Computer Charting

[sstromberg]

Our hospital is going to computer charting and many of the nurses are opposing this. How do you think it will benefit patient care and helping our staff utilize time better? Or is it just a pain?

[Spidey's mom, ADN, BSN, RN]

We use Pharmtrak for our meds and it is frustrating to say the least. When a doc wants to look at the trend of pain meds for a patient, I used to be able to show him a 5 day trend on PAPER . . just grab it from the med chart. Now I have to wait for the other nurse to get off the computer or the ward clerk who is printing labels or maybe pharmacy is looking at that same patient in pharmacy so I can't "see" them . . then I have to log in . ..then I have to tab over to "Reports" (YOU CAN'T USE A MOUSE WITH THIS PROGRAM) and search for my patient .. . the rigermarole included in finding the patient is tooooo long to explain . . anyway, finally I get to the med sheets and the doc is getting pissed because it has taken 10 minutes to get info that I could have handed to him in 30 seconds.

We do not have a computer program that is user friendly. I am NOT afraid of change. I've only been a nurse 6 years. I know how to use a computer.

Just cut some of us slack ... we do not see how computers, so far, have added any convenience except maybe to pharmacy who can charge for their meds easier.

steph

[SmilingBluEyes]

Yes, ours is "mouseless" too Steph. OMG a MAJOR headache. And the paper it wastes is criminal and obscene.

[Sleepy 7]

You may be able to look at paper faster but without redundant scanning YOU WILL MAKE MISTAKES.

MAC is the best Careview charting is by far the fasting and most logical spreadsheet based expandable system. MEDITECH is DISGRACEFUL AND DANGEROUS RN'S WILL NEED A SECRETARY JUST TO CHART AN HOUR. God forbid you have a sick ICU pt with meditech I don't know what they would do with pt's that dynamic and Ill

[TallGirlAni]

I work for a veteran's hospital, and we have computer charting (CPRS). I am a new grad and this is all I know. Some of the seasoned nurses admitted that they hated when they had to convert from paper to computer because it was a change. But now, after they had gotten used to it, many told me that they really appreciated how much more efficient it is vs. paper charting.

First, accessibility of the patient's chart and all of it's pertinent info is within a few strokes of the keyboard. If you know your way around the computer system, you can find all the essential pieces of the chart quickly. When I come into work, I print out my patient's end of shift report--complete with code status, current diet order, age, last vitals, FS, diagnosis, IV fluid and rate, and any report the previous nurse has left. We also do a quick face-to-face report with the offcoming nurse if we have any questions. Then, I go to the computer, and within the patient chart, I access the orders (which are great because they are never handwritten, are current, and I can tell if they have been acted on). I access labwork, current medications and when they are expiring, what tests and labs have been ordered for the patient, and all of the patient's progress notes by all interdisciplinary team members (typewritten).

IF the dietician is in her office and typing a note, I can see it right away, once she signs it. I can also look at the MD notes and what their plans of action are going to be regarding the patient. Everything I need to know is accessible and instantaneous. I spend the first half hour of my shift going through all of these tabs, looking for inconsistencies in orders, if meds need to be renewed, looking at lab values (anticipating if patient will need potassium or blood). This gives me an overall view of what is going on with my patients so that I can question any new orders that might come up.

I work a PM shift, so I like to make my phone calls to MDs before they leave for the day and the on-call doctor is on.

While anticipating a patient coming from recovery room or the E.R., I can look up notes and labs on my patient and any delayed orders that will be released to me once the patient arrives on my floor. Therefore, when recovery room wants to give report, I have specific questions that I ask the nurse. The more info I have, the more prepared I will be.

Overall, the major thing is the handwriting issue. No more worries about transcribing orders in error due to sloppy handwriting. I read the notes pretty quickly because they are typed.

When it comes time to charting, we have assessment templates, and we just click boxes, and when we paste it to our note, a typed note appears. We can then edit the note, adding or subracting things from the note. Once the note is signed and we have to add to the note, we attach an addendum. I have signed a note that I wanted to delete.

I know that changing the way one has been charting for years can be difficult, but it is really an efficient, easily accessible way that more and more hospitals are moving toward.

Once you have learned and maneuvered through it, then let me know what you think. You may be surprised on how much easier it will make things for you in the long run.

[Wise Woman RN]

We will be going to computerized charting, but the program doesn't cover what an acute rehab unit needs to reflect, so not only will we be doing the computer, my manager says that we will probably continue with paper charting as well... Happy Day!!!

[MNlpn]

I hear ya!!! We are starting the switchover now too on our ARU. We have to chart all the patient assessment stuff in the computer. But, we still have to go to the chart to do our FIM scores on paper. It's very time consuming and some of the nurses on days/eves are SO busy with patient care, that charting just doesn't get done. And GOD FORBID, there should be NO overtime:nono: If you incur overtime its cuz you're not budgeting your time well.:angryfire Like management knows anything about what the nurses go through on the floor. Anyway, thats a whole nother story!

[Pepper The Cat, BSN, RN]

We have had computer charting for some time and have adapted to it. One plus is that it is much easier to read written notes - no trying to read people with bad writing.

However, we just went to computer kardex and report and do NOT like it. It is so time consuming to have to look at the kardex on the computer. I used to be able to get most of my pts info from one page- now I have to go through 6 or 7 different screens! My last night shift, I went to get the DNRs for the entire floor, it took my 1/2 hour. Used to do that in 5 minutes!

So I think there are good parts and bad parts to computer charting.

[jmgrn65, RN]

Well, I agree with ArwenEvenstar and will say instead of "I think it's the bomb!" I think it should be bombed!!! And quickly. :angryfire

We do computer charting for our meds and I swear most of us are ready to shoot that darn computer although it is the program that is unwieldly, difficult, frustrating and very time-consuming. I cannot imagine trying to do my patient's charting on a computer and trying to find information that I can easily find by LOOKING ON A PIECE OF PAPER versus having to go in and out of sections, not being able to back out of a place you went to by mistake and then having to start all over, gosh. . I could just go on and on.

Computer charting, God Help Me.

steph

We have had computer charting in our ICU's for many years now, but not on our floors. I love it. I work in the ICU as resource (PRN). I usually work on the floor. Recently we converted our meds to computer and that has been a disaster! So I say don't judge computer charting because of the meds. It is different. Just my

[nursemary9, BSN, RN]

Hi

We`started computer charting about 2 years ago. As everyone can see, I'm pretty old & have been a nurse for over 40 years. Well, I absolutely HATED it the first month!! Very shortly after that I decided I LOVED it!! That is how I still feel about it. we use a program called CARE CONNECTION. It is a bit complicated to learn, but it's wonderful now. I get done with the charting so much quicker. I get to actually spend more time with my patients. I really just love it.

Our MD's are now even putting in there orders. It works VERY well. You can't really miss new orders with the little prompts.

Mary Ann

[Sleepy 7]

Like I said careview-computerized spreadsheet based FAST.

Meditech/EMAR well,I can't really describe how bad.

Oh and as far as looking up a pt that is coming from ER or elsewhere

Only one nurse at atime can look at a pt on Meditech and , get this,

If we look at a pt on another floor before they actually "admit them to ICU"

we will be fired by the Orwellian Tennessee based co. that bought or once

decent Non profit hospital.

I am a computer generation also but with a program as bad as Mtech........

Oh and your thoughts on taking the entire computer on wheels into an isolation room ???? our present MAC system has a seperate scanner.

EMAR/Meditech setup has a +/- 6 ft tethered scanner that cannot be removed- ah rocket science at it's best.

FORWARD TO THE PAST!!!!!!!!!!!!!!!!!!!!!!!!!

[PANurseRN1]

Ok, this answer is coming from someone in the informatics world, so, it is biased.

But...computer charting is the way of the future.

If you have to constantly go in and out of programs, it's a bad application. Your facility should have defined what they were looking for and evaluated multiple applications. Users (meaning nurses) should have had the opportunity to 'test drive' them and give input/feedback.

If that wasn't done, if your facility buys or builds something without going through this process, I'm sorry to say it can be time consuming, labor intensive and frustrating.

However, look at the bigger picture. By entering data into a database, you'll be able to spit out legible reports, if it's a good system it can send reminders, flag problems/issues, store pre-printed patient education materials by diagnosis and probably most important of all, can be accessed for research purposes.

Research can range from staffing needs to effectiveness of treatment plans.

So, while change is something that most people resist, I urge you to keep an open mind.

The time will come that all the patient info will be kept on a PDA at the patients bedside and accessed centrally if necessary.

Many states (mine included) are working on a common technical language so that all health information can be coded and shared (with appropriate permissions and security in place).

This is one of the president's goals and CMS (Center for Medicare Services) will be requesting this type of data for reimbursement.

Think of it...instead of a coder in a medical record room reading a chart and coding the whole inpatient stay under the single most beneficial DRG code, actually having codes stored within the application you're using.

For example, if a UA/C&S is ordered, the lab sends back positive result. The program would suggest antibiotic based on the sensitivity report and your facilities formulary, cross checked with the patients allergies and current medications. If the doctor orders an antibiotic, an 'pop-up' message could appear asking if this patient has a UTI as a complication. All the coding for surgeries, complications, equipment, consults etc. could be stored and reported with the click of a button!

I think it's the bomb!!

There was not one thing in this post that I felt was a positive. Personally, I would find it irritating as heck to have a freaking pop-up "suggesting" this or that. I HATE pop-ups, period, and the idea of some computer program thinking for me is just a bit too much like HAL 9000. (And if you've seen "2001: A Space Oddyssey" you know how badly that turned out.)

When I worked in home care we went from paper to computer charting. What a nightmare! Admissions that normally took 2h took 3-4h because of the innumerable "pages" that had to be filled in. You had to always be near a phone so you could receive/transmit info., and this was back before anyone had cable/DSL. We were expected to do this from our homes as well as pt. homes.

The idea that you have to log in to a computer to look up something like vital signs is just ridiculous.

I like computers, in their proper place, but not to the extent some are describing.

[PANurseRN1]

TechieNurse wrote:

How about a disc, or even a chip, that the patient could bring with them to appts that would have all their information encoded (accessible with appropriate security). Patients who are unconcious, or unable to communicate due to injury or language barriers could be appropriately assessed and treated.

I'm thinking Star Trek technology here, and it's right around the corner!

The trick is, making sure that Nursing is involved in the evolution of this technology, not only to insure user-friendliness, but to be sure that their needs/desires for charting are included.

Sorry...but I'm excited about this whole thing :)

Whoa. No way. There is way too much potential for this to be abused. I'm not a car and I'm not a collie. Thanks but no thanks.