Electronic Charting Question

TDCHIM · Oct 18, 2010

What kind of system will you be using? Or hasn't that been decided yet?

pippylockstocking · Oct 18, 2010

Biggest issue is with CPOE ( Computerized Physician Order Entry ) or "K-poe" as some will like to pronounce it. The docs don't like having to enter their own orders. They will avoid for as long as they can. They will ***** N' moan. They will use sneak tactics to get out of doing it. For example... many of them will just telephone their orders into the RN... seems innocent enough right? They will try to give you entire order sets or admission orders over the telephone. That's not what they are supposed to do. I worked at 2 hospitals doing this. The 1st gave them 6 months to get on the bandwagon. Then it was mandatory. The hospital I work at now started piloting the policy on other units. Soon my unit will be CPOE and it's not going to go well with the docs. They are moaning about it now. At a big teaching hospital it's not a problem because there are many interns or residents or PA's who can do all the computer entry. But at smaller community hospitals the docs don't have the additional staff to do it for them.

As for Nursing documentation... 1st hospital had a wonderful system... easy, user friendly, easy to navigate, fast, and organized. Hospital I work at now just got their system about a year ago. It's called CPSI. It's slow, it crashes all the time, and it's not user-friendly. You gotta click on a hundred different places just to get to the one item you need. In my opinion it is not easy to navigate and thus it is time consuming. Wish I could remember the name of the program from the 1st hospital. That one was a breeze!

Up2nogood RN, RN · Oct 18, 2010

We have had CPOE for the past year and were really excited but it seems that's there's always a reason why the docs can't do it. Very frustrating because they've made the docs electronic order sets as easy as the paper forms but they don't enforce them.

We use McKesson? now and it seems to work fairly well but were informed of the switch to Epic within 2 yrs.

Pepper The Cat, BSN, RN · Oct 18, 2010

Well, after this weekend I'd have to say "what are the downtime procedures?".

We are computerized - all lab work, test results, all charting, etc. Only thing done on paper are MDs order and MARs. Although the MARs are computer generated. Our system crashed at 9:30 am Sat. I had several pts requiring daily coumadin doses by the MD on call. I could get Sat INR results but not Fridays. MD on call was not on on Friday so would not know results. Lucky for me, system came back up about 5 minutes before MD came, so we could dose coumadin properly. System crashed again 4 hours later and stayed down for another 12 hours!

Let me say, after having to paper chart I really appreciate computer charting now, but think they should be some way to access backed up charts for lab results. Perhaps there was a way, but being the weekend, there was no one to ask !

I would also say, watch for the need for double documentation. When we get an admission, a pt goes sour, etc, we have to write a nsg note but then have to write the exact info again in the shift report. We always say there should be a way to have the info go into both the focus notes and the shift report at the same time.

Up2nogood RN, RN · Oct 19, 2010

Well, after this weekend I'd have to say "what are the downtime procedures?".
We are computerized - all lab work, test results, all charting, etc. Only thing done on paper are MDs order and MARs. Although the MARs are computer generated. Our system crashed at 9:30 am Sat. I had several pts requiring daily coumadin doses by the MD on call. I could get Sat INR results but not Fridays. MD on call was not on on Friday so would not know results. Lucky for me, system came back up about 5 minutes before MD came, so we could dose coumadin properly. System crashed again 4 hours later and stayed down for another 12 hours!
Let me say, after having to paper chart I really appreciate computer charting now, but think they should be some way to access backed up charts for lab results. Perhaps there was a way, but being the weekend, there was no one to ask !
I would also say, watch for the need for double documentation. When we get an admission, a pt goes sour, etc, we have to write a nsg note but then have to write the exact info again in the shift report. We always say there should be a way to have the info go into both the focus notes and the shift report at the same time.

Yikes, our computers went down Saturday at 0500 and came back up a little before 0700 but still very slow and glitchy. Supposedly there is a master computer that will print ALL active pt orders since we have no way to see our pt orders since they're all on the computers we can't get into. Since this wasn't a 'planned' downtime I don't think the nursing supervisor printed our orders for some 400 pts, hoping the sysem would come back up. We have crappy downtime forms and avoid them like the plague at all costs.

pippylockstocking · Oct 19, 2010

Oh I have heard of Epic... have only used it briefly... can't tell you what to expect. But check my post regarding the docs and their reluctancy to use CPOE. They always try ways to get out of it. The docs at our hospital are telling the secretaries that they won't have jobs anymore. Which is not true because at the 1st hosp I worked at with CPOE, we still had secretaries and were a much needed team member.

Hoozdo, ADN · Oct 19, 2010

No double, triple, or quadruple charting the same things.

For example, I am used to Cerner Millineum charting. Don't make me chart every

drug titration change on the continuous meds flow sheet and rechart the same thing

under I&Os. The program needs to be smart enough to chart I&O drugs because

I just charted what I did under continuous meds flow sheet.

Don't make me chart glucose numbers, then have the glucometer upload the same

number. Don't make me chart the same IV start date/time at least 4 times in

the same shift - carry through the information.

Yeah, I will be on your committee. :idea:

mikeworksRN · Oct 19, 2010

Thanks, all. Excellent answers. The system will be CPSI. We're waiting to see how a relatively easy program will be configured to confuse and create havoc...

pippylockstocking · Oct 20, 2010

oh man... CPSI? if there's anyway you can talk them out of that then you should... that program is lousy! It's very difficult to navigate, slow, crashes all the time... There are much better programs on the market.