Electronic records and computerization:Improving care or creating more chaos?

[FireStarterRN, BSN, RN]

As our hospital moves towards more and more computer driven care, I'm finding it more difficult and frustrating to be a nurse. I'm really getting tired of this new aspect of life. I was talking to my social worker friend and she is also suffering under this. She works for mental health.

I just seems as if, as well meaning as it might be, it's not accomplishing it's goal. It's creating more chaos at the the bedside and more job security for tech support and computer companies. They keep tinkering with the systems and cause unexpected problems. Recently I went to put in some orders and there was a glitch in my unit's computers. I had to take my orders to another unit and have the unit secretary there enter my orders, even though I had the time to do it and she was busy with something else.

I'm wondering if we are setting ourselves up for a huge infrastructure collapse. I also question the wisdom of putting our faith in computer programmers. It seems as if their programs always fall short and cause the bedside nurse frustration and grief.

[SandraJean]

It seems to me that I am spending a lot more time documenting and that takes time away from actually caring for my patients. It's frustrating.

[Sassybottom]

All throughout school I rotated through hospitals that relied on a paper system. One hospital had a very amateur computer system - think black screen, blinking green letters, the early apple computers - yuck.

Anyway, I am now working at a hospital that allows nurses to electronically chart on a patient. I am sooo much happier with this electronic system. It is so much more efficient - no lost papers, no hunting down or waiting around for others to finish up with the chart, and everything is so much more organized. I dread wading through old charts for things like a patient's pacemaker model. Sure, there are times when the computers will fritz out or slow down but I will gladly accept this over going back to paper charting.

I would love it if the doctors and other health care members started typing up their progress notes.

Overall, I am a huge huge fan of moving towards more and more computerized records and charting. I would never want to go back to a paper system.

[madwife2002, BSN, RN]

When I came to this country I first worked with computer charting I thought it was really good but I didnt realise how much time you save until I moved to a new job where we paper chart. I cannot wait until we adopt a computer system and I start computer charting again.

[EmmaG, RN]

It really depends on the system used. Where I worked before starting the travel job used Meditech, and we had an awesome IT department that didn't hesitate to customize the system to our needs and requests. Once past the learning curve of switching to computer charting, it was much faster. For a time we used handheld computers (looked like gameboys lol) that were wicked fast--- I could chart in the room while assessing the patient, then plug it in for download and be done with it. The downside was that as night shift charge, it was up to me to run off all the records produced during the day and file them on the charts. Ugh. Reams of paper every night...

Since I've started traveling, I've come across some very burdensome systems where I'm taking forever to chart. In these cases, I wish I had the old flowsheets back again.

[WickedRedRN, BSN, RN]

Seems to me it depends on the software being used. I have been in facilities with awesome systems and software, charting is so quick! Then I have been places that purchased outdated software coupled with not so top of the line equipment and it was total chaos during the rollout, not to mention 6 months later still having lots of problems.

Now, I am stuck in the dark ages, no computer charting, everything is paper. Dear Lord...I cannot believe how much paper there is and how long it takes!!

But you bring up an interesting point. A coworker of mine tells me he gets regular email updates telling him how computer charting is a liability nightmare for nurses. I still maintain you can type any descriptive note and therefore should be able to CYA in any case.

[All_Smiles_RN]

I am a huge fan of moving to computers. Our system goes back three years at this point. So I get a name of a patient coming up from the ED. I can read old H&Ps, consults, progress notes, cath lab reports, labs, ct scans, etc etc. I'm more prepared when the pt comes up from the ED. I also see current lab values, when the next set of cardiac enzymes are due, NPO status, etc before the pt gets to the floor. The system has an infection control flag so you know if they've ever had MRSA/VRE/C-diff immediately.

Once you become more familiar with the system and the glitches are worked out, I think you'll love having all the info you need at the click of a button.

P.S. the system we use is Sunrise XA (windows based software)

[EmmaG, RN]

But you bring up an interesting point. A coworker of mine tells me he gets regular email updates telling him how computer charting is a liability nightmare for nurses. I still maintain you can type any descriptive note and therefore should be able to CYA in any case.

The first system we used was horrible. The computers were in the rooms as well as the desk, and they didn't have a normal keyboard; each button would type out a phrase rather than a letter. It was awful... then one night I passed by an empty room to see the monitor going wild. It was charting on the previous patient. All on its own. Nonsense, run on sentences... and I couldn't get it to stop.

We went back and read through a number of charts and found that this had been occurring on nearly every patient at some point. Even (as I had witnessed) after their discharge. What a damned nightmare. It couldn't be deleted, and the IT person refused to help us edit, telling us it was "no big deal". I asked him if he'd be willing to testify to that effect in all lawsuits that might arise during the time these computers were self-charting. He didn't have an answer to that one.... and luckily, we got rid of him AND that crazy system.

[Preemienurse23]

The hospital I used to work at just went to paper charting and it was an ok system. But the NICU I am in now, has the most amazing charting system. I love it! Most of my responses are in an easy menu to choose from, For example if I start an IV it has the various sizes, locations, how we prepped the skin, dressing..etc. I have all the room I want to type notes. And the best thing is, NO READING DR'S HANDWRITING!!! The Dr.s and NNP's all do their notes and orders on the computer! One of our Dr's designed this system before he retired. I would be happy if I never had to paper chart again.

[not now, RN]

We primarily do computer charting with a little still in the chart. This gets confusing because I can't remember where to find things sometimes. We are supposed to go all computerized soon ("No pen by 2010!" seriously, that's what they say). ICU is still paper because they need a different system, ED is completely on the computer.

The assessment charting is awesome because it's all "by exception" which makes it faster, in theory. You used to be able to copy your previous assessment from the day before and just change what needed to be changed. Now, when you chart your assessment the previous assessment (from the previous nurse, not yourself) is shown on each screen and you can change it as you see fit.

All physicians/NP/PA are "encouraged" to write their orders on the computer. When it's done it's great because it prints for me to put in the chart, order processing and pharmacy receive it without having to fax it to them. Oh, I also don't have to decipher handwriting.

Physicians can also check the progress of their patients (V/S, labs, X-ray, ect) from home or their offices and write orders. We can do a "Condition Update" and write requests recommendations that they can see from home/office.

I don't like having to log in and out every time. I don't like when admissions doesn't put my patient in the computer. I can't see the ED report until it's logged into our system. At times I feel like the system doesn't give enough information "at a glance" meaning I can't scan the nurses notes like I used to. The biggest problem? Not everyone is comfortable using the system, both nurses and doctors, which can cause confusion.

[EmmaG, RN]

"No pen by 2010!" seriously, that's what they say

:lol2:

That is hilarious!!

[Dolce, RN]

I love computerized charting!!!! It is the way to go. The benefits are truly worth the effort to learn the system. Multiple healthcare providers access the chart at once. Notes are all legible. Orders go to the pharmacy, kitchen, lab, nursing, therapy, and social work electronically. It is more uniform and streamlined. I am a waaay faster typer than I am a handwriter. I love having instant access to patient information from where ever in the hospital rather than having to track down the hard chart. No more writer's cramp!!!!