This month my ICU will switch from paper flowsheets to computerized charting.
How many of you out there have made the switch to computer charting, and what do you think about it.
I admit I have a few reservations about it. I can quickly fill out the vitals, assessments,and other details with little effort on the flowsheet. The doctors can pick up the flowsheet and see 24 hours of details right there.
I typed in the wrong time average for computer documentation. It takes me an average of 20 minutes (not 30) per patient to transcribe my notes into the computer and do nurses notes. That means with 6 patients, that is 2 hours extra needed to document in the computer instead of doing paper charting - 2 hours I often don't have during regular shift hours. That does not include the extra documentation for admits. And I have no clue how much time I waste not being able to quickly find out VS like I used to with paper charting of VS.
I assume you don't have computers at the bedside? We have a computer in every pt room and just chart as we go. No need to write anything down; just chart what you do when you do it.
Sounds like your hospital's system is a bit flawed.
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.
Our computer charting system has it's flaws, to be sure, but it is well liked by most all of us. We've used the same system now for several years so we're all well accustomed to it. We have computers at every bedside, as well as at each nurse's station. There's even one in the med room.
Also, if need be, we can access the hospital's computer charting from home (if, say, you mischarted some vitals or documented that the IV you started was in the left arm when it was actually in the right). No one can change your documentation but you.
We do have computers at the bedside. But it would take longer to log on and chart on each assessment (head to toe & pain) at the time it is done, and be more irritating to the patient as I work nights, than it takes to keep notes and chart later.
Our facility still allows the flowsheets in ICU as there are 6 beds and two computers. So it can get a bit hectic if we're full.
I love the flowsheets. There are nights when I can't get away from a bedside to get to a computer at all. The flowsheet is it on a stick. VS, I can put my drip titrations on it if I didn't have time to go pick up that piece of paper, nurse notes, etc. I do still remember how to chart a head to toe narrative assessment and it takes less time on paper than on the computer, although with the computer I won't miss a detail.
The times when I can't get to the computer to input anything, I do have to find time to put a note in that says, ok look at the flowsheet, it's all there.
Some routine have-to-document-for-jcaho things are in our system along with the "list" so you just check a list of crap that you did/are doing and voila, it says you did it. That part I like. The part I don't like is the built in care plans. The titles to the care plans are... medical diagnoses, for the most part. That's nice but it's missing some good ones so occasionally we have to fudge it. This is where the RN feels the pain of having to "supervise"- RN's do the care plans and admission assessments, no matter whose patient it is. Bleh!
On the other hand I wish care planning had been this easy in school!
Then when you write a note - gotta pick a nursing diagnosis to go with the note. And don't forget to make a note on each dx per shift, otherwise that dx is complete and you need to do some darn thing to it in the computer that will get rid of it, and document that as well.
!!!!!!
Needless to say I don't do all of that. No I don't personalize the care plan. The NOTES are personal to the patient for pete's sake! No I don't rearrange the goals and such. Anyone who reads my notes and has two brain cells can see that the care is individualized for the patient. I'll add nursing dx if they really are needed. Too few ICU care plans have "decreased cardiac output" in my opinion. But you know what? When it's all said and done nobody but JC looks at the care plan. The notes are where it's at. What did get done, what didn't get done, why?
If the computers were at the bedside there would be more notes in, but still wouldn't guarantee that the care plan would be all fancy and frilly like they seem to want it to be.
I work in a small hopsital and we made the transition about a year ago. Some of it I like and some of it I hate. A lot of the trouble is that it is sometimes way too slow and it takes 45 minutes to chart various different things and look up various different things that I could have had done in 20 minutes with paper. A lot of the doctors do not like it because they can't just go through the chart and have all the information right there in front of them at the same time. It is aggravating because it is much harder to find info on old charts. Also gotta love when they have to shut it down for "day end" or updates.
:roll We only have two computers in our hospital! I could just see us all crowding round trying to get on there to write our notes! When I started here they didn't even have printed handover sheets! They're slowly coming over to the dark side to join me here in the computer age but I don't think we'll have computerised notes for a very looong time.
I am certainly not among those who are computer illiterate. At home we have state of the art everything; therefore I can spot a crappy system/setup/program in a microsecond. And that's what we have. It's slow (yet they think upgrading the program will fix that.) It's cumbersome. Lots of screen space is wasted with stuff we don't need. The layout of the postings is poorly designed and you cannot, no matter what you do, see the entire flowsheet notes for any one given time/date and I find it helpful to see something in entirety in order to really know what has happened. I like(d) to chart with my various papers out where I could see everything at once and could put all the v/s in all their places at the same time (for example) Computer charting makes that impossible.
We do have bedside charting in some of our rooms, but not all. I don't generally use any of them because I think it's a possible privacy violation, with all the visitors milling about.
All in all, I think the bean counters must think it's a good thing, but I don't. And blaming the program design is all well and good, but if you're stuck with a poorly designed one and have never had a goodly designed one, then you're still stuck with a bad design. I do the best I can, but administration isn't putting their money where their mouths are in this case.
I'm so looking forward to the day when I can retire. Won't be long and until then, it's "I can do it, I can do it, I can do it---one more time."
Specializes in CCU,MICU,SICU,CTICU,Renal, Recovery.
I have used paper in the past, and a mix of both and computer charting for the last 8 years at my full time job with paper charting @ my agency jobs and to be quite honest.. computer charting is far superior. We can easily look back at running I/o's we take in account for all intake including a-lines, S.G., Cvp, and the ease of assesment by reviewing and changing tabbed rows depending on the patient's drains, chest tubes, ballon settings, profiles is far more accurate and detailed than I would be able to write as we make changes so quickly in the acute setting. All in all .. better for the ICU nurse and better for the patient. We also have a system of order writing that has the MDs/ PA's log on and write there orders on line, therfore all default drug interactions , allergies, duplicate labs, all show up in a window to verify or explain. And that leaves a running "kardex" in the system with the most up to date chart on line, with an ability to see orders and home meds , clinic appointments notes.. from previous admissions without obtaining old charts.. If its done right, or even just "pretty good" way better than paper. Plus I type much faster and more legible than I write and so do so many others...
I love computer charting - and the fact that MDs have to imput their orders DIRECTLY into the computer - makes my life easier!
I wouldn't take a job where they still do paper charting.
If you are worrying about seeing all the info for a 24 hr period - your computer program should have the capability to 'trend' for days, weeks , 24 hours etc - you can see it all in charts....
Don't fight it - no one likes change - but this is the future and it will help you keep track of your work too.
I prefer paper documentation as I can easily document throughout the shift as I do tasks. With computer charting, I have to double document as I don't have time to log into the computer and document each time, so I have to take notes on assessments, pain, etc. and then document it in the computer later when I have time. It takes me about 30 min per patient to document everything in the computer. Finding out VS from CNAs is a nightmare now as they seem to think it is more important to document them in the computer than to inform RNs of abnormal VS. I spend way too much time trying to find out VS as if they aren't in the computer timely, I then have to track down the CNA who often doesn't have the paper sheet with them to inform me.
It sounds like it is your system. Logging on takes me a sec, I put my pt's in status board so I can chart every quickly and look up VS and I and O's for now and for last week in nothing flat! Much easier than finding a CNA. We don't have computer's in each room or COW's yet, but there are enough around the desk and Med carts to chart as you need. I carry my printed shift sheet on each pt with me and jot down things as I need too , just to keep me straight. For a admit I do run a blank admission from so that is double charting to go back to and put it in the computer. But since we have the form to follow, have all the questions at hand. We have had computer charting over 10 years and it has become more nurse (and Dr) friendly all the time. Don't think I could go back to paper. We do have allot of canned notes we can use for routine things, just change what is needed.
Also can document notes and write anything we want or need. It takes awhile to get used to it ,I tell my CM all the time that I LOVE Change and the spell checker!
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twarlik
573 Posts
I assume you don't have computers at the bedside? We have a computer in every pt room and just chart as we go. No need to write anything down; just chart what you do when you do it.
Sounds like your hospital's system is a bit flawed.