Article NY Times! Spot on...I think so!!

Nurses Activism

Published

[h=1]When Hospital Paperwork Crowds Out Hospital Care[/h]

Here is an opinion piece about how paperwork in a hospital can take precedence over patient care.

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Specializes in Reproductive & Public Health.

There was a great kevinmd article about how we are so concerned about distracted driving but don't seem to give a thought to "distracted doctoring." Such a good point. It's crazy how many admin tasks we are expected to do in addition to caring for our patients. Just as an example, at the hospital where I work at as an RN, our VS machine doesn't talk to our EMR, so I have to manually transcribe q 5 min vitals for our PACU patients. No biggie if they recover in 20 minutes, but I had an almost 2 hour pacu patient the other day and spent probably an additional 2 hours transcribing, in between caring for my other patients.

When I am seeing patients in clinic as a CNM, I have to make sure I am assessing the minimum number of systems to meet coding requirements (even if the issue in question requires in depth discussion of a single system, I have to take part of my precious 15 minutes to ensure I meet the billing requirements). I spend way too much time on the phone working out prior auths, figuring out why my rx was deemed "not medically necessary," trying to track down results for imaging that never get sent to me, and signing off on every single hand out that my assistants give to our patients. All of this results in less time spent actually focusing on my patients and their actual needs. If my annual exam is concerned about her family history of breast cancer and has no other complaints, I want to spend the bulk of my time on that issue, but yet I still have to discuss a zillion other (important, but not priority) issues so I can check the boxes and get reimbursed.

I don't miss paper charting, but it is criminal that EHRs have been designed towards billing and NOT towards actually meeting the needs of patients and their health care team.

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Truly spot on!! Read the article last night and was thrilled that someone was able to describe such.

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Specializes in Healthcare risk management and liability.

And let us not forget all the little EHR boxes we have to check to document that we are meeting our 'quality metrics', most of which have little to do with actual quality of care or improved outcomes.

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Specializes in Surgery Vascular/Endovascular/Trauma.
And let us not forget all the little EHR boxes we have to check to document that we are meeting our 'quality metrics', most of which have little to do with actual quality of care or improved outcomes.

Anyone else Disturbed by the fact that MDs are being forced to give a drug regimen (ABX for preop surgery) based on these metrics, not on the MDs judgement?

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I'm so glad I don't work on the floor anymore! I don't have rounding flowsheets, fall risk flowsheets, flowsheets for everything known to man...that the patient has or potentially might someday have. I work in an area where we document the care we give and nothing else. If I put a foley in I put a foley in. However we position, I document it. If drains are put in, I document that. I document the people involved, what we did/how, and what we used to do so. No crazy silly flowsheets for me. And no charting on 4-7 patients at once, as I'm 1:1 with my patients in the OR. We do have a"universal protocol" screen, but this is important to make sure we're meeting those boxes unless there is no time to do so (life threatening emergency, etc) to help protect our patients. I document we placed SCDs and that they're on, but I don't document them q1hr.

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Specializes in Public Health, TB.

The hospital that I used to work in, and now take students, requires a Braden skin scale be done every shift. My understanding is that this tool was originally meant to be done at baseline, 48 hours, and then weekly and was aimed at extended care.

The hospital nurses are diligent at documenting every eight or twelve, or four (if floated mid shift ) hours, and yet their rate of ulcers is up. It appears more time is spent documenting risk than actual skin assessments and interventions.

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Specializes in Surgery Vascular/Endovascular/Trauma.
I'm so glad I don't work on the floor anymore! I don't have rounding flowsheets, fall risk flowsheets, flowsheets for everything known to man...that the patient has or potentially might someday have. I work in an area where we document the care we give and nothing else. If I put a foley in I put a foley in. However we position, I document it. If drains are put in, I document that. I document the people involved, what we did/how, and what we used to do so. No crazy silly flowsheets for me. And no charting on 4-7 patients at once, as I'm 1:1 with my patients in the OR. We do have a"universal protocol" screen, but this is important to make sure we're meeting those boxes unless there is no time to do so (life threatening emergency, etc) to help protect our patients. I document we placed SCDs and that they're on, but I don't document them q1hr.

I work in the OR and our EMR (Cerner surginet) is the bane of existence to both the OR Nurses and the MDs. An EMR should assist the nurse in capturing essential nursing documenting, not tie the nurse's hands and prevent taking care of the patient..

The EMR I use is very good at capturing info for the excecutives but bad at documenting for the nurse. I have to manually add additional info in the comments section to accurately document and this takes time away from patient care.

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I work in the OR and our EMR (Cerner surginet) is the bane of existence to both the OR Nurses and the MDs. An EMR should assist the nurse in capturing essential nursing documenting, not tie the nurse's hands and prevent taking care of the patient..

The EMR I use is very good at capturing info for the excecutives but bad at documenting for the nurse. I have to manually add additional info in the comments section to accurately document and this takes time away from patient care.

We're using Epic now at work. We used to use CPM (Centricity Perioperative Manager). Life using CPM was very frustrating. It was not "built" to play nicely with anything. You had to log out of the program to access the schedule, and had to log in again, differently if you had to chart anything in or for pre-op or PACU. We had three different systems prior to implementing Epic (each containing part of the picture of the patient's situation).

Epic is not perfect, but they are letting us help with customization/upgrades. It is AMAZING to be able to see all lab results, the MAR, all notes, on a patient within clicks. No more calling the floor because they forgot to print the MAR on an OR patient and the inpatient holding area didn't catch it, and we need to know last dose/time of last dose of (insert any med here). No more calling the blood bank to see if there is a T+C resulted on your patient because you are locked out of the results system and tech support has a 15-minute wait time to speak to someone and you actually need blood ASAP…

We have to do things like consumption/charges, which is asinine, but usually I have time. In emergencies or situations where we abort a procedure (code, not able to perform procedure, monitoring changes, whatever)…my priority is handling the situation. That's true always – that my priority is handling the clinical situation, but in most elective cases there is time to do consumption/charges. I handle the situation and the documentation I have to do based on what happened, and then I get around to worrying about consumption/charges.

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We use NextGen in an outpt setting. It was more user friendly a few years ago, but they no longer let us alter/specialize our templates so it's pretty much become a non-stop headache.

With every upgrade new "time suckers" are added. Changing records like resolving an allergy are next to impossible and often require the assistance of our IT dept.. Who has the time for that? Plus the constant slowness/freezing of our networks. IT says.. it's just another 30 secs.. guess what.. sometimes we don't have the extra 30 seconds. Typically that 30 sec delay isn't just for one click, but for ALL- so that 30 second delay x 30+ clicks adds up..

In the end I do LOVE EMR, but we just need to be able to customize things. That would help.

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Specializes in Medicare Reimbursement; MDS/RAI.

An EMR program that was downloaded into our computers and implemented by our BUSINESS OFFICE MANAGER with NO formal training from the company, and the BOM as the ONLY PERSON allowed to customize is what we nurses are all having to deal with where I work. It is a faulty system full of "down-time", assessment forms full of unnecessary demands, and completely non-friendly for older nurses who may not work much on a computer outside of work. It was cheap and the BOM talked the admin into it because he knows nothing about computers and doesn't even have one in his office.

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Documentation has steadily increased and I agree with the article author that charting in home hospice is more than in many inpatient settings. In a society that is concerned with litigation and pays health care providers based on certain met targets it is not a surprise that we spend a lot of our time documenting.

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