MD orders via computer

[gracedRN]

OK, this may have been covered in another thread, sorry if it's repetitive.

Recently the policy at the facility in which I work has the doctors entering orders in the computer, as opposed to the paper chart.

Nurses were told, "Be extra careful checking orders!" So I have to take the computer's word for it. Scary to me.

Last week, a consulting physician even called the attending to ask if one order was correctly entered, it seemed an inappropriate order.

Does anyone else have experience with this? Does anyone else think this unsafe?

[traumaRUs, MSN, APRN]

I work in multiple hospitals and all but one have computerized ordering. Much safer IMHO. There is no middleman. We as providers are responsible for entering orders. The bedside nurses have small portable computers that beep when new orders come up or they can just access the larger computers too.

Has been proven to be safer.

However, from your post, I'm gathering nurses paper chart while providers use computer? Uh, nope that's not safe. Should be all computerized charting.

When I round on pts I always talk with the bedside nurse too and let them know if I have any stat orders and kinda what the general plan is for their pt. However, I've been the bedside nurse and I always appreciated providers who have done this for me.

[RNKPCE]

There are automatic safe guards in computer charting you can't have on paper. Some of the previous posters gave examples. If I receive a telephone order for a med and I enter a dose lower than commonly ordered I have to state why. Most meds are already in the system with the common dosages listed and you just have to click. For instance Digoxin .125mg qd. You would have to do a type in to entered something really odd like Digoxin 37mg qd. I'm not sure it would even be possible. These orders are then double check by pharmacy before the drug is dispensed.

The computer system does not mean nurses still don't have to determine if a medicine is safe to give. For instance giving lisinopril 20mg qd to someone whose blood pressue is running in the 90's systolic would in most cases not be safe.

Couldn't imagine life without computer physician order entry.

[TDCHIM]

OP, is your facility in the process of switching over to an all-computer charting process? I have heard about many places using CPOE as a "dipping a toe into the water" approach towards a larger medical recordkeeping changeover. Is that the case at your hospital?

[llerkl, ADN]

Computerized order entry is great for the most part. I LOVE that you can determine WHO wrote WHAT and the exact time it was written. My personal opinion is, at times the computerized system keeps Docs/Practitioners FARTHER from the patient bedside. Example: You are concerned about a symptom/change in condition you are seeing in your patient........you notify DR X via telephone about the situation.......she/he puts orders in, based on what you have shared. Yes, you have used your critical thinking skills to share an observation.....but the Doc has not LOOKED at the patient (I know this is not always possible).

Another issue is the "soft stops" or warnings that pop up with some order sets.......sometimes clinicians just acknowledge these and keep on going, without really thinking about what they mean or how they apply to the specific patient at hand. This can cause BIG problems!!

Learning to use computerized order entry is frustrating at first, but eventually navigating the system becomes an advantage and time saver for nursing. Change is hard!!:)

[RNFiona]

Way safer than taking a telephone order from an MD with thick accent talking on his cell phone with screaming kids in the background.

[RNFiona]

I hate paper charting and phone orders. It is so outdated. As a traveler it is so hard to go from a paperless system to one that is antiquated.

[liveyourlife747]

Our facility is switching to provider order entry this month! I'm nervous that I will miss something And that ill be sitting in front of the computer more than doing pt care. Other than that I think it is a great advance. Just the change is what is getting to me right now.

[DoeRN]

Our facility is switching to provider order entry this month! I'm nervous that I will miss something And that ill be sitting in front of the computer more than doing pt care. Other than that I think it is a great advance. Just the change is what is getting to me right now.

You will be sitting in front of the computer more. More charting less patient interaction.

[liveyourlife747]

^^ and that's what I will have the most time struggling with!

[eCCU]

You will be sitting in front of the computer more. More charting less patient interaction.

Depends on what charting system you get. Some are as easy as pie others are like a maze!

[DoeRN]

Depends on what charting system you get. Some are as easy as pie others are like a maze!

Still not as fast as paper charting. I have used electronic charting for 11 going on 12 years with 5 different systems. Some were much more user friendly. And goodness don't there be a system crash.

But from my experience paper charting is a lot faster. I like computer charting because you don't have to decipher handwriting

[applewhitern, BSN, RN]

I have been doing computer charting for about 9 years now. I love it. I no longer get writer's cramp in my old fingers. The docs put their orders in, and it really is much easier than trying to decipher their chicken scratch. Personally, I find it frees me so I have MORE time with my patients! You also don't have to try to read other nurse's handwriting.