Capturing charges is main function of EMR

Basically yes. The same way that unit dosing has safety and prevention of med errors as secondary benefits only; the primary driving force behind changing from using stock medications for inpatients to unit per dose packaging was to capture more revenue for the facility.

Insurance reimbursements are the focus for the administrative side of things since collecting as much revenue per admission as possible is always the primary goal.

Well, yes, precisely. Just like all the B* about excellence, dedication and awesomeness of care.

Regarding communucation, the only thing proven to work is information printed on the sheet of paper and given into hands of every interested person, with frequent reminders after that.

I was recently informed in a medico-legal inservice that shift summary notes are no longer required, everything should be found in the EMAR flowsheets. Funnily enough, one can't charge off of shift summaries, but one can charge off an EMAR. Screw ensuring continuity of care - there's CEOs out there barely getting by on 1.4mil a year (or whatever they make, I don't know).

I'm 1.5 yrs into a career, and I'm revolted by how manipulative administrators can be, convincing nurses the changes are for patient care when it's really just to pad profits.

Yep. We just got an email regarding all the emergency drugs we've taken out of the OR Pyxis that were documented on the anesthesia record instead of the EMAR- because the patient was barely clinging to life. Heaven forbid we worry about getting emergency drugs into the patient without charging!

They have gotten REALLY angry with us pulling drugs from our pyxis under the override entry. As opposed to pulling under the patient's name. If I'm the runner in the emergency I probably don't know the patient's name. If I'm setting up an emergency case for a patient being transferred in but hasn't arrived yet - I basically have to pull drugs under the override - because we may not have a name (and disaster names are not assigned until arrival), they haven't arrived so they aren't "admitted". There are so many more problems of greater importance...but...you know...

I was recently informed in a medico-legal inservice that shift summary notes are no longer required, everything should be found in the EMAR flowsheets. Funnily enough, one can't charge off of shift summaries, but one can charge off an EMAR. Screw ensuring continuity of care .

I've noticed this in my clinicals. The nurses tend to write shift summaries pertinent to continuity of care, eg, things nurses want to communicate with eachother.

However, we have been instructed that this is not best practice and we can't write anything in the shift summary that can be found elsewhere in the EMAR.

We're supposed to write notes an MD. Would want to see, which is the pts progress toward discharge. It's kind of an ambiguous thing for me as a student nurse.

The scene which will be dear for my heart for long, long time: the person who was terrorizing the whole place about every non-signed off (read: not charged) 10 cc saline prefill being unceremoniously removed out of the room by one grieving family member right after unsuccessful code. She attempted to enter and go through trash and whole post-code disaster with the sole purpose to account for the said every single very important prefills, and that guy, who was very big and rather intimidating, explained her in a few very politically incorrect words on characteristic inner city jargon that the he and family must. be. left. alone. now.

There was no more talk about these prefills since then

Us too. We have to document on the IV site every two hours. Can you imagine having to go in and wake someone up every two hours so you can see their iv site. But think about how much money the facility is getting. We went from 1 documentation of iv site (charge) per shift, to 6. I wonder how much the hospital charges for these iv site checks. That's a lot of new revenue.

It is all about meaningful use. If you are "proving" that you are using the EMR to it's best advantage, the facility gets monies for that. But you have to hit the high notes.....education was huge, along with the "usuals" of pain and follow-up, risk assessments and the like. There is a considerable amount of money that a facility receives from the government for this. All to get EMAR's as part of facilities everywhere...

And yes, there's no more grabbing stuff in emergencies. Hoops must be jumped through. Nurses need to be held accountable for each and every little tab of Tylenol.

Ah, the business side of nursing. If only they could get rid of those pesky code things...