Computer Charting

ArwenEvenstar · Feb 17, 2005

My 800 plus bed hospital is in the process of converting to computer charting. One unit at a time is slowly switching over. I'm in the float pool, so I only have to computer chart every so often when I am floated to a unit that has already started it.

I HATE it! But perhaps since I am only doing it every so often it is just hard for me to get the hang of it.

To me, it makes charting more complicated because there is so much going "in and out" of parts of the program. You have to "in" to one section for I&O, into another for nurse notes, another for vitals, another for assessment, another for nurse rounds,....ETC. It is VERY easy to forget what you have already charted or have not charted! I find it frustrating and confusing, and end up going "in and out" double checking what I charted or not.....This must be a problem, because I've noticed that some of the units have a list taped on the computers reminding nurses of all the different sections they must chart in.

Also, you can't just grab the patients clip board quickly to check what their last vital signs were, or I&0, or whatever. No, now you have to log in to the computer, pull up that patient, go into the right section, etc. Time consuming! UGH!

And you must always immediatly log out. You might be tempted to stay logged in to save time. But if you do that, someone else could go in under you and chart. I already had that happen to me. I forgot to log out and found a PCT had charted stuff under my log in on a patient!!!!!!!!

For me, the computer charting is much more time consuming than paper charting! I don't like it. But like I said, as a float nurse, I only have to do it every once in awhile. Perhaps with time and doing it consistently, it would get easier. As there seems to be "mixed views" on the floors at my hospital that have already started it. Some nurses seem to love it and others hate it.

By the way, I am leaving the hospital after 14 years for a non-traditional nursing job. Exploring various options at the moment such as private duty.

jetsetter · Feb 17, 2005

The only type of charting I know is computer, learned it in school, and the two different jobs I've had have used computers. It's all in what you're used to. All charting takes time. We're going to be getting computers in every room. Not too sure about that one, privacy, ya know?

It's really about prioritizing. Take good notes, and when you get 10min, type like crazy.

TechieNurse · Feb 17, 2005

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!!

allnurses Guide · Feb 17, 2005

My 800 plus bed hospital is in the process of converting to computer charting. One unit at a time is slowly switching over. I'm in the float pool, so I only have to computer chart every so often when I am floated to a unit that has already started it.
I HATE it! But perhaps since I am only doing it every so often it is just hard for me to get the hang of it.
To me, it makes charting more complicated because there is so much going "in and out" of parts of the program. You have to "in" to one section for I&O, into another for nurse notes, another for vitals, another for assessment, another for nurse rounds,....ETC. It is VERY easy to forget what you have already charted or have not charted! I find it frustrating and confusing, and end up going "in and out" double checking what I charted or not.....This must be a problem, because I've noticed that some of the units have a list taped on the computers reminding nurses of all the different sections they must chart in.
Also, you can't just grab the patients clip board quickly to check what their last vital signs were, or I&0, or whatever. No, now you have to log in to the computer, pull up that patient, go into the right section, etc. Time consuming! UGH!
And you must always immediatly log out. You might be tempted to stay logged in to save time. But if you do that, someone else could go in under you and chart. I already had that happen to me. I forgot to log out and found a PCT had charted stuff under my log in on a patient!!!!!!!!
For me, the computer charting is much more time consuming than paper charting! I don't like it. But like I said, as a float nurse, I only have to do it every once in awhile. Perhaps with time and doing it consistently, it would get easier. As there seems to be "mixed views" on the floors at my hospital that have already started it. Some nurses seem to love it and others hate it.
By the way, I am leaving the hospital after 14 years for a non-traditional nursing job. Exploring various options at the moment such as private duty.

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. :crying2:

steph

misti_z · Feb 17, 2005

We are in the early stages of computer charting. Admission & discharges are done on the computer now. I am very excited about it and also in the minority on my unit. It is frustrating being in the early stages of it because there are somethings that have to be charted on paper and on computer-like home medication list, and working on a renal unit it is not unsual to have patients on 15 medications--, so that is VERY time consuming.

I wish we would go completely into computer charting all at once. It would be hard at first and frustrating for some, but let's just get 'the show on the road'.

SmilingBluEyes · Feb 17, 2005

It's ONLY the "bomb" when its nurse friendly and useful as well as efficient. ALL of which MEDITECH IS NOT.

so no, it's NOT the "bomb" for us. It's a BOMB!!!!

Tweety, BSN, RN · Feb 17, 2005

I agree it's the wave of the future. When I first started this job 14 years ago we were writing these long detailed narratives that covered head to toe. You know the kind....patient is alert and oriented times 3, bowel sounds hypoactive in 4th quadrant, urine cloud, breath sounds clear, etc. etc. Charting by computer has decreased the amount of time spent charting in my opinion. But since then JACHO and the hospital have made charting a bit more tedious with more forms etc. So it's debatable if it's freed up charting time and benefitting patient care. But I definately prefer a computerized flowsheet that charts by exception, rather than the long narrative notes of the past.

We're a little backwards in that we're not 100% computerized, we chart our assessment on computer, but there are few forms we fill out like care plans, restraint flow sheets, etc. I also chart my pain medicine administration by hand as well because being a trauma unit we give out a lot and it's a pain to log in the computer when we give it, and the one hour follow up.

Also on the night shift they do maintenance and they go down occasionally for hours at a time. That's a pain.

When we went to computer I was one of the instructors of my coworkers. Many resisted it simply because it was new and unknown and people by nature tend to get comfortable with the familiar. Also, we had a lot of people of a generation that wasn't computer savy. There were many people who didn't even know how to use a mouse. Even had one nurse retire rather than learn the computer.

I would approach it with an open mind, knowing it's going to be a big pain for a while. Because resistance is futile. :)

TechieNurse · Feb 17, 2005

All those paper forms that are so easy to look at and get information quickly...

Have you seen what happens to them when they're stuffed into a chart and patients have multiple admissions, or a complex history?!?!

I can't tell you how many times I've had to use those white circle thing-ies to keep three hole punched papers in charts! I wish I'd invested in their stock!

How many times have you found a piece of paper with info and no name?

Or found flowsheets that belong to a chart for a patient that's been discharged (and their chart sent to Med. Records)?

Computer charting saves trees and preserves records!

Now before you say 'yeah, but systems crash', decent ones will have redundant servers to preserve information for just that possibility.

Right now, we have online (accesible via the internet and a password through the firewall) real-time ekgs and x-rays.

Think of it...sometime in the near future, patients could enter any facility (big city, rural, in another country) and if they have connection to the internet, they can have their doctor, or even a specialist review their EKGs/x-rays...

It's revolutionary! We're on the cusp of something great happening here!

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 :)

HappyNurse2005, RN · Feb 17, 2005

It's ONLY the "bomb" when its nurse friendly and useful as well as efficient. ALL of which MEDITECH IS NOT.

that i agree with. i am astudent at a facility that uses meditech and oh my gosh, i think meditech royally sucks. I am so glad I know I don't want to work at that facility (for other reasons), because if i had to use meditech all the time, i'd go nuts.

paper, anyday. or a good computer system, but i've yet to see one. i have used EMAR and MAK for meds, and those aren't so bad. i like computerized meds, less chance for error.

imnmk_rn · Feb 17, 2005

Well, I have to say I am used to computer charting - and we are in the process of changing to a different application and changing to an entirely computerized medical record (right now, MDs still write progress notes and orders on paper, and we have a paper Kardex and plan of care, but the rest of our charting - vitals, assessment, I&O, meds, etc is all in the computer). And honestly, it's what you're used to. Even though the program we currently use has its bugs and has annoying things, we are familiar with it... but going from one system to another, everyone is having a hard time with. Any change is stressful - but take it as it comes, roll with the punches.

Here are some of the positives of computer charting....

-Computers that interface with your monitor... example your vent settings, HR, BP, etc come over into the computer when you click on the time. Very nice for those q15 minute vitals!

-Reports that pull lots of info together - being able to see I&O graphed for a certain number of days with weight; being able to see from your MAR not only what the pt's recent blood glucose measurements have been and insulin(s) they have received, but also how much D5W they are getting in their various IVs, what you've charted as their diet, etc.

-Multiple people using the same chart at once (keep in mind, most charting systems make it impossible for two people to document meds at the same time)

-Calculations done immediately for you - I and O data, drip rates, weight change...

Yes, there are downsides to computer charting. And it IS very annoying when it slows down or goes down altogether... but then we are all complaining about the paper charting that the majority of my coworkers and I are not familiar with anymore, since it has been so long since we've had to do it... Go with it - it's the wave of the future. And smile... there are worse things that have hit the scene. Like I said, any change is stressful.

SmilingBluEyes · Feb 17, 2005

Well, I have to say I am used to computer charting - and we are in the process of changing to a different application and changing to an entirely computerized medical record (right now, MDs still write progress notes and orders on paper, and we have a paper Kardex and plan of care, but the rest of our charting - vitals, assessment, I&O, meds, etc is all in the computer). And honestly, it's what you're used to. Even though the program we currently use has its bugs and has annoying things, we are familiar with it... but going from one system to another, everyone is having a hard time with. Any change is stressful - but take it as it comes, roll with the punches.
Here are some of the positives of computer charting....
-Computers that interface with your monitor... example your vent settings, HR, BP, etc come over into the computer when you click on the time. Very nice for those q15 minute vitals!
-Reports that pull lots of info together - being able to see I&O graphed for a certain number of days with weight; being able to see from your MAR not only what the pt's recent blood glucose measurements have been and insulin(s) they have received, but also how much D5W they are getting in their various IVs, what you've charted as their diet, etc.
-Multiple people using the same chart at once (keep in mind, most charting systems make it impossible for two people to document meds at the same time)
-Calculations done immediately for you - I and O data, drip rates, weight change...
.

If only

seems our computer system has few of the above advantages...nothing about it is automated, it interfaces with NONE of our monitors, and we still have to calculate all I and Os ourselves...and it's rife w/possibility for grave human error. It's not always a good deal when it's poorly-designed and thought out.