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

[Been there,done that]

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 ?

[TDCHIM]

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.

Boy, that's a crying shame. You could have the greatest EHR system in the world, but without easy access to it while working with patients, it would still be useless.

[murseynurse]

I feel exactly the same. I am working on an elderly care unit. All care plans on the computer. There simply is not enough time to do this when you are very hands on. We have healthcare assiatants but they do not appreciate the nurse role. They think we are taking it easy sitting at the computer.... I feel quite stressed and feel like just quitting nursing altogether. Anyone else feel like this? Any coping tips?

[SmilingBluEyes]

Administration IS aware; they do not care. It's all tied to reimbursements and payments. It's not going away and they make money off nurses' backs.

Welcome to nursing 2016.

[akulahawkRN, ADN, RN, EMT-P]

First off, congratulations for reviving a thread that's only about 5 years old. Now that we've progressed about 5 years since there was any activity in this thread, it might actually be interesting to see where people's thoughts and feelings are about computer charting now vs then.

In my current job, we're using a Cerner EHR. I'm an ER nurse so I use FirstNet instead of PowerChart. I used to be a Paramedic and back then all my charting was done on paper and that took about 10 minutes doing 911 or about 30 minutes doing IFT, per patient contact. Doing 911 was nice because I usually didn't have much of a history or meds list to go through. Doing the IFT stuff took longer because there usually was more of a history and meds list to copy to my chart and more "stuff" I would have to chart about for my assessment. As long as I kept up with the charting, I was usually done with the chart about 10-15 minutes after the call was completed.

I'm familiar with Cerner and with Epic (and EHRs based on it). If you're used to using a "simple" spreadsheet, you can probably learn to use either without too much difficulty. The hard part of using any EHR is learning where something "lives" that you must chart about. Once you know that, you're good to go. As I stated earlier, I'm an ER nurse. The FirstNet interface isn't too bad, though I'm still learning the finer points of the system. Entering triage stuff into the system and doing my assessment takes the most time because of the data points needed. If the triage is already done, entering the assessment into the computer only takes me a couple minutes. We do charting by exception but there are times that I'll chart what I find because that stuff is pertinent, even the "negative" stuff and it only adds about 10 seconds to my charting. Quite honestly, while I don't mind Cerner that much and I actually liked Epic more, it really doesn't make much of a difference to me. Once you know where stuff "lives" in the computer, you can do what you need to pretty quickly.

Probably my biggest peeve about charting in general is that if you're charting by system, you very well could end up charting some aspect of an injury in several different places because it impacts different systems, for instance. An injury to a knee could very well end up requiring charting under MSK and Skin/integumentary because you have a laceration, abrasion, and ligament disruption all in the same area. I'd much rather chart, in one place (Extremities) the laceration, abrasion, and ligament disruption. It's just faster to chart and easier to read. In the grand scheme of things, it's a minor thing, really.

The "other" big issue with any EHR is ensuring that there are a sufficient number of computer terminals available to do the charting. I love doing bedside charting at times, but as long as I have a computer where I can do my charting that's NOT at the bedside, I'm good with that. At least our Docs don't have to borrow a "nursing" computer... they have dedicated computers for their use!

One of the more interesting things I've seen is when there are prox card readers on the terminals so that you just have to be close enough to the computer to automatically sign in and you can chart right away. Only one place I've seen has it. The best part of that system is that once you leave the immediate area of the computer, it automatically secures itself.

On the whole, I really don't mind doing computer charting... but like anything, you just have to get used to it and once you are, you're good to go. I have, however, heard more than one nurse state that she'd quit the day they were required to switch away from paper charting to computer charting. One minor thing in "defense" of paper charting is that sometimes you can have a graphic of the body that you can draw on. It's easier to simply mark the graphic with what you find than it is to write it down... and you can also show how proportionally large or small a given wound or skin problem really is.

Is there room for improvement? Sure.

[amzyRN]

I have EPIC and I love it! Charting is a breeze with this. I don't think having to chart extensively on care plans is particularly useful though. We have computers in the rooms, theoretically charting can take place at the bedside. I actually like getting away from my patients to chart. I look forward to getting out of the room to chart.

[cayenne06, MSN, CNM]

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 agree. On the balance, EMR wins hands down, but that does not negate the problems it has. Lack of interoperability being the main one, of course. I started on paper charts way back in 2001, and definitely prefer EMR over all, despite the problems. We just switched to Athena at my clinic, and have a dedicated team for clinicians to contact about suggestions or problems. It's a great system for the most part, and very user-friendly. And thanks to the support we have, the system just gets better as we identify and fix the problems. Just this week they fixed most of the double charting issues in the system, which has saved a ton of time.

In contrast, the hospital I work at as an RN just switched to full EMR (was half and half up until then- which is absolutely the WORST of both worlds). It is terrible. It doesn't talk to our monitors, so our EFM strip is still printed out and stored, and all vitals have to be manually transcribed into the system- not good enough to simply have them in the EMR we run our EFM on. We do have computers in each room, but they are primarily used for the EFM system and it is often not feasible to be charting in the patient's room- and we only have 2 COWs on the unit, so most of the time we are running back and forth between the patient's room and the nursing station to chart. It's annoying as heck. And SO MUCH double charting and clicking back and forth between different flow sheets to document something as simple as an IV insertion or focused assessment.

Nothing like transcribing q 5 minute vitals into the electronic health record. Or clicking back and forth between 3 flow sheets to document your straight cath and urine output. And no alerts for new orders- you have to check the "face sheet" for each patient to see if any new orders have been put in. Sigh. So fun.