First day with hospital wide computer charting!

ONCRN84 · Jun 26, 2008

It'll get better. Our hospital is actually the opposite... our ER doesn't use the computerized medication administration, but all the floors do. Our hospital has had it since before I was there. We have computers in all the rooms to do our med charting, so none of the COW hauling. Our biggest problem is the damn scanners. But we're getting those new too in a few weeks.

We recently went Live with computerized charting. All of our DARs, orders, admits, and of course meds are computerized. It'll take a while to get everyone used to it, but I like it a lot. Eventually the plan is to have doctors put in orders directly to the computer. Right now, they write in the chart, the secretary inputs them, and we verify the computer order with the written order. Very similiar to what we were already doing, but with an updated system.

Our ER also has computers in all the rooms. They do history, meds, and initial assessment on the computer, but their orders are still on paper.

Hang in there! Eventually it will become normal and you won't be able to figure out what you guys did without it!

Jules A, MSN · Jun 26, 2008

It does take a while to get comfortable but I bet you love them once you are used to working on them. Hang in there.

Dixielee, BSN, RN · Jun 26, 2008

Grumpy old nurse here.....I still hate them. I work ER and we do everything but code STEMI's and traumas on computers. It is very tedious and slow, generally you have to re-boot at least once per shift after you have put everything in, so you lose it. The docs do put in orders and they hate it because so often what they really want is not an option so they order something close and we have to figure out what they really meant.

Wait times are way up, LWAT's (left without treatment) are way up, and patient, nurse and physician satisfaction are down. More and more of the docs are giving verbal orders because they don't want to fool with it, which makes us stop what we are doing to enter the orders.

Floor docs are also suppose to order on the computer, but they are increasingly calling us with pages of verbal orders so they don't have to do it. Meds are all messed up, because the docs put in routine meds, pharmacy assigns them an arbitrary time, so it makes us look like we have missed doses because they show up on the EMAR as hours before we even got the order. Last night I had the floor nurse call me back wonder why we did not give the patient calcium and vit D that had showed up on the EMAR.......well docs and pharmacists, you need to get together on this, because we do not have time to start all routine meds in the ER, esecially since we don't keep most of them in stock. Oh well, I could rant on and on, but I have to get ready for work where I can complain about them even more.

If anything pushes me out of nursing, it will be these computers. We use Cerner by the way, and no it is not getting any better.

Keepstanding, ASN, RN · Jun 26, 2008

good luck with the new system tiger. you will surely tone up your arm muscles while pushing your wow to and fro ! :chuckle

RNperdiem, RN · Jun 26, 2008

There are computers in all the patient rooms here. We have also recently switched to computer charting.

I can't imagine hauling a COW/WOW around with me all day.

If you have a gym membership, you might want to cancel it as you will be getting an upper body workout at work.

Eventually I did become faster on the computer, but it still takes longer to log on, type passwords in, point and click away than it would take to chart on paper. To do all this charting, I stand with my back turned to the patient for long periods of time, and I don't like that; it seems rude somehow.

racing-mom4, BSN, RN · Jun 26, 2008

We are just in the beginning stages of getting computer charting, we are supposed to go "live" this fall. I am glad you mentioned the insulin witness problem, that sounds like a true pain, I will write that down and let admin know if we can avoid that...

I did clinicals at a hosp that used the COWS ( must laugh at the WOW name) and I hated the scanners, I used to joke with the patients "this is why I didnt take a job at Target" as I always had problems scanning. I am sure this is against a privacy law, but I soon started putting one of my pts bar coded stickers on my work sheets each day---so I could scan the work sheet vs the patient---I know goes totally against the reason of scanning the patient...but hey I did it, and it worked..I just tossed my sheet in the shredder at end of shift.

So do you drag the "wows" into the pts room if they are in isolation?? I know we are getting computers for each room, so I am hoping that means no "wow"

BlueEyedRN · Jun 26, 2008

Did we get portable scanners??? NO, they thought someone would steal it. I have a patient moaning in pain and here I am with the morphine... trying to push this 200lb machine over the door threshold, making all kind of noise. Then scan the patient, scan the med, and enter all their vitals before I can administer the morphine...

I actually really like the computerized med charting. It feels a lot safer to me. I learned on it, then moved to a hospital that used the paper MAR and then back to the computers and it is nice to know that I have an external check on what I'm giving. However, not having a portable scanner is stooooopid. I hate when a decision like that is made and then when they realize how much it sucks for everyone, they can't really change it because it would cost so much to fix. These people need to think like nurses. Grrr. And honestly, a lot of times when I need to give a med quickly, I just give it and then chart it afterwards. It is totally overriding the reason for the scanning, but when they need it now, they need it now.

nursej22, MSN, RN · Jun 26, 2008

We have been computerized for 12 years--we were promised a paperless system, but we use more paper than before. Several departments have stopped using computer charting (ICU, ED, OR, PACU, IR, Cath Lab) because the program is too awkward for them. but the floors are stuck with it, but if you need to know something about what happened in one of the above departments you have to wade through a pile of forms-each deparment has created their own charting that works for them but not for any other department.

We don't have scanners yet, so we are to print a copy of the MAR and bring it to the bedside every time we administer a med, as well as have the patient state his first and lat name and date of birth each time.

And trying to find info in the computerized record is a joke. At the beginning of shift I l am expected to look at 5-10 screens per pt, plus do the face to face hand-off with the off-going shift with 4-5 pt assignment. And ER and ICU can't figure out why we don't want transfers at shift change.

Our program seems to be set up for administration to audit our work rather than provide safe, timely care for the pts.

MNmom3boys · Jun 26, 2008

Not sure if it gets easier, or if you just get used to it... I remember feeling the level of frustration you are expressing when we did our go-live in April. At least I no longer feel that level of frustration on a daily basis. They have been pretty good about changing some things to make it easier on the floor.

But, there are still some things that are still hard, and will remain so. Hauling the huge machines down the hall and into rooms (especially at night - no way to do that quietly) is hugely inconvienent not to mention physically demanding. The double witness on insulin and the couple of other drugs is horribly frustrating because now you are hauling the big machine and a co-worker into the room with you. Paper was much easier.

There are some aspects that are easier with the flow of information from one worksheet to another, but I also find it frustrating to have to scroll through 5 or so worksheets to get report and document on at least that many different ones throught the shift. I am just recently fairly sure when I leave after a shift that I have documented everything in the right spaces, and filled in all the right boxes. They claim our level of care hasn't changed, just how we document it. I don't think the level of care has changed, but the level of difficulty and amount of work involved to document it certainly has increased...

Good-luck woth your transition!

pagandeva2000, LPN · Jun 26, 2008

My hospital has computerized charting in specific areas, so, not all of us are on line (thank goodness my clinic is, though). Since 10/07, inpatient started using EMAR also, and it took some time for me to get trained to use it since I am outpatient. However, I signed to do agency per diem on med-surg and therefore, was allowed to learn. I did my orientation yesterday, and I was not as overwhelmed with the EMAR as I expected to be. The benefit of it to me is that everything, the orders, the labs, allergy information and whatever else was right on my fingertips. I can even look up unfamilar drugs rather than drag a drug guide in my already heavy pockets.

The inpatient rooms do not have computers (or carpets, thank goodness), but the medication cart has a screen on it, and drawers that can be labeled with room numbers and medications from the pyxis. So, we can go from room to room, look up as we go and immediately sign for them. If I have to keep a running log in what I am doing, I print up a medication sheet for the patients I am assigned to every 4 hours. Little notes that I like to do, such as "call the doc to take this med off hold-vital signs, etc" can be written on it.

Lastly, what I am happy to gone are sloppy MARS with so many crossings out that our less than considerate nurses have done. If an order is cancelled, it just plain doesn't show any longer. Once you administer a medication, the next dose is what now appears. It's not as bad as I thought it was. Only disadvantage is that you have to pull all of your medications before med pass, because if you are an hour late, then, you are just canceled out...period.

pagandeva2000, LPN · Jun 26, 2008

But, there are still some things that are still hard, and will remain so. Hauling the huge machines down the hall and into rooms (especially at night - no way to do that quietly) is hugely inconvienent not to mention physically demanding. The double witness on insulin and the couple of other drugs is horribly frustrating because now you are hauling the big machine and a co-worker into the room with you. Paper was much easier.
There are some aspects that are easier with the flow of information from one worksheet to another, but I also find it frustrating to have to scroll through 5 or so worksheets to get report and document on at least that many different ones throught the shift. I am just recently fairly sure when I leave after a shift that I have documented everything in the right spaces, and filled in all the right boxes. They claim our level of care hasn't changed, just how we document it. I don't think the level of care has changed, but the level of difficulty and amount of work involved to document it certainly has increased...
Good-luck woth your transition!

Let me ask, do both, you as well as the other nurse have to document seperately that you witnessed the insulin, or does one person document? I ask this because on ours, they ask for the name of the nurse, and to be honest, you can just put down anyone...whether they know it or not. That, makes me VERY uncomfortable. If it ever showed up in a court of law that your name is down as a witness, and you did not see it, or was even on duty...

I'm just asking to see if anyone else has experienced that...thanks!