I’m debating about whether this is sketchy. I am good with computers. I like to learn how I can utilize the info to my benefit. I like how to do something/access info.
So we have epic and it is a fairly large package close to the top tier. It is not very customizable due to it being a large company that utilizes this package (like over 15 hospitals in a out 2-3 states) and this was maybe 4th to last hospital getting Epic over 5 years ago in the company besides new hospitals opening or merging. So it’s not like it is the first year of epic. They have had it.
I use both ED and the flowsheets because I have worked in both trauma centers and ICUs. I have traveled and worked multiple jobs at once. I like the flowsheets because once I memorize the tabs, I can basically chart an entire assessment using tab key and 1-6 keyboard strokes (like pupils 3;r;b populates 3 mm round brisk) instead of moving the mouse around which is slower. However, I do use both about equal to chart assessments. I do my hourly rounding for ED under the ED narrator (like they have a button that populates click boxes like “resting comfortably,” “no distress noted,” call light in reach, snacks, drinks, report called, patient updated, updated on results, etc. They push hourly rounding documentation in the ED like they push pain revaluation scores elsewhere.
How do they chart stuff like that? Blank notes. So an ED patient will average 5-18 blank notes in the chart. If I want to look at a prior ER visit, I ignore nursing notes from here because usually they are “patient resting on cot” or “patient in imaging.” Yeah... you have click boxes that can populate the fluff into the ED timeline without clogging up the notes. I’d rather see a note saying what lead to a patient coding or the patient freaked out and ripped the computer monitor off the wall and tried to beat the resident with it. I can see a running note of where it is one nurse note with times and the note has addendums with other info.
I also like to know where things are in epic. Each epic is different and they have had this epic for a long time so they should know more about it than me. They don’t.
Now, one of the supervisors told me that I am not expected to teach my preceptors and basically just agree with them because I tried to show my preceptor that they have a tab for documenting when the blood reaches the vein. My preceptor said “I don’t need you to show me anything.” Not exactly friendly or open to learning.
So I watched him basically butcher the sedation narrator. He did not use a single one step med for 15 doses given of the med and instead typed out the info in blank notes. Not joking. You can literally do 3 or 4 clicks instead of keying out “15 mg of medication given by Dr. Resident” over 15 times. It also adds it to the mar. I use blank notes sometimes in the sedation narrator if they don’t have a comment/blank box built in or something significant needs to be charted. Also, guess this hospital doesn’t require sedation scores/scales when sedating patients? They utilize RASS scores normally.
Oh and they’re not allowed to use trauma narrators because they miss too much stuff. Other hospitals in the company that are larger utilize the trauma narrator. I am guessing it is because they free text everything in the trauma narrator too.
The charge nurse tried telling me there is no way to access the ekgs once they are submitted so they don’t submit ekgs till respiratory does it once a day at like 2 am. I found the internal website in eight minutes of looking And pulled up the ekg I submitted. Yes, it does not show up to epic if done before the order is in but utilizing the old site you can pull old ekgs. It may be why they don’t print old ekgs anymore? I don’t think they know how to access it.
I ask questions like “do we send nebulizers home with pediatric patients” and that leads to blank stares and “wuut?” The RT who worked elsewhere knew that smaller hospitals do that was able to answer that question.
There are some practices that make me cringe. It does feel like this hospital has a core that has never worked elsewhere in an ER and so bad habits are passed down. Like the epic charting. It isn’t the first year of epic charting but they’re sold on “this is the way we do it and we will always do it this way” Uh OK. Once upon a time providers did 5 compressions to 2 breaths so should we be doing that still? Should we be inserting foleys into everyone just because they’re admitted?
I did come from a magnet hospital that actually researched and tried new things. Before that, I worked at a company that was pushing stuff like decreasing UTIs, pushing nurses to be responsible to identify sepsis, EKGs within 5 minutes, etc. I mean, that hospital system we had info about TPA times and who had the best times.
It just makes me worried if the staff is this against knowing how to utilize epic. If we have changes to standards, are they going to change or want to learn versus saying “we always did this.”
