I'm working on a project right now, with the goal of mobilizing back to paper chart in an EHR downtime.
One of the biggest problems we are having is making and using a paper chart. If you are an OG nurse, I would love to connect and pick your brain or feel free to comment below:
1. When new notes, orders are added to a chart, how were you made aware?
2. were RN orders ( or RN tasks) placed on the blank Dr order sheet or was there another location for RN orders such as vitals, wound care etc?
3. How were active meds kept track of? In the paper MAR? The ones Ives seen only have 3 days worth of dat, so did that have to be transcribed again and again?
4 when a Dr placed orders, how were you alerted to review or check the chart?
5. If an order was for an ancillary dept, who's job was it to let them know?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
heron said:
One of the young'uns got all thin in the nose over it. Too disrespectful, she said. There was a short-lived attempt at a COB forum over in the breakroom but no go - too many of us are no longer posting.
Ya know what? Young'uns don't get to decide whether or not I can call myself a COB. I'm a Crusty Old Bat!
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
heron said:
Same here ... the scolding was hilarious, though.
I miss all the COBs - these fora were so lively back then. Times change, I guess ...
Yeah, me too. It's not the same place anymore. I'm glad to see it's veering away from the "all the older nurses are bullies who just hate me because I'm young and beautiful" malarky though.
Not sure what you consider an OG nurse. The Kardex and MAR in the first answer was what I was using until electronic everything switched over...in 2017!
Everything else described is the same as well.
Side note: the actual meaning of "OG" is Original Gangsta. :-)
Not sure what you consider an OG nurse. The Kardex and MAR in the first answer was what I was using until electronic everything switched over...in 2017!
Everything else described is the same as well.
Side note: the actual meaning of "OG" is Original Gangsta. 🙂
Language evolves - I like my take better. Old nurses rock, though, so maybe gangsta is the better descriptor.
I've only been a nurse for 3 years and never did paper charting. That's weird. When I worked in LTC the power went out and we had to chart on paper temporarily though.
I also have a question. In absence of an EMR, how did nurses and pharmacists coordinate medication orders and administration using paper charts?
Sometimes they were written on multi-copy forms, one copy went to pharmacy to fill meds. Nurses then transcribed orders onto MAR/TAR. Sometimes orders were faxed to pharmacy with nurses transcribing as above. Stat orders were called into pharmacy by nurses or filled from floor stock, transcribed onto MAR by nurses, with paper copy eventually following. Specific forms and processes varied between facilities. Need for deliveries was minimized by having extensive floor stock.
We had a flag tab and a special place in the chart rack for charts with active orders. We had a Unit clerk, somebody trained in medical transcription or the like, who would transcribe the orders onto the paper MAR. The nurses were responsible for double checking the transcription and signing the order off. We also did a daily check to see if any orders got missed on Night Shift. The paper MAR was for three days and night shift. Nurses would also double check these for proper transcription after the unit clerk transcribed them before they went active for the day. For ancillary departments, there was usually some sort of clipboard system, and also general communication between actual human beings. There was no click click and everything gets done magically. You had to talk to humans. It was significantly better. I hate technology.
ooo I need to read this asap, I graduated in 2021 and started a job soon that's mostly paper charting.. I'm NERVOUS
Don't be nervous. Having to chart on paper made us more likely to check our charting. Should you go from paper to electronic at the same place, you will wish you had paper back.
Ruby Vee, BSN
17 Articles; 14,061 Posts
Ya know what? Young'uns don't get to decide whether or not I can call myself a COB. I'm a Crusty Old Bat!