CPOE and still using paper UGH

[hes2371rn, ADN, BSN]

At my facility we implemented CPOE about 1 year ago. We have multiple systems that do and don't talk to one another, but we are still using paper charts. One of the hardest things is getting all of the physicians to use CPOE and not handwrite orders. I suggested that we take away the "paper" physician order sheets but then there was a question as to how the nurses were to do their chart checks without the physician order sheets. My suggestion was to make up some type of form that reviews everything that should be done in chart check, and have the nurse sign off that they did that each shift.

Has anyone had this type of issue implementing CPOE, have any suggestions??? Thanks

[Wile E Coyote, ASN, RN]

What worked for my facility was that the medical leadership set a hard date to switch to cpoe and stuck to it, period. The paper option was simply off the table. Someone in your facility needs to present that to your leadership. Of course, the message of just how broken it is right now needs to get through to them, as well. If they care, then it will change. If they don't, it will remain on nursing's shoulders like so many other issues.

Our EMR system has chart checking capabilities built-in. It's only good for the core charting items, as OR, ER, Cath lab, etc don't "talk" to it...perhaps similar to your situation.

[hes2371rn, ADN, BSN]

What worked for my facility was that the medical leadership set a hard date to switch to cpoe and stuck to it, period. The paper option was simply off the table. Someone in your facility needs to present that to your leadership. Of course, the message of just how broken it is right now needs to get through to them, as well. If they care, then it will change. If they don't, it will remain on nursing's shoulders like so many other issues.

Our EMR system has chart checking capabilities built-in. It's only good for the core charting items, as OR, ER, Cath lab, etc don't "talk" to it...perhaps similar to your situation.

I am working my with CNO on this, it has been brought up to all MD's in the proper committees that CPOE is here to stay and has to be done. Many are compliant, but there are still some who do not use at all. there is no EMR per se where I work, only in the ED. The rest is all paper, then a program to put in orders that do not go through on CPOE, a VS program, and one that you can look up labs and consults (I know its crazy). So when upper management was complaining that the physicians were refusing to use CPOE I said "just take the paper away", but now we are trying to figure out how the nurses can do their chart checks, which are normally documented on a physician's ordersheet

[MunoRN, RN]

I'm not sure why it is you feel you still need to do chart checks with CPOE? Generally, the purpose of chart checks is to review back over a specified time period in the paper chart and make sure all the written orders have been seen and entered into the computer. Since that step (writing an order that now needs to be entered by someone else), no longer exists, there is nothing to "check". The only thing left is to "acknowledge" the new orders which typically an EMR will have some way of doing; usually a screen of new orders that can be reviewed and cleared after being acknowledged.

[hes2371rn, ADN, BSN]

Unfortunately our CPOE orders are either "processed" or "not processed"...the not processed order require manual order entry into the computer, so chart checks are still required to make sure those orders have been put in.

[roser13, ASN, RN]

2.5 years into EMR and management is still accepting paper. Makes me pull my hair out every single day as the paperwork never arrives or arrives and is lost. In the meantime, corporate paid mucho dollares for the initial EMR program and continues to pay in the tens of thousands monthly for the upkeep & continuing support.

[NurseStorm, BSN, RN]

We have an option for chart check on our system. The physician order sheets have been removed and are stored in a back room in case of computer down time or significant emergency and computer issue, etc. We also have a few areas doing hybrid charting (some paper, but orders, labs, etc are all on computer) such as mother baby, labour and ICU.

[blondy2061h, MSN, RN]

My chart checks now consist of me scanning through the orders put in the EMR with it filtered to "today" and "yesterday" just to see what med changes have been made, so if my patient gets a rash, I can think "Oh yes, they were started on Vanco today" or when they have an AM lab glucose of 295 I can remember that new order for 120mg of medrol I saw. Also, they can put in miscellaneous orders for things that don't translate to the MAR, like "If systolic blood pressure greater than 160, recheck after pain medication given before informing on call provider," so those orders are good to see. Once we are assigned to a patient, the EMR will show a flag when that patient has new results or orders. We just need to click the flag to see them. If I know I'm back the next day, I can leave the flags turned on and click them first them when I come back to see everything that's changed in the 11 hours I missed.