when do you chart?

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Specializes in ED, Cardiac-step down, tele, med surg.

I am really liking the ER so far and I find it very challenging both mentally and physically. I'm trying to get a rhythm and flow and am trying to understand the thinking process and work-flow of an efficient ER nurse. My preceptor is a good example. They look and see what needs to be done and starts with that, what meds need to be given, what procedure needs to be done to keep the ER flow going. A quick scan of patients, make sure they are stable, then move on to the tasks and during that process, get vitals, necessary info, assessments.

Somewhere in that flow of proper prioritization (patient needs ABCs and down the line) to getting patients in and out of the ER the charting of vitals, rounding, other documentation is supposed to taking place. I have found that it is very hard to catch up on charting, but the charting needs to be done. When do I do it then? There's got to be a method.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Whenever you can! Watch your preceptor. Are you using an EMR? Are there laptops for charting?

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Specializes in Emergency; med-surg; mat-child.

I chart at bedside, except for discharge stuff, which I can do when I have a moment. Unless someone is coding, I have time to chart. If someone is coding, then I'm not the one taking care of my other pts and the nurse who takes them can do the charting however they like to do it.

I have always done bedside charting as much as possible; I can see the pt, make sure I have the right side, limb, etc., and get direct quotes from them for their CC. I am a fast typist, though (former transcriptionist) so I may have a leg up here. But for the most part, it's just clicky boxes and how long does that take, really? If two minutes' charting time is making that much of a difference in your shift, there are other things to work on wrt time management.

If nothing else, the assessment should be charted at bedside, and if you scan meds, clearly those are done then, too. Other stuff can wait, but you're seeing the downside of waiting. Try doing it at bedside for a few weeks and see how that changes your flow. If you hate it, you can always try another method. Lots of nurses on my floor use index cards with pt name and bd and then jot down notes for later entry, but I prefer to do it in real time because I WILL forget things and I WILL miss things. Figure out how you operate and go from there.

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Specializes in Emergency.

After emergent care is done on esi 1 & 2's, i chart the initial care & interventions. I then chart on the fly as i do things. Esi 3/4/5 pts after i them & again on the fly as i do things. Don't fall behind because you will forget what you've done. Easier said than done but speed will come with experience.

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Specializes in ED, Cardiac-step down, tele, med surg.
Whenever you can! Watch your preceptor. Are you using an EMR? Are there laptops for charting?

We have WOWs. I'm taking all the patients now, so I'm doing most of the charting unless my preceptor is helping me and they are still helping me, except with charting.

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Specializes in ED, Cardiac-step down, tele, med surg.
After emergent care is done on esi 1 & 2's, i chart the initial care & interventions. I then chart on the fly as i do things. Esi 3/4/5 pts after i them & again on the fly as i do things. Don't fall behind because you will forget what you've done. Easier said than done but speed will come with experience.

That's what I've been doing too, priority meds and interventions on ESI 2 (I haven't had any ESI 1s on my own yet, just helping out), then tasks to keep the flow moving and then I try to chart but sometimes get interrupted. I think I'm still getting used to their EMR too, which I don't really like that much. I would like to chart as little as possible (I mean just the bare essentials).

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Specializes in Emergency; med-surg; mat-child.
After emergent care is done on esi 1 & 2's, i chart the initial care & interventions. I then chart on the fly as i do things. Esi 3/4/5 pts after i them & again on the fly as i do things. Don't fall behind because you will forget what you've done. Easier said than done but speed will come with experience.

Good point. I haven't had any ESI 1 pts yet, but I worked as a recorder and that's the only way I can see charting being done in a code, because for sure, yes, DO THE WORK and worry about charting later. For ESI 3 and up, though? I'll probably stick to bedside because of the forgetting of things.

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Specializes in Emergency; med-surg; mat-child.
That's what I've been doing too, priority meds and interventions on ESI 2 (I haven't had any ESI 1s on my own yet, just helping out), then tasks to keep the flow moving and then I try to chart but sometimes get interrupted. I think I'm still getting used to their EMR too, which I don't really like that much. I would like to chart as little as possible (I mean just the bare essentials).

Getting used to the EMR is HUGE. If you don't know where to put information, it's a huge time suck. That will come in time. We use EPIC, and I use a lot of hot keys and shortcuts to speed up my charting, and that helps a lot, too. The flowsheets are the same as the bedside charting, but the ED flow is different, and that still catches me up on the regular. It's coming though.

I would recommend against "bare essentials" because if you are ever called to the bench to testify on a case, they're going to ask you about what you charted and if it's just basics, it could go badly. At minimum, record direct pt quotes and quality assessment charting. We're supposed to be getting an upgrade that shows required documentation, and anything else is optional. I suspect that lots of people chart in lots of different ways (they'll click WDL and then also go in and chart all areas of lung sounds as clear, which is a waste of time IMO). If it's abnormal, chart it thoroughly, chart your interventions, and chart pt reaction to the intervention. If they have a fever, you give apap, and don't reassess their temp, you could be nailed. Defensive charting sucks but it's worth the extra few minutes IMO.

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Specializes in Emergency; med-surg; mat-child.

I would recommend against "bare essentials" because if you are ever called to the bench to testify on a case, they're going to ask you about what you charted and if it's just basics, it could go badly. At minimum, record direct pt quotes and quality assessment charting. We're supposed to be getting an upgrade that shows required documentation, and anything else is optional. I suspect that lots of people chart in lots of different ways (they'll click WDL and then also go in and chart all areas of lung sounds as clear, which is a waste of time IMO). If it's abnormal, chart it thoroughly, chart your interventions, and chart pt reaction to the intervention. If they have a fever, you give apap, and don't reassess their temp, you could be nailed. Defensive charting sucks but it's worth the extra few minutes IMO.

I'm the freak who buys a lot of just in case, though, so feel free to ignore me.

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Specializes in ED, Cardiac-step down, tele, med surg.

I think it's good to chart defensively and is wise to chart interventions and responses to those and reassessments. I just haven't been able to do that in an efficient way yet using a new EMR. I used to use EPIC which was awesome. I have too and would hate to get sued. So I will heed your advice.

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Specializes in ER, ICU.

There is only 1 time in the ED- NOW. Do it, chart it, because there is no later. You can never remember everything and if you fall behind you will inevitably leave something out. Unless someone is literally dying, take the time to chart before the next task. Good luck.

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Specializes in Emergency Department, ICU.

If I am the one doing the initial triage on my patient, I also go ahead and do the necessary focused assessment and chart it before I leave the room. If I am coming in to a patient that has already been triaged, I do the focused assessment and chart it in the room when I go introduce myself to the patient. I also make a point of making my first nursing note at that point. I try to be pretty thorough with my first note because that's the one that is going to jog my memory the most if I ever end up in court, and it's also the one that I'm going to use to fill in any documentation I may have forgotten later. I make sure I chart my IV before I chart my meds, etc.

I agree with most of what you've been told. If you have a critical patient, you're going to be 1:1 in the room with that patient and hopefully able to chart between meds/titrations/etc. (except in an actual code, where you should have help and someone should be documenting something somewhere). Otherwise, you always have time to chart- if you didn't chart it, it didn't happen. The biggest time saver for you to feel like you have time to chart is to be sure you're clustering your care, IMO.

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