EHRs stink!

[imintrouble]

My small rural hospital has transferred to totally electronic charting. Implementation started about 3 months ago, and was completed about a month ago. I feel like my license is in jeopardy.

Med errors are shocking. Nothing critical, but an error is an error.

Nurse notes are inadequate simply because we have no time. I know. I know. It's my responsibility. No time / is no excuse. I need to take as much time as necessary to chart competently. The thing is charting is left til the end of the shift because everything else has to be done within time parameters. By the time I can chart, I'm physically and mentally used up.

Ancillary staff is entering VS, I & Os. CNAs are entering their own notes.

I don't have time to double check everybody elses' work because it takes 14 hrs to do my own.

I leave work and I absolutely know I've not covered my butt as I used to do with paper charting.

Management keeps saying "It'll get better". It will. It already has. But what about now?

Everyday for the last month I've left work feeling inadequate. The stress is almost unbearable. It's not

just me. We all look shell shocked at the end of the day. The last night I worked I literally did not eat anything for 12 straight hrs. Nobody has time for a lunch. Taking an hour, means adding one to the 14 you're already there. I liked my job. I liked where I worked. Now I just view it as a mine field I try to negotiate safely.

When can I expect sanity to return? Or will it?

[imintrouble, BSN, RN]

Thanks everybody. It helps to know 1) It does get better. 2) Not all systems are the same.

I was honestly starting to believe it was MY problem I couldn't get fast enough. That was what was bothering me the most. I'm no spring chicken and it's hard to compete with kids who had a lap top in grade school.

Thanks again for all your input.

[~Mi Vida Loca~RN, ASN, RN]

Hate to say this but it really gets better. The only problem is that many hospitals are rushing to implement the system lacking better implementation. I don't know what the rush is but i think its related to the new Health Legislation. I work for the biggest Healthcare in California and we use an Epic Based system tailored for the organization and have been Live for the last 3 years and loving it. But to get there the system was implemented in 2 phases. Phase I started in 2005-2008. In Phase the system was used to store medical information such as labs, imaging, EKG's and provider notes on ER and PCP visits. Nurses still had to chart on paper we used paper MAR's. MD's could do some charting but all orders were done on Paper. Phase II started in Mid 2008 where everything now was done on computer ; orders, labs, MAR and the cool part was scanning medications to ensure safety. By this time we were used to the system plus it took them 5 months of classes and test runs before we could go Live.And when we went live they had EPIC certified staff + IT work with us on the floor for another 2 months for support. Of course there were issues when we went live due to change but as of today we love the system and don't we hate it when there is a scheduled maintenance/update(which happens on nights) and we have to pull out the paper charts.

Back to your case...i have a per-diem in a rural hospital ER which just implemented the system a month ago to an EPIC system. They were using IBEX. Everybody is frustrated since they only scheduled nurses for 3 days(18 hrs) of training one month before implementation and they only had EPIC staff + IT staff for only 2 weeks and they were gone. As an experienced Epic user i am getting afraid of the situation where orders are missed or people don't know where to find orders. We are unable to scan medications and in many instances people over ride medications. The purpose of EHR is to encourage efficiency and safety. And the worst part is that they have not uploaded old records into the new system. So i understand your frustration. As a Super User i have some tricks of dealing with bugs:

- Have a white board or a book where people can write their concerns and problems with the system.

- Have processes created for the common tasks e.g administering medications, I & O's, Lines, Vitals, e.t.c

- Have a policy on what support personnel are supposed to chart in the system. For example the ED techs are able to chart vitals, make a note that an EKG was done and also enter the time, write a note about a splint placement e.t.c. Support staff should be discouraged from writing too much.

- Every bug encountered should be logged and forwarded to system support staff in the IT dep't/ Help Desk.

- Have weekly meetings between staff, management and super users to see if previous issues have been resolved.

And after that it should be easy. Once you know where to find what you want it becomes easy and there is increased efficiency and flow.

Pros of EHR's

- Increased efficiency and Safety.

- Better consolidation of information. Its easy for me to know more about patient condition and previous visits to department, mulch-disciplinary noted, easy access and compare data e.g labs(old and new) , visits, print old EKGS's, MD's can compare imaging, allergies all at one click where information has been verified and less easy to make a mistake.

- Centralization of care. Everyone involved in the care can access the charts and care continues; hated it those days everybody wanted the chart and there were delays.

Cons

- Makes critical thinking seem redundant; there are order sets to be followed and some department policies are overtaken. 3 years ago i could order Tylenol for a baby with fever in Triage , draw labs based on systems, could administer a nebulizer to someone wheezing or even order an X-ray for someone with ankle pain. Today i can't and have to wait for the MD to see them. I can do some stuff without waiting for an MD e.g EKG, SL with blood draw when its definite we need them but i will have to wait for the MD to order the labs plus i will have to ensure that he/she enters the orders. Of course the MD expects that you did all this but they have to ensure the entries are done.

- Nurses concentrate too much on the computer at the expense of the computers. MY argument is that you can always back chart what you have done. Just like they taught you in nursing school; first look at the patient.

Sorry about the long rant but i hope this helps and trust me it will get better

We still have order sets and can do those things you mentioned with EHR. The orders are already put in.

[RNFiona]

I actually find computer charting FASTER and and more efficient. Most paper charts are illegible.....I chart as I go as much as possible...I NEVER leave it till end of shift and I almost always get out on time...and I like that the computer prompts you to enter things you may have otherwise forgotten with a paper chart. Also it's nice to not have to spend half the shift looking for the damn chart.

[RNFiona]

I think it depends on the system and the user. I have used many different computer charting systems and will take ANY of them over paper charting any day. Some folks are just very resistant to change, even if it is for the better.

[RockinChick66]

I find your post interesting because I feel like the EMR makes my job much easier.

[tyvin, BSN, RN]

Electronic Medical Records Deadline: Penalties For Not Using EMR?

I am in favor of EMR's but I think the rush is not good for some places and people. If the places are not ready to put EMR system in; I mean what if they don't have the money; aren't set up for it tech wise? Everywhere I go lately nurses, techs, and the like are more preoccupied trying to learn the software then really paying attention to what's up. Way too much stress. That's what happens when non-medical, non-health care persons draft legislation. They have had from 2010 to begin.

[tyvin, BSN, RN]

EMR vs EHR: Understanding The Differences | CareCloud

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