Electronic Kardex for Psych Nurses

[Seasoned]

To Seasoned /Experienced Nurses,

Well have they taken or intend to take your kardex away?

The powers that be are probably calling the kardex outdated, a dinosaur, calling you addicted to it. Maybe they are proud of the electronic records they spent a fortune to get and trained you to use but your colleagues want to keep a kardex. The free-standing psych facilities understand the need with keeping a kardex or some version of what a kardex offers:the same information of all patients in one spot on a clipboard ... something. Psych Units in a general acute hospital have the least understanding of the importance of a kardex. After all all the other units in the hospital operate the same and fine. The electronic record is built on a medical unit model and leaders just don't understand...how having certain information only in individual patient profiles and doing "bedside" shift report is the primary nursing care approach which is inefficient and inappropriate nursing in a community milieu setting with the team approach to nursing care in a shift i.e., psych units.

:) Well you are not alone in your frustration and I offer some help and request help. Leaders do not understand that, particularly being off duty and virtually all the patients are new to you, issues that one nurse forgot to mention in shift report can be dangerous to the patient or the milieu e.g., a or their violence level is labile and 2 days again attacked staff or another patient. Staff may remember the incident but which patient? Where is there a list of all the diabetics, violent patients, patients with court orders for criminal holds, how a patient looks, etc in one resource that the Charge nurse must know exists on the unit? How do you keep that information current or accurate on each patient such that the unit acuity as a whole is apparent for appropriate staffing if nothing else? Well folks, that type of listing available in one spot is known as a KARDEX! Yes originally it was the name for the information housing. It then became the name of the one stop resource.

If you have the EPIC EMR here is a way to get that information:

1st - CREATE the actual kardex format the same way you develop your personal patient list. EPIC will print out just your assigned patients or the whole unit, you choose. The kardex listing can contain most basic things, e.g., Room No. Patient, Age, Sex, Primary Problem (admitting dx), Pending D/C Date, Length of Stay, and Admission Comments (i.e., a blank space to write in stuff) of each individual patient on one sheet as well as the total number of patients and the time the data was assembled. Label your new listing "kardex" so you know what it contains. Patients from your list is dragged to the kardex title. All appear! Or drag the Unit Patients to the kardex title to get the whole unit. Ah... sorry it is an individual patient name drag.

2nd - RESEARCH with that matrix printed out (sorry only in portrait set-up style) you can write in what you need that is lacking. To get the latter information you have to go into each individual patient profile under "Patient Summary" or "History" in the menu . For example I am in a psych specialty, the primary diagnosis is only psych. It is dangerous nursing not being aware of the medical (physical) dx as well so we have to write it in. After you open a patient's medical record, vertically down the left side is the menu. We click on History (or Patient Sumary) and get the other stuff we write in: diabetic, seizure d/o, fractured arm, etc.

3rd - SAVE that original information matrix as your personal kardex via copier print-out. That will be a copy you can write shift notes on then discard it at the end of shift report or give it to your relief nurse. The next time you work, print off another copy for shift notes...etc

I created the above survival tool and colleagues are extremely grateful! It is supposedly temporary until Informatics creates something exclusively from EPIC in a simple print-out. After abrupt loss of our kardex tons of toner and reams of paper was being used as individual nurses print excessive information from the electronic files to get the basic clinical information they needed. Contact me if you want me to walk you through it. Or PLEASE contact me or post if you can improve on my system!!