in use at my facility. It's a tri-fold card thickness monster with every possible assessment on there, and all sorts of room to time your drip titrations, etc. I have no clue how they plan on getting that baby into sunrise but good luck! If they do get it in, I hope it's more readable to floor nurses than it is now... takes me a while to figure out what I want to know on it, sometimes have to drag the chart to the unit and ask a nurse to translate.
  4. by   Misty1
    Quote from Indy
    My facility is in the middle of switching to sunrise/eclypsis (however you spell that). So far we have lab work visible, order entry but not meds or pharmacy orders, and flowsheets for vitals and I/O. If you ask me it's being done arsebackwards. I didn't use the thing at all until we had to put orders into it, because the DOS based system worked just fine and I could actually use it faster with the keyboard 'cause I can type.

    I would love for them to have put in nurse notes and assessment sheets, admission assessments, etc. in first to force us to use the system. That way we'd already know how to work it when it came time for order entry, instead of all the double work we're doing. Our graphics flowsheets now have to be done twice. Paper for cranky physicians who don't use the system and computer for everyone else. I'm doing one or the other first and it's a PITA. Oh yes, and the list of crap you can put in as "nursing orders" is ridiculous. "Smile at pt. daily" isn't on there but it might as well be! You can do "conditional" orders, like what to do in case of an emergency. !! In case of an emergency, I am not looking in sunrise to see if I can do something or put it in the computer! I'm doing whatever needs to be done!

    And I've seen the paper ICU flowsheets that are in use at my facility. It's a tri-fold card thickness monster with every possible assessment on there, and all sorts of room to time your drip titrations, etc. I have no clue how they plan on getting that baby into sunrise but good luck! If they do get it in, I hope it's more readable to floor nurses than it is now... takes me a while to figure out what I want to know on it, sometimes have to drag the chart to the unit and ask a nurse to translate.
    Never heard of Sunrise but our facility used Eclypsis. I found it very userfriendly and streamlined. If it is anything like our facilities computer system I think eventually you'll really like it.
  5. by   Indy
    I think it's made by the same company, there's one of the opening screens that says "eclipsys" on there somewhere. "Sunrise clinical manager" is the other name for it. I'm doing better with it than I was last week, but still sometimes have to show my brain to the doc who's in a big ole hurry.
  6. by   burn out
    I love computer charting over paper. I have been a nurse for 20 years and only the first year did I have to use paper- it was long and tedious. Now we not only use the computer for charting and labs and order entry but we are now using scanning bars to scan meds and patients (like in the grocery store) and this has greatly cut back on medication errors.
  7. by   jackie88
    We use Meditech and hate it. It has pulled us away from the bedside. Yes, it is easy to point and click but we did not go into nursing for data entry. It can take over an hour to get thru all the admission screens. Not to mention the inconsistant picture you get from this charting. It is too time consuming to read others notes or spreadsheets. I can't imagine a lawyer getting ahold of our charts!
  8. by   beautifulb
    We had 4 hrs of inservice time for the computers. For the first few days the nurse educators (the 3) roamed around the hospital to offer guidance...during the day shift. At night we had 1 computer tech to help. We had the same pt. load.
    The computerized system is not that bad but I do not like the e-mar. For prn's the pharmacy has to put in a time because otherwise the system won't take the order. So if something is prn q4 then it will be entered in as prn q4 with times such as 0600, 1000, etc. At first glance it looks as if you can only give the prn's at certain times. It worries me b/c that is not how the order is written. On the written mars the exact order was written. It sometimes seems like a guessing game and you are consistently double checking the orders.
    Also, at times medications "fall off" the e-mar after midnight. Sometimes it is for no particular reason and other times because a medication needs to be renewed. If a pt. is on chronic oxycontin for etc. and at midnight it becomes the 5th day, the medication automatically disappears, and you would have no way of even knowing that that med was ordered.
    Also, the pharmacy leaves at 9pm so orders can't even be entered into the e-mar.
    Ugh...I didn't realize that I disliked it so much.
  9. by   msn2008
    Nellie Nurse,
    How is Cerner now that you've used it for several months? My hospital tried to go live housewide in May but ran into too many problems, especially with EMAR and we've been paper charting ever since. Orders are still being entered into the computer, and labs, radiology, some progress notes and H&ps are there, too. Evidently an upgrade to the system is in process, but I haven't heard a new go live date. Thanks for your response in advance; any other comments about Cerner are appreciated, too.
  10. by   imenid37
    Quote from jackie88
    We use Meditech and hate it. It has pulled us away from the bedside. Yes, it is easy to point and click but we did not go into nursing for data entry. It can take over an hour to get thru all the admission screens. Not to mention the inconsistant picture you get from this charting. It is too time consuming to read others notes or spreadsheets. I can't imagine a lawyer getting ahold of our charts!
    I am with you. We have Meditech and I hate it too. Not to mention that practically every week, our hospital decides there is something else we must chart. It is cumbersome and slow. I might like another system. I just have to live w/ Meditech, but it wouldn't be my personal choice.
  11. by   Jumblygirl
    Have done computer charting for 6 months. The system routinely crashes, or slows to a crawl. Have had issues where only able to access some computers, but not all. Paper admission database - used to take 20 minutes -tops. Computer admitting is slow, unresponsive, tedious and repetitive - now requires 40 minutes to admit. Often spend precious time trying to find one "COW" (computer on wheels) that is fully functioning, which results in RNs competing for the few available working computers. Meanwhile - we are glued to the computer - not watching tele - not checking on patients - while we are required to chart every 4 hours - whether there a changes in a patient's condition or not. To complicate matters further, ER has 1 system, other areas of the hospital have another system, and the remaining areas continue to paper chart and admit. I often long for the opportunity to float - just to have the opportunity to paperchart again. In word - at our facility - computer charting and its attending headaches - stinks.
  12. by   ern91
    meditech is awful. seems like every week administration adds something else to the program for us to chart. med reconcilliation in the er is especially time consuming since we do it on all patients, even the pt's that are not admitted. all the questions to screen for abuse, tb, immunizations for pnuemonia etc. and this is just the triage screen!!! when we had paper charting, seems the screening aspect of pt care tok less time
  13. by   tlcprn2u
    Charting on COWs should be easier, user-friendly, and not take the nurse away from his or her patients even more!!
    In Florida, last hurricane season, with all the power outages, and generator failures, nurses had to resort to their own resources to get medicines and supplies b/c none of the computerized systems worked!!
    Oh, the wonders of technology! And where were the back-up plans and systems the facilities were supposed to have in place???

close