OG nurses: how did you use paper charts?

[Nmichelle]

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?

[NRSKarenRN, BSN, RN]

Thinking back to 1979 documentation when I worked nights.... Our forms came form Briggs Medical --can do image search for different forms.

1. + 4.  New physician orders were flagged by unit clerk days/middles or night nurse by folding order sheet 45 degrees to stick out of chart to review and sign off.  They were duplicate so copy could be removed and placed in pharmacy bin for pickup --no fax machines til 90's.  Nurses signed off beneath orders indicating review q 8hr shift (colored pens  red, green, black); night nurse signed off 24hr check below last physician order to make sure all orders reviewed: " 24hr order check / Nurse name LPN/RN _______________________" black ink line to end of page so doctor couldn't enter another notation afterwards.   Stat orders --nurse paged overhead by unit clerk if not in view of unit clerk.

2. RN tasks were kept on separate nursing kardex folded in metal file by room# and added to chart upon discharge --admit nurse started form, updated q shift as needed --remember using pencil on some sections that could be changed like diet, VS frequency,  daily labs etc. wound orders were in black on back side of form.  Kardex used to give shift report + check if covering for meals.

https://allnurses.com/kardex-what-used-t333360/

3. Med administration were separate form: 30 days listed.  When med changed --list "ended (if for specific # days/ or stop" draw line through remaining days.  Separate  line for each time administration   OD (daily),  BID, TID, Q4/Q8/Q12 if  specific time interval-often antibiotics.  Skipped line between each med on form so med stood out.

PRN meds were listed on bottom or separate sheet

5. Ancillary dept --notified by unit clerk or nurse on nights for Resp therapy, lab,, EKG tech, radiology  for stat CXR etc.

[nursej22, MSN, RN]

We had 24 hour med admin sheets. Scheduled and PRN meds on separate sheets. The current sheets were kept in a 3 ring binder in the nurses station, old ones placed in chart. New sheets were printed by pharmacy in the late evening. Night shift nurses checked the new sheets against the previous ones for changes, errors. 

The chart always went with the patient to X-ray, or procedures. And if it didn't come back with the patient, it seemed that it was always up to the floor nurse to fetch it. 

When I first started nursing in 1987, the chart covers were metal and held the chart forms by Spring. Woe to you to drop one and spread papers everywhere, especially on someone with a prolonged admission. 

In the mornings, there would be huge stacks of charts on the clerks' desk after doctors rounded, while the ward clerk plowed their way through, to find the stat, now and ASAP orders and get them processed quickly. 

[greener22, BSN, MSN, RN]

Been a nurse since the mid 80s I'm definitely OG and I definitely remember how to use paper charts and I can answer all of your questions. 
We were notified when they were new orders in the charts because of position would flag it and put it at the desk. The charts had a little mailbox type of flags that could be extended at the top like a bookmark.

Yes the Mars were on paper and it depended on which one you used if it had three days or seven days or 30 days on them. Paper charting for 30 day format or sometimes still used in long-term care.

If I needed to communicate something with another department I picked up the telephone tell them that the patient in room seven or whatever needed a new x-ray or that the diet order had changed...

Nursing tasks were kept on a Kardex, similar to what is in the brain on epic. It was a cardboard 8 x 11 or sometimes 8 x 10 paper that we wrote out in pencil things like the patient's IVs, dressing changes, when vitals were to be done etc. and then those were updated every shift or with every order written by the doctor.

The night shift staff would update the paper MARS.

The world is much safer now with ESR but much slower. I'm happy to have a longer discussion with you if you DM me.