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Discussion

Nurses don't check orders??

I've noticed on my unit that nurses tend to rely heavily on the Kardex for dressing orders, VS frequency etc.

The kardex is written in pencil and destroyed after patient is discharged.

I was giving handover, had a busy shift and did not have time to update kardex for my patient.

I mentioned there were BID dressing orders for the patient and summarized verbally what should be done. She said "oh thats not in the kardex". I said oh OK but its ordered (EMR) and the nurses have been doing it as ordered. She said, " oh no one checks the orders"

Anyway I added the order to the kardex for the oncoming nurse.

But I'm confused? I always verify kardex with orders because it's written in pencil and not legally part of EMR. I check orders for all patients at beginning of shift after handover. I agree the kardex is a helpful tool for nursing/handover. Thought it was odd the nurse said "no one checks orders". Just wondering what everyone else thinks.

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    SHE doesn't check orders. How do you get through the shift without checking orders? That's a lawsuit/death/etc waiting to happen. Didn't we see the outcome of not checking and following orders with the Vandy case? I would be anxious and afraid of following a nurse who didn't check orders, especially her.

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    I think this is a problem, or potential problem, golly, could lead to some serious stuff for somebody some day. Our house supervisor went over the orders every night with a fine tooth comb and insured the MAR/TAR were up to date (computers were just being talked about back then). I don't know when they ever used them, but when I saw them, the Kardex were just taking up space. I used to tell the CNAs to refer to the Kardex but I never had time to mess with them.

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    If keeping the kardex up-to-date isn't an expected part of appropriately taking care of orders then it is dangerous and needs to go.

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    • Author
    7 minutes ago, JKL33 said:

    If keeping the kardex up-to-date isn't an expected part of appropriately taking care of orders then it is dangerous and needs to go.

    In my training I was informed that it is a lower priority responsibility. So if you don't have time on your shift, just inform next shift you didn't have time to update. I also find sometimes you find Kardexs with outdated information

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    • Experts
    23 minutes ago, NurseBlaq said:

    SHE doesn't check orders. How do you get through the shift without checking orders? That's a lawsuit/death/etc waiting to happen. Didn't we see the outcome of not checking and following orders with the Vandy case? I would be anxious and afraid of following a nurse who didn't check orders, especially her.

    My thoughts exactly. I have been known to go back and check more than once on the same shift. I notice when I don't check such stuff, even on a one patient only home health gig, lots of things slip by here and there. Most minor things, some things have been very major. The only reason I haven't been criticized for missing something (being timely, I see it eventually), is because in truth, the supervisor doesn't check what they should be checking.

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    • Experts

    Why are Kardexes even being used in the presence of EMRs? We are able to print task lists.

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    15 minutes ago, Christina.f0602 said:

    In my training I was informed that it is a lower priority responsibility. So if you don't have time on your shift, just inform next shift you didn't have time to update. I also find sometimes you find Kardexs with outdated information

    I understand all of that. But if the employer is going to require that information be duplicated to a second location, it has to be kept accurate or it's just a danger.

    What exactly is the utility of the kardex with EMR in the picture? Maybe there's something I'm not understanding but kardex seemed like its most useful situation would be paper charts in which the original information is just altogether more difficult to access.

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    • Author
    5 hours ago, JKL33 said:

    I understand all of that. But if the employer is going to require that information be duplicated to a second location, it has to be kept accurate or it's just a danger.

    What exactly is the utility of the kardex with EMR in the picture? Maybe there's something I'm not understanding but kardex seemed like its most useful situation would be paper charts in which the original information is just altogether more difficult to access.

    AFAIK, the utility of the kardex is to aid in handover and provide a summary of the patients orders and PM history (NB no med orders are on the kardex at all). Only used by the nurses and charge nurses.

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    Doesn't your EMR have a summary area that can be used for shift reports, though?

    It would be ideal if someone could look into ^ that possibility with the hope of possibly getting away from the kardex system where information has to be duplicated by hand.

    ??

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    • Experts

    The kardex system is a dangerous and outdated holdover from pre-EMR days. It is a breeding ground for errors in care and wastes time we just don’t have. Anyone who is currently using them needs to contact their EMR rep and have them teach you a better way to plan your care using the technology available to you.

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    • Experts
    6 hours ago, JKL33 said:

    If keeping the kardex up-to-date isn't an expected part of appropriately taking care of orders then it is dangerous and needs to go.

    This reminds me of when I worked med-surg and we started out using Kardex. One time I noticed something wasn't transcribed so I showed it to the HUC. Apparently, the manager had had a meeting with the HUCs and told them not to put everything on the Kardex any more because they were being phased out. However, there were NO guidelines about what to leave off and what to put on, and the nurses were not notified of this. I pitched a fit.

    Of course I was spoken to about pitching a fit to the HUC. I told the manager that if each HUC could choose what to transcribe and what to leave off, then the Kardexes had no use, were downright dangerous and needed to go on the spot.

    Needless to say, I quit using them from that day.

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    Haven't used Kardex is many many years, but when I did, we still did once a shift chart check to make sure we were carrying out all orders. On night shift they were expected to do a 24-hour chart check and keep things up to day on the kardex but EVERYONE was expected to do a chart check. We do the same now, but electronically.

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