Nursing unit set up...help!

[tanhaight]

We are opening a new tower at my hospital that is set up differently than what we are used to in the old building. Nurses will document on computers outside patient rooms but the charts will be kept at the nursing station at the end of a very long hallway. I call it a nursing station but in reality nurses are not to congregate there, only unit clerks have seats and will enter orders to the computer.

We had wanted drawers built at the computers (outside rooms) for the charts but we were outvoted and so they will be kept in a central location. Next year we anticipate being fully electronic but we still use the charts for Physician progress notes, skin and wound pictures, and most importantly MD orders. We still dont have MD electronic order entry. Sigh...

We forsee charts not being returned to the nursing station, nurses leaving them next to the computers by patient rooms instead of returning them to the main station or better yet, MDs asking nurses to run and get charts for them. Does anyone else work on a floor where the charts are at a central location and what did you do to ensure that nurses didn't spend their entire shift running back and forth?

So far we have thought we would use phones, have a 'runner' who would return charts from the floor to the station. Any other ideas would be appreciated!

Thanks

[RNperdiem, RN]

No, but I have seen the opposite. The charts and med books are kept beside each patient room, and when computer orders print out, the secretary takes the order down to each room and places it in the chart.

With computer charting, the doctors are less concerned with the location of the book chart.

[LouisVRN, RN]

Yes, that is primarily how our floor works. We were told we can not keep charts outside of patients rooms because it is a HIPAA violation. (Totally can see a family member going through a patient's or someone else chart). It's really not that bad. I mean how long out of the shift do you really need the chart? 20 minutes maybe? Besides if it is anything like our floor you are walking all over the place anyway. A runner to get charts? Hahaha that is a nice idea, but I doubt if that is financial feasible. It is much easier to just get the chart yourself when you need it and then take it back. Yes, occasionally we have doctors who will come and ask for charts, but if they are not at the main station and the nurse is not supposed to leave them unattended it shouldn't be too hard to track down the nurse and find the chart.

[NMA851]

Wow NOT totally electronic? We do have paper charting for us to complete on the PC's but we also have computers in EVERY PT room. No matter where we go or what room we are in, EVERYTHING follows us (or we follow it) :):). Furthermore, we have to SCAN SCAN AND SCAN just about every little flippin' thing we do - including the PT's armband which must be done before you can as much as access anything. There's alot more about these technologies I could talk about but I do not want to trample on your thread so to speak - or get "off topic"!

When it comes to getting orders/requesting orders, all I have to do is email the MD, for lack of better words, who responds with electronic instructions and signatures via his handheld. It's like a Blackberry basically. The one I carry will send me the response and populates into the PT record. Then I can go about my business. Until there is a response though, nothing can be done - and there is no "verbal" authorizations anymore either - it's ALL done this way or no way. Honestly - I have nothing but GOOD things to say about the way this works - the margins for errors, at least as far as charting/orders/paperwork is concerned, has been SIGNIFICANTLY reduced. There are several checks/balances that I mentioned above with the scanning of EVERYTHING. If a particular med strength is unavailable and I can draw a partial, we're able to do that, waste the rest if necessary, and because I used a different strength, it sends an Exception to the MD letting him/her know the time, date, etc. etc. as to why I did what I did. Whenever I scan the med, it pops up a message stating wrong strength is the ordered strength unavailable? You answer yes, I get a prompt of "do you wish to substitute?", I answer yes, and voila - off I go. Then the systm is smart enough to recognize if an error is about to be made, i.e. it's impossible to substitute in order to get the ordered dosage.

This has MANY more good points than bad - about the only BAD (more irritating than anything) is the amount of scanning of EVERYTHING. A bag of saline? Really? A blanket? Tissues? What syringe? I can't wait until they make us start scanning everytime we put a pair of gloves on, flush the toilet, or better yet, whenever we walk into a PT's room!! Hope you at least SMILE with this part :):).

I do not understand why they would want "runners" when that seems to be a bit cumbersome at times however HIPPA really is a touchy subject. EVERYONE wants to error on the side of caution and I understand that. However, I don't see an issue with "paper" charts/logs/books being right there by the patient but in a LOCKED drawer. There's the HIPPA protection at least!!

Once you're up & running fully electronic, trust me your life will be MUCH easier as far as the dreaded paperwork.

Take it easy,

NMA

[tanhaight]

Wow, I wish we had electronic order entry like that! The MDs entering paper orders in the chart will be the big challenge if the charts are sitting up at the nurses station and the nurses are way down the hallway.