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 ?
We have has ours in place for about 2 years now and we have worked and streamlined as much as we could. Unfortunately, there are areas that are repetitive, but that is just how the program is . We use EPIC...once we got things figured out it is actually quick to use. But you also have to have a good committee in place to work with the system. We spents hours and hours going thru stuff, cleaning it up, rebuilding a lot of it. It was so frustrating. There are still bugs in it, but you can always find a way around it. The I/O section is the section that gave us the most grief with IV's not being pulled in things not calculating right.
We chart as we go along (each bedside has a computer) and the teaching and careplans are easy to use once you get used to it. And orders...we can read them, they go to the appropriate areas (ie radiology, pharmacy) and that has made our lives a lot easier!!! No more chasing around to find who wrote it because you couldn't read it!
You just have to go with it...it isn 't going to go away, so you have to make the best of it. Grumbling is allowed, but be constructive!
I love computer charting and can't even imagine what paper charting would be like. On the other hand, a lot of the charting is repetitive and seems like a waste of time.
I'm a nursing student and I've experienced both paper and computer charting. I have to say that I greatly enjoy the computer charting so much more than the paper charting.
My very first clinical, the hospital had paper charting and paper MARS. My goodness, talk about a nightmare. I never seemed to be able to find the information I was looking for, and trying to figure out what med is what on a reconciliation sheet could take forever. Errors were messy and annoying.
For my clinicals after that and this semester we use computer charting. I love it. I can look at the orders, MAR, notes from every type of profession in the hospital, etc. When I have a patient that's been transferred to our facility from another outside hospital, it's a pain in the butt to try to decipher the handwriting, interpret the short hand, and look through the bulky chart from the transfer because I love the computer stuff so much!
It's not so much if electronic or paper documentation is inherently better or worse for patient care; paper or electronic can be problematic depending on the efficiency of the particular system in place and inherent limitations of different systems as well as financial constraints.
Instead of jumping to conclusion that electronic or paper documentation is always inferior/superior, note the deficiencies and problems of the particular system in place.
I do agree that many electronic documentation systems are very poorly designed for bedside charting. Very frustrating!
I find electronic charting a hindrance to good and proper patient care. I do not like to chart at the bedside, because I cannot "chat" and chart. Also, at times it can be a problem having visitors hanging around and being able to read what I chart. All those forms someone was complaining about? You'll have them on computer charting too....the difference is that you can't be looking at two or three of them at the same time, and forgetting what you've done or not done is harder to spot. I know for a fact that my charting now is not as thorough as it was when I paper charted.
I love computer charting!! Sure, I've worked places that were on paper (and now slowly going to computer), and I much prefer computer. If your system is streamlined and fairly user friendly it should take only a couple minutes per assessment, even with the most complex of pts.
Honestly, it really depends on the type of system and how your facility is set up to accommodate EHRs. There are some programs that are just awful from the very start. There are others that have excellent potential, but if they aren't appropriately tailored to your organization's needs, they can be a real pain. But a solid program that's planned and designed with plenty of input from people on the front lines can be a real plus. I agree with jjjoy - it isn't that all EHR systems are automatically better or worse than all paper systems, but a question of how well the system in question is planned, designed, and implemented for ALL purposes, especially patient care.
Does your facility have any sort of oversight committee that addresses such issues? Could you and the other nurses on your unit send a memo listing the specific problems you're encountering and your concerns regarding the impact on patient care to the appropriate committee, the head of your health information management department, or even to your CIO?
Yes, Epic is BY far the best system I have worked with. It depends on the facility of course, but I had to chart a complete assessment q4 hours. The physician order system was awesome. However, I have worked with systems where only nursing charts electronically,and we still have the time consuming efforts of reading and noting orders,,, a true nightmare!
I don't mind electronic charting if it can keep up with me. It becomes frustrating when the system is running slow and you have to wait for the next page to load. I too take my lap top with me and chart at the bedside. It allows me some extra time with the patient, extract more info from them, watch them and there is always one thing I forget to look at or ask and this saves on sneaker tread...I'm right there to get the missing piece of info....was the IV in the right or left arm? was it an 18 or 20g? etc.
I don't mind electronic charting if it can keep up with me. It becomes frustrating when the system is running slow and you have to wait for the next page to load. I too take my lap top with me and chart at the bedside. It allows me some extra time with the patient, extract more info from them, watch them and there is always one thing I forget to look at or ask and this saves on sneaker tread...I'm right there to get the missing piece of info....was the IV in the right or left arm? was it an 18 or 20g? etc.
Lap top? You have a lap top? I'm dragging a thing that weighs thirty pounds down the hall every time I want to give a prn med.
I sometimes get to work in the short stay unit where they still do paper charting, and believe me, its MUCH quicker to enter it by hand.
BittyBabyGrower, MSN, RN
1,823 Posts
We have has ours in place for about 2 years now and we have worked and streamlined as much as we could. Unfortunately, there are areas that are repetitive, but that is just how the program is . We use EPIC...once we got things figured out it is actually quick to use. But you also have to have a good committee in place to work with the system. We spents hours and hours going thru stuff, cleaning it up, rebuilding a lot of it. It was so frustrating. There are still bugs in it, but you can always find a way around it. The I/O section is the section that gave us the most grief with IV's not being pulled in things not calculating right.
We chart as we go along (each bedside has a computer) and the teaching and careplans are easy to use once you get used to it. And orders...we can read them, they go to the appropriate areas (ie radiology, pharmacy) and that has made our lives a lot easier!!! No more chasing around to find who wrote it because you couldn't read it!
You just have to go with it...it isn 't going to go away, so you have to make the best of it. Grumbling is allowed, but be constructive!