Electonic documentation,how much time does it take from the bedside?

[Been there,done that, ASN, RN]

I have recently learned 3 different EMR's. I feel the time needed to document in this format GREATLY takes away the time I need for patient care. There is NO end to the areas needed to document my nursing interventions.

Administration does NOT factor in this additional time necessary for documentation, just another "duty" we are Responsible for!

How can nurses make administration aware of this ?

[solneeshka, BSN, RN]

Great question. It takes way too much time away from the bedside. There are nights when it feels like I spend half my shift charting, and I'm not exaggerating. The problem is all of the modification that needs to be done to the template in order to include everything you've seen. And all that time hunting down where the "parameter" is to add to the basic assessment in order to chart something that's too important to leave out, it's maddening. I've seen many nurses deal with this by simply charting really crappy assessments. I've seen others deal with it by pretty much just copying the assessment from the previous shift. Me, I take the time to do it right and then deal with snide comments because I don't have a spare hour to sit around texting or surfing the internet. Really, really wasteful!

[steelydanfan]

So much of the form assessment is overkill and duplication. Yet the IS people INSIST you put certain things in a certain box, even though they have ALREADY been charted elsewhere. Why? Because it is easier for THEM when they go to do compliance evals. Have any of you had problems trying to order through Central Supply? Tried to order a shampoo cap for a pt. Not under "shampoo". Not under "cap". Where was it? Under "hygiene, personal pt.". No nurse input happened there.

Oh yeah, I shoulda known, huh? There was NO nursing input to ANY if the programs we run, heck, they can't even keep the system from crashing at least once a day. The doctors continually complain about the decrease in nursing care and how all they see is nurses in front of computers. I keep telling them, " You can fix this, they did not factor in more charting hours to the system, complain to management". If all the docs got on board, management would do something. They just don't listen to the peons. I can't WAIT to see what happens when computerized doctor's orders start. The excrement will hit the whirring blades is my guess.

OBTW, thank GW Bush for all this. When he was in the hospital for something, he got totally ****** that some of his records were not IMMEDIATELY available, and the rest is history.

[Work in Progress]

Every kind of computerized charting is different, so I can't comment on the ones you have had experience with, but ours is really quick and efficient. It takes me 3-7 minutes to chart a full and detailed assessment, depending on how complicated it is. We just implemented it last year and they are constantly working to improve it. It takes a fraction of the time of our old hand written documentation, which took me longer to do even when I was simply charting my CNA/Nurse intern things. We also have computer physician order entry, which is also very quick and efficient. From the moment it is entered, it takes probably less than 2 minutes for the meds to become available in the pyxis under the patient's name. There is no faxing, no checking off orders, no deciphering of handwriting and no searching through paper to find parameters or orders if there is not an updated Kardex. I love our computer programs and wouldn't go back to paper for anything.

That being said, I can see the frustration with a lot of those programs. I encountered some of them in school at different facilities, and not all of them are easy or intuitive to navigate.

[HyperSaurus, RN, BSN]

I wonder if it is a matter of whether you first learned to paper chart or went right to EMRs. I'm a nursing student and all I've ever known is electronic charting. While the program is admittedly crappy, it still only takes me about 5-10 minutes to post a detailed assessment, update the vitals and I&0, and make any necessary progress notes.

We haven't started with electronic MARs yet, although that is coming.

[neenrn]

I work in an OR, when they "upgraded" EPIC we inherited a bulky, cumbersome system. I now spend all my time charting ... some cases are done before I can even get to documenting the time out. I feel like I am there to chart not circulate the room. And that leads to a lack of patient care. I am not cool with that.

[Up2nogood RN, RN]

Every kind of computerized charting is different, so I can't comment on the ones you have had experience with, but ours is really quick and efficient. It takes me 3-7 minutes to chart a full and detailed assessment, depending on how complicated it is. We just implemented it last year and they are constantly working to improve it. It takes a fraction of the time of our old hand written documentation, which took me longer to do even when I was simply charting my CNA/Nurse intern things. We also have computer physician order entry, which is also very quick and efficient. From the moment it is entered, it takes probably less than 2 minutes for the meds to become available in the pyxis under the patient's name. There is no faxing, no checking off orders, no deciphering of handwriting and no searching through paper to find parameters or orders if there is not an updated Kardex. I love our computer programs and wouldn't go back to paper for anything.

That being said, I can see the frustration with a lot of those programs. I encountered some of them in school at different facilities, and not all of them are easy or intuitive to navigate.

Our EMR systems very similar. It's not taking time away but adding time with my pts as I chart my assessment at the bedside. The pts love it, more time to chat. Oh and we only chart one assessment per shift (charting by exception) unless there's a change, it just takes a few minutes and I seem to be able to really get to know my pts. I've worked at another facility where an assessment is done Q6 hrs, changes or not and is very redundant. I also work at a facility with all paper charting and it's super cumbersome to carry and flip thru charts all night!

[jossjjojo]

Electronic documentation is far more organized, accurate and faster than charting with paper and pen. Been there, done that, EMR's only for me.

[coolpeach]

We are going to electronic charting at the beginning of the year, but right now we are still charting on paper. The charts are gigantic!!! The first time waster and just finding what you need. Then we have to do a 24 hour assessment form, a graphics form, a teaching form, a safety form, and long form hand written focus notes about everything that you did that shift on that patient (it usually takes up 2 pages). There are also other forms if the patient has a PCA, a wound vac, a pump etc. The forms are never ending!!!!

With paper charting we literally have to sit in the nurses station and chart. If I have 5 patients I will literally spend half my shift charting. Sometimes I feel I am more a paper pusher than a nurse. After every thing is charted we have to review the orders for the last 24 hours by trying to decipher the handwritten doctors orders and comparing them to whats in the computer.

I can't wait for electronic charting...Anything has to be better then this.

[TonyaM73, ASN, RN]

I have just moved from a LTC facility to the hospital. In the LTC we used paper charting, which was fine for submiting your notes, but couldn't find a thing when you needed it or you couldn't understand the writing. In the hospital, everything is right at your fingertips on the computer, if it has not been filed away in the chart yet. We can chart at the bedside and talk with the patient. When you can't remember which arm the iv is on, you just turn around and look. I really like it a lot and my patients seem to like the fact that I am in the room with them more often and am taking a good interest in their overall physical and mental health. I just let them know what I am doing and tell them that I will ask questions occationally to be able to chart accurately.

[RNperdiem, RN]

Luckily where I work, nurses were involved with the selection of software for computer charting.

Several years ago all of us attended classes for a horrendous computer charting program. The nurses who had influence protested enough so that we never bought that software system.

Nurses helped select the system we use today and are involved with tech support for changes needed. Our hospital was sensible enough to provide enough computers to go around.

Even with a good program, I miss the days I could fill out the ICU flowsheet from vitals to output in less than 5 minutes.

[MsbossyRN]

Some places use great electronic systems. We are no allowed to double chart. If its checked off in one program, no need to put it somewhere else. Charting by exception helps too. I would rather chart on a computer as opposed to paper charting any day. I think it makes everything easier. Everything about my patient is right there in one place. I find that charting doesn't take away from patient care in most cases. Most nurses I work with don't spend most of their day charting. We are in there with the patients getting stuff done. Now if something is serious, like a rapid response then of course a lot of charting would have to be done. Suggest the improvements where you work at, hopefully changes can be made.