Almost a year ago our small non-profit hospice moved to electronic medical records. For many reasons this is a good thing and I feel competent with the program. Charting by computer definitely takes longer but we still prefer it. Our patient census is 90 to 100; we have three part-time case managers and five full-time. We are the only hospice in the area without a ceiling on census.
My question regards admissions. Each admissions RN is required to do 2 field admissions per 8 hour shift. This includes meeting with the family and patient, explaining all aspects of our services, signing consents, assessment of the patient, assessing caregiver learning style, verbal and written instructions for care of the patient, use of comfort meds and other comfort measures, review of the hospice binder, etc. After assessment of the patient we need to enter the information into a template, enter visit frequencies into a separate section, input all the medications, DME, functional limitations, allergies, diet, hospice admission criteria (checklist plus narrative), global functioning scale, open all problems and interventions on the care plan, chart another clinical note on each problem and why we opened it (this also in narrative form), fax the doctor for orders and make sure they sign the orders, call the pharmacy and DME companies, obtain the signed schedule 2 for narcotics from the MD, leave report for the case manager, the social worker and the night RN. We're not able to fax or synchronize from the field so we return to the office to do that. It we miss a detail there are repercussions. We are mandated to get the comfort meds into the home the same day, which we agree with. What we have trouble with is trying to do this for two patients and be finished in 8 hours. Actual time spent in the home is anywhere from one to three hours and averages about 1 1/2 to 2 hours. We usually don't take the computer to the bedside so as to give our patient and caregivers full human attention. If I have a patient who adores technology and is curious, then I'll whip out the computer and show them how we input the info.
My supervisor thinks we're "inefficient" for not being able to get everything completed in under 8 hours. We hustle and we're thorough. It's exhausting.
The program we use is Allscripts. I really like it but it is a long admissions assessment. Does anyone else use this program and successfully get two admissions done in 8 hours, along with all the extra stuff that has to be done? Why aren't we able to finish? What are your secrets? When we did it exclusively on paper it was a much quicker process. Despite my long description post here, I am able to keep my nursing notes succinct and relevant. Travel time one way ranges from about 20 to 90 minutes.
If doing a routine home visit for established patients, 5 or 6 a day is manageable. We see our patients at least weekly.
Specializes in Med Surg, Administration, ER, OR, SCU,.
Allscripts is a terrible program... not user friendly and very cumbersome. That being said, after you've worked with it for a while, you can complete the admission documentation in about 1-2 hours but I never do it at the bedside. 2 admissions per day is tough but not impossible but that would be all you could do. You need to allot about 4 hours for an admission... and that's if it's a simple admission!
I am an admissions nurse and we are expected to complete 2 each shift. We don't use Allscripts; we use another program created just for our company. I've been doing computerized admissions approximately a year now and it depends on the admission. I have done 2 in 6 hrs, 2 in 9 hours and 3 in 9 hours, but it was affected by the complications in the case. I'm fortunate in that my medical directors have Egan and can send c2s from anywhere, but I still may have to spend another hour just charting after doing the bare minimum paperwork (plus activating optum, calling in meds, et cetera)to get them admitted. I hate having to rush, but sometimes you don't have a choice. And if something is shortchanged, it's going to be the paperwork over the patient teaching, assessment, all the important stuff. I only get frustrated when I'm also on call that night and have to make visits instead of completing my admissions. There are times I miss the paper admissions because when I have to chart on paper then transcribe to the computer it feels like wasted time.
SCgirl1962
28 Posts
Allscripts is a terrible program... not user friendly and very cumbersome. That being said, after you've worked with it for a while, you can complete the admission documentation in about 1-2 hours but I never do it at the bedside. 2 admissions per day is tough but not impossible but that would be all you could do. You need to allot about 4 hours for an admission... and that's if it's a simple admission!