Paperless in PACU

CVSDnurse · Jul 21, 2008

I am on week 4 of orientation to the PACU from the Cath lab. Both areas utilize 100% electronic charting, although they use different systems.

In both areas I have experienced your situation with one big advantage, the transfer of vital signs to the documentation system. In the PACU it is a "click" to pull the data from the monitor.

As I am still trying to get a feel for my flow, but I have found that if I can enter a reading for vital signs at the correct interval, then return to post document in that field the correct assesments that was occuring, it is a bit of a time saver.

You will see the biggest advantage to electronic records for patients that are "returning customers" because you will have lees to initiate, also it is nice to have all the information at your finggertips.

While it is true that as you become more comfortable, it will get better (meaning you can get what you need faster), there is still a big role for your IT department.

If you are an area of "champions", being the first to experience the electronic medical record, then there should be a flow of your needs to the IT/Meditech department to improve the workflow.

In particular, there needs to be some work on having the monitoring system talk to the documentation system to fill in the vital signs for you.

Also, the "duplication" that you are needing to delete when patients have been in both pre and Pacu needs to be evaluated.

Is it just automatically autopopulating forward? (this should be a manual option to "copy forward") or are you eliminating the documentation of care previously provided?

I would suggest talking with your manager to see what resources the IT department has for your area, and to request some if they are not in place.

I have watched a lot of "little changes" take place in the 4 weeks I have been in PACU just around the new computerized physician order entry to try to make it easier.

I also know it took a year to make the monitors and documentation system "talk" to eliminate the manual vital sign entry.

In my years in cath labs, there was no way to avoid "late entries" when you are providing acute care to your patients, wether it was written or typed.

Make sure you are finding how to make "late entries" in your electronic medical record. This is another discussion to have with your manager.

As long as you provide the care, then be sure to "document it" so the lawyers know "it was done", you are doing a good job (even if it takes longer than it used to )

Scratch paper on hand, and your vital sign capture device holding a memory of events are a must.

thisismylicense.rn · Jul 24, 2008

Thanks for the feedback. I found out that our SDS unit was the Beta test, so we have been "working out the bugs". We have a long way to go before it flows easily; but I am beginning to see some positives. I find that sometimes it takes awhile to get that initial assesment documented, but once it is in, you just have to update as you "take care of the patient".

Thanks again for the encouragment :)

All4Seasons · Jul 26, 2008

Any PACU nurses out there already doing EMR charting? Last week our hospital went "paperless" for preop and PACU areas. This involves using several file sheets for documenting assessments and vital signs. In preop, I have not found it to be a problem - you have the luxury of focusing on the patient without any crisis at hand. You record in the computer as you prep them without any interruptions.
PACU is a whole different scenario - you may spend the first fifteen minutes securing airway/suctioning/running to pyxis for pain meds/applying warm blankets/orienting pt, reassuring them/etc. etc. The PACU assessment forms in Meditech are not user friendly. You have to add the PACU interventions and then delete the duplicates if the patient went through preop, and that is before you even begin charting..... You have to manually enter the vitals every 15 min, just a whole lot of clicking. . . . . .
I feel frustrated that I have to fumble with the "WOW" - workstation on wheels- more than with my patient now......
I know that IT says that once we get more familiar with the system, things will go smoother; but I seriously have my doubts. Any advice???

This time last summer I was EXACTLY where you are now, thisismylicence.rn. Because the powers-that-be decided that the entire Perioperative portfolio had to be 100% computer-charting,PACU was stuck with a really awful (in our opinion) program that we had to use,as it came with a package deal that was purchased some time ago. The PACU nurses,once we had a look at this thing -protested MIGHTILY - it was essentially met with 100% negative reviews by the nurses-except by some of the 'super users' who were first taught all the ins and outs of the program,so that they could teach us. I mean it was met with A LOT of flack (and for good reason) -luckily, on our suggestion,many modifications were put into place that made it better -don't hesitate to do this,too.

One of our biggest beefs was (and still is) that our moniters didn't/don't interface with the computers (even 2 new generations we've had since don't!!)....so initially they were expecting ALL vital signs would be entered by hand....yeah,riiiight,in a unit which minimally records them Q 15 mins and Q 3 mins if medication has had to be given to treat hyper/ hypotension,or if someone is crashing :bugeyes: We fought tooth-and-nail to keep our paper v.s. record. So far,so good. Our ultimate wish is that they find the $150,000 they tell us it'll require to link them up.You don't have that problem...good.

We were supremely worried that pt care would be compromised due to needing to fiddle around with computers, and balked at the thought that we would EVER get comfortable (and efficient) enough to favour them. Well,with some good,solid planning by nurses,many of us love the computers now (last week I came on duty after vacation to find out that the Horizon program was down -some glitch,and I was actually disappointed! If you had told me that a year ago...:typing

What we nurses have put into place are:

Scratch pads at every spot on which we write down the admission v.s.,the drsgs,the csm checks,the drains and tubes,the iv details,the particulars from the anesthetists' reports,etc - if we're lucky - another RN or more,is doing all the settling work -zeroing art lines,getting the warmies,putting ivs on pumps,etc while we start the chart. If we have to do the entire admit ourself,then quite often someone else will do the next check due on our other case.

Unless it were an extreme case,we DON'T take a 2nd case until the first case's admission has been logged in -they were going to have us not be able to refuse a new admission while this was done -but we changed their minds :nono: The anesthetists don't like to be put on hold,but that's the name of the game, at times, now. I must say,these nurses I work with are excellent,and you never see games being played in PACU -if a room (s) is on hold -it's on hold for a darn good reason. And puffed-up surgeons storming in don't scare us...we're all adults here, people...

A great benefit to having this system in place for the pt's entire perioperative course is that,if I have time before the pt rolls in (and I usually do) I can find out all kinds of info that I'll need -the preop v.s (with which we use as part of figuring out if the pt meets discharge criteria -like yourselves,no doubt), their PMHx,the meds they're on, what the surgical procedure was,the type of anesthetic used,whether they had local as well as the G/A or spinal, the meds given preop,etc -it's invaluable in that way.

Hang on, good luck,and don't hesitate to make suggestions to make it a better system for you :)

jen

thisismylicense.rn · Jul 26, 2008

Thanks so much for the feedback Jen. We are working with IT and giving suggestions every day to improve the workability of the program. Trouble is, every time you load the interventions, they have changed something!! I realize it WILL get better EVENTUALLY. I like your practice of having scratch pads available at each station. What we have been doing is printing off the rhythm strip of the first VS and writing notes on the back....

It is a shame that our system also can't seem to find money to supply us with the link to data dump the VS from the GE monitors. It would make charting much easier. :)

Thanks again!!!

All4Seasons · Jul 26, 2008

You're welcome,hon -and thanks for the thanks! :)

jen