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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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    We threw out the Kardexes when we started EPIC 6 years ago. Some use the template as a brain sheet, but everything goes through the EMR.

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    Before EMRs we relied on the Kardex to be accuate every shift. It was not possible and was not common practice to look up every order when hanging fluids, doing wound care, etc.

    In the EMR world, I don't know that there is a use for Kardex anymore, especially if you aren't making it a priority to keep it updated. If I were you I would take this to management and see if you can work out a more efficient communication tool.

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    I hate Kardexes. I was floated to a unit that used them and after report I still had not one clue what was going on with any of my patients. The other nurse was holding it reading from it, so I couldn't even follow along, and I need to write things to retain them. I eventually had time to sit and look up history's and orders but until then... it was a mess.

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    I was a unit secretary at the tail end of the Days of the Kardex, and it was our responsibility to update it when we took off orders. It was the nurse's responsibility to make sure we wrote the order on the Kardex (and/or the paper MAR) correctly. I believe that was pretty standard.

    If the unit is still using a Kardex, shouldn't that process still be used?

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    • Guides
    On 2/27/2020 at 11:37 AM, Wuzzie said:

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

    I didn't realize they were still using the Kardex at all.

    But to the question, they aren't orders and shouldn't be regarded as such. It's been a while, but I recall some that had areas erased & written over so many times you would have to check the chart anyway.

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    • Expert

    Kardex is not reliable, always check orders.

    Our hospital switched to EPIC past Saturday, we threw out all Kardexes, so happy!

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