EMR and CPOE--is it really safer?

SummitRN, BSN, RN · Mar 22, 2014

There is incontrovertible evidence that CPOE with Decision Support drastically reduces errors on the order side both with erroneous orders, transcription error, and improper orders.

It does NOT eliminate order entry errors.

RNperdiem, RN · Mar 22, 2014

Electronic charting/orders are not meant for the end user.

It exists so "big brother" can monitor us more closely. Computer charting is much easier to audit for compliance. Electronic charting is also tied up now with patient billing. We have been taught that with out new software, unless we chart an antibiotic in the I&O computer charting correctly, patient insurance/medicaid/medicare will not pay for it.

I do remember paper charting. Computer takes much longer that I almost consider the computer my third patient as demanding as any other. It is here to stay.

applewhitern, BSN, RN · Mar 23, 2014

I don't find it safer, and I sure as heck don't find it faster. Our computers freeze up constantly (always at your busiest moment) and putting in orders and/or charting takes 3 times longer. Our system is cheap, clumsy, takes multiple, multiple steps to do just one thing. To make it worse, we can only put orders in, and chart at the patient's bedside. I don't mind charting at the bedside, but to put in admission orders takes forever, and we have to stand up; they won't allow us to sit down in a patient's room, but we aren't allowed to put orders in at the nurse's desk, either. Makes no sense. Our ER doctors refuse to put orders in themselves, so we do it.

THELIVINGWORST, ASN, RN · Mar 23, 2014

Well those Drs that don't learn to do I tight, won't be reimbursed for Medicare pts

THELIVINGWORST, ASN, RN · Mar 23, 2014

It right*. Oh GOD

guest2210 · Mar 23, 2014

The EMR system is as accurate as the information that is entered. Many facilities allow the RNs to enter the physicians orders, while others absolutely will not allow it, unless that doc is in an emergency situation or is on the road and does not have computer access.

I knew several docs that would go around the corner from the nurse's station or to another floor, then call the nurse and tell them they were on the road. Once found out, the medical directors stopped that practice.

The tools that are available with the EMT systems, when utilized correctly, are actually safer and more accurate. Try placing frequently used admission orders as favorites requiring a check mark to order then fill in the required information. Depending on the system your facility is using, this can also be done for frequently used meds, ancillary therapies, consults and xrays (MRI, CT scan, etc.)

Another practice instituted by some facilities upon implementation of any EMR system, is to have night shift reboot all of the computers during their shift. It drastically reduces "freeze up during the busiest times" during other shifts.

SummitRN, BSN, RN · Mar 23, 2014

RNs should not be entering orders for MDs. That is a form of transcription and a source of error that defeats the CPOE gains. It is only justifiable in an emergency.

is to have night shift reboot all of the computers during their shift. It drastically reduces "freeze up during the busiest times" during other shifts.

IT can set the computers to do this automatically at staggered times with warning.

guest2210 · Mar 24, 2014

RNs should not be entering orders for MDs. That is a form of transcription and a source of error that defeats the CPOE gains. It is only justifiable in an emergency.
This issue was raised to the medical directors in several facilities that I have been at and they stood behind the nurses entering the MDs orders.
The next facility I go to, I will suggest this and see if this is possible. It hasn't been done at the other 30-40 places I've been.