New ED Program: Charting vs. Patient Care

[heidi5093]

I am looking for some well founded opinions on how much time is spent with charting and how much time is being taken away from patient care. I am from a small, rural facility. We have a 5 bed ED, with one nurse staffing it and one on call doctor (who may or may not be staying in house). Sometimes, the NAC and HUC can be utilized from the hospital, but not always. Mostly, the ED nurse is a lone wolf in there. Our facility recently adopted a new ED charting system. Everything is now time stamped (MD in room, Pt in radiology, Pt from radiology, etc...). Administration is now watching those time stamps like a hawk. The system we adopted is not the newest version. It has its issues, one being that support is not readily available. We end up having questions, and have no one to call. So much time is being spent with this new system trying to keep everything charted as we go, that patient care is suffering. Its a panic to time stamp events, clear reds, ordering, etc...When we are busy (which happens routinely), she has to NAC, HUC, Nurse, chart, enter orders, take vitals, clean beds, etc... all by herself. The concept behind this system is not bad. A more user friendly version would be helpful. Being able to track visits is the reasoning behind this, which is understandable from administrations stand point. But, adopting a program that requires so much time, and causes so much stress with limited staff and limited training on the program seems like a bad way to integrate a system. So, my question to all you out there is how do you feel about how charting is headed? In our facility, it is difficult to chart as you go in the ED most of the time. But, we are being forced to, so something has to give. Unfortunatly patient care is suffering in lue of charting and pleasing administration.

[BellaInBlueScrubsRN]

You can't change the time entered at all? Confused on what a time stamp is.

[JetBlitz]

Hmm.. it sounds like a system I've heard of called ASPIRE, is that the one?

Those time goals are hard to achieve when patient care is of utmost priority and charting is second, especially when you are understaffed. To make it work, you will definitely need 1) a proper training to the time model you are using. 2) a dedicated IT service person to help you with problems with the program. 3) even though you are a small hospital, for the time being, you will need extra staff on board to help lighten the load while getting used to the new system.

My colleagues and I had trouble with our time-tracking system since we would more often than not be in the "red" and trying to clear those --- we are a medium hospital --- but we are understaffed as well. It becomes frustrating when we're trying to beat the "clock" and we can't do proper nursing care... but when there was a meeting with the DON who walked us through, it was to help us provide faster and better services to our clients. Bad news, in the real world, when we can't meet the demands of the time-goals the staff get in trouble by upper management; however, inversely related is that by meeting the time-goals, our patient care suffers and our patient experience scores drop.

But right now, we're leveling off the more we get used to the system and staffing levels are adjusted to help us.

My advice would be to continue an open communication with your management in regards to the patient care being delivered and the time goals you have to meet. It is very difficult to adjust to, but never allow a new system to jeopardize the quality of care given.

[Altra, BSN, RN]

Agree with the previous poster -- keep the lines of communication open.

There is an adjustment period with any new system and it's likely to dramatically slow productivity in the short term.

Work with your management to make tweaks, and give it some time.

[EmergencyNrse]

Patient care always comes first. I'm a traveler and see a new computer

system every 13 weeks. I admit that I don't get everything in the system

sometimes but I have never left a patient hanging.

Charting of IV starts, port access, foley insertion.... sometimes it's

charted, sometimes it's not. Meds are the exception. They get done but the chart auditors will have to assume that IV meds/fluids were given through an IV that was there somewhere.

It's a compromise. Getting the job done or apeasing the iChart Gods.

You can only hope that as you become more familiar with the system

that you will become more efficinet with the charting.

Good luck.

[thelema13]

An on-call doc and not in house? Scary....