did the md's pen go into v-fib??

[SNB1014]

ARRRRGGGHHHH!!

oh Geez, hands down the worst part of my day is my hourly chart checks for new orders and having to speak to foreign drs on the phone.

background: we have physical paper charts the docs/pa/np write orders in and it is up to the unit secretary to enter the orders (for approx 55 pts) but if she is swamped/nurse gets there first, the rn enters the order in the computer. the rn is also responsible for confirming the correct written order was put into the computer by the secretary.

problem 1: i cannot read these Godforesaken scribbles. at times, only 1 letter of a word is decipherable, the number 6 looks like the letter H, etc. it looks like their pen went into v-fibb and expired somewhere around the signature where all i see is a couple random zig zags and a loopdeeloo. if i didn't physically witness the md write in the chart, i have little clue which md ordered what. don't they have stamps or something??

problem 2: the vast majority of our drs are talented foreigners mostly indian/iranian, chinese/phillipino etc. calling for a critical value/change in condition and request for a new order is just painful. perhaps it is the phone that is warbling and distorting their english because in person i hardly have this issue. i end up asking for clarification and a repeat like 2x and when i repeat the order back i still mess up the frequency or something unless they say "NOW/ STAT".

i feel embarrassed dumb and annoyed. i have been at this facility for approx 3mos and evidently my coworkers have learned to converse and read the language of MD Vfibb.

some say that if you read the same order phrase/word, from the same dr 10,000 times you start to be able to figure out what they mean. some fill in the blanks and hope for the best. others shrug and say "ummm no clue. if they still really want that order tomorrow they'll probably rewrite it and maybe i can read it that time..."

do your hospitals have the md type their orders into the computer themselves? maybe there is a dr smart phone- nurse computer order entry capability?

this seems archaic and convoluted to me.

thoughts/suggestions??

[bratmobile]

I was just saying after 3 of us were huddled over a written TO trying to figure it out that we need to create a gameshow for nurses called "Guess That Orderrrrrrrrr"

[SaoirseRN]

One of our internists has horrible handwriting and aside from a quick one line order, always types them.

We don't enter anything into computers. Physicians handwrite orders into the charts, clerks fax to pharmacy (who enters med orders for the computer generated but printed paper MARs), and transcribes the rest also onto paper. We have prepared order sets for many things -- post op, palliative (hospice), insulin, delirium management -- which cuts down on some of the clarity problems because they can just tick boxes.

I've worked at this place for six years and can decipher most of the habitual bad writers simply out of repetition -- usually there is a pattern once you become familiar with it. There are a couple, though, who just scribble and often I've had to call to clarify.

[anotherone, BSN, RN]

this is ridiculous. Unless desperate for income, I intend to never work in a facility that is not fully emr. This job is difficult enouhh without playing guessing games woth orders or being unable to read notes

[TiffyRN, BSN, PhD]

Our hospital went to CPOE several years ago and postings like the above make me nostalgic. . . NOT!!! Geesh, I remember the gathering of the nurses late at night to try to decipher the chicken scratch so we could complete 24hr chart checks. I saw you were relatively new to this and it seemed that once you get used to the writing and decipher enough of it, then you start to be able to read it better. The docs need to be learn better though as these scratched out orders are flat out dangerous to patient care.

I remember one cardiologist who really had one of the better personalities, but his writing was nearly impossible. It looked like a five year old's, if you made the child write with his non-dominant hand!!

I myself have pretty hideous handwriting but I always made sure to use my neatest printing when I wrote verbal orders.