Umrn1

I am new to UM, for large hospital, uses Allscripts with Interqual. My question is when I have private insurance company who requests clinicals, is it procedure to not only attach h&p, notes, etc. but to type out the info in the SI & IS boxes? Seems like extremely time consuming and "double charting" to type everything in boxes as well as attach.

We do program the Iv pump for run time. I don't think I have the option on our pumps to go back and look at a history of sorts. We use Alaris pumps. On a good day and I am able to go back to chart and document on the paper IV flow sheet. I'll write in start and stop time at the first because I know there is no way I'm gonna get back in that room in thirty minutes exactly or one hour exactly. If the flow was interrupted then I will correct the flow sheet times if necessary. If anyone knows how to see a history on Alaris pumps, please let me know how. I can also view a history on our electronic MAR of what I hung and I know for how long, but it's the transferring it to the paper flow sheet that's the problem. If I'm less busy - no big deal, really. Usually I'm so crazy busy with more urgent matters, that the paper flow sheet is not my priority. I guess ultimately I really just need to know if anyone else uses EPIC and knows how to put in a stop time on that program's electronic MAR so that the paper charting can come to an end.

Yes, I totally understand paper charting on MAR and have had to do it that way before. I guess that is what I'm more used to actually and perhaps that's why this is a little difficult for me to embrace. Again, I know it sounds hard to believe, but when doing ALL meds on paper chart I had to go to the chart for everything, so even though time consuming and a pain also, I was in the chart a lot and everything got documented the same way. I never missed anything. This new way is disjointed. Everything is in computer except the stop time option. The chart is an afterthought and for that reason gets missed. If I were in the chart more - no problem. Or if stop time were in our computer MAR - no problem. At first I thought it was just me and being new, but soon discovered seasoned nurses and everyone else having same problem. No, it's not hard, just looking for a better way to stay consistent and not lose money.

I am a med-surg RN with an IV documentation problem. Here is my delimma... In our hospital, we use EPIC EMR. When we scan to hang any IV fluid/med bag, we have to leave the patient room and get the patient chart from a little closet just outside the patient room and write in the fluid/med hung along with start date and time and end date and time. My nursing manager and director have explained to me that by keeping a start/stop list of these IV fluids, that guarantees our reimbursement and has saved us a lot of money. If we fail to document start and stop times, we lose money. I have so much trouble remembering to stop, go to patient chart and write this down. I know it does not sound to difficult, but when I leave the patient room and cross that threshold, I'm off running to another task or patient need. Some nurses have started removing each patient's flow sheet from the chart and carrying them around on their clipboards to remember, but I don't carry a clipboard and find that to be just one more cumbersome problem, and I fear of misplacing the entire sheet. I am asking what does your hospital do to keep up with start/stop times for IV fluids? There must be an electronic way or at least a more efficient way. Any feedback will be so very much appreciated:o

I am a med-surg RN with an IV documentation problem. I don't know if this is right specialty area, but here is my delimma... In our hospital, we use EPIC EMR. When we scan to hang any IV fluid/med bag, we have to leave the patient room and get the patient chart from a little closet just outside the patient room and write in the fluid/med hung along with start date and time and end date and time. My nursing manager and director have explained to me that by keeping a start/stop list of these IV fluids, that guarantees our reimbursement and has saved us a lot of money. If we fail to document start and stop times, we lose money. I have so much trouble remembering to stop, go to patient chart and write this down. I know it does not sound to difficult, but when I leave the patient room and cross that threshold, I'm off running to another task or patient need. Some nurses have started removing each patient's flow sheet from the chart and carrying them around on their clipboards to remember, but I don't carry a clipboard and find that to be just one more cumbersome problem, and I fear of misplacing the entire sheet. I am asking what does your hospital do to keep up with start/stop times for IV fluids? There must be an electronic way or at least a more efficient way. Any feedback will be so very much appreciated:o

Im am looking for what other hospitals do for doumenting IV start/stop times. There has to be a better way than how we do it...... I am a new BSN-RN with eight months experience on a twenty-nine bed very busy general surgical floor, day shift, six patient load. I feel really good about how I am doing and have had very positive feedback, however, my nemisis is our IV flow sheet documentation. We are new to using EPIC EMR, but are still keeping a paper log of every IV we hang listing start date and time, type of IV and rate, location of IV in patient and stop date and time in the patient chart. The nursing manager and director explained to me that in order to get reimbursed, we must have start/stop times of the IV's, and that the flow sheet has saved a lot of money. I'm all for increasing money and budget, but my problem is that our patient charts are located in small closets just outside the patient rooms. When I take a IV fluid or med into the patient room, I scan it in EPIC and hang it. When I leave the patient room, I can't seem to make myself go immediately to the little closest just by the patient door and write in the log what I hung and what has stopped running. More often times than not, the patient has a request for something that I run get them, or as soon as I clear the threshold, I am running to another beeping IV or call light or some other need. I have tried checking what all I hang and writing in at the end of day, but usually am too short on time. Other nurses also complain about remembering or having time to write it in and have clipped it onto their clipboards and just carry it around with them, but I don't carry a clip board and find it cumbersome and a pain also. I've thought about just taping it to the wall beside the computer in the patient room, but others come by the closets to check that sheet occasionally, so that won't work. Basicly what I want to know is what does your hospital do to keep up with IV start/stop times. Do you use EPIC? Is there a more efficient way? Is there a computer way? Do you have a person that keeps up with it other than nurses? Any feedback will be so much help:o

Okay, minimize the number of accesses into the system. I agree is definately not the same as swabbing. Thank you for the post:)

I am a new nurse with 7 months experience on a general surgical floor. Looping tubing is the norm. I need clarification on where looping is considered a risk when the port looping to is alcohol swabbed. We use blue quick connect caps on the patient side. The patient side is swabbed and new tubing attached. It seems to me that if swabbing the pt side before new tubing is attached is okay, then swabbing a port on the tubing itself is okay as well. In fact, the tubing itself is generally cleaner than the patient side anyway - unless it's been allowed to drag the floor or something I guess. More info would be greatly appreciated. This discussion has made me think differently about being more diligent in checking our IV policy and protocol :)

Oh yes, I have also always tried to 'reward' my aides who really rock, or who may not have rocked at first, but after getting to know me and our patients have really stepped up to the day and responsibilities at hand. I get them a candy bar or ice cream or other little treat when I can and thank them at the end of the day for their hard work and help and let them know the patients are all very happy today and satisfied. Even if I can't get a treat, I thank them. I know I shouldn't have to thank someone for doing their job, but our jobs usually require us to go above and beyond anyway. I had a CNA the other day who had been pulled and who was not at all happy about it, patient complained about her even. She did not talk much, but I could tell she was really a hard worker, just mad at the situation. Eventually, she realized that she could talk to me as a peer, we got to know each other a bit and that it wasn't going to be a terrible day after all and she rocked. I got her a candy bar and thanked her for sticking it out. She was so shocked! It makes me sad to realize other nurses are mean or disrespectful. It gives us a bad name. It also makes me sad that some aids could care less and are mean and disrespectful also. I think the management are on to the bad ones and are going to weed them out.

Great and very helpful responses! Some time has passed since my post and I've been trying harder and harder to follow up and to let the CNAs know that I completely understand the staffing issues we have from time to time. I've spent more time and effort in helping the CNAs know where we stand right from the beginning. I get my assigned CNA (s) and start the shift not only by turning in my "assignment sheet" we are required to fill out for the day, but by actually giving report to them. I have had several tell me that no one has ever taken the time to do that and it seems to help them really understand which patients are the priority ones and safety risk ones and the results have been better cared for patients and happier CNAs. I'm getting done on time more often now and feel much better. The management has not actually repremanded a single CNA ever that I know of and I don't want that unless there is proven neglect or injury to a patient. There have been management/CNA staffing meetings to give over all reminders of tasks, delegation, priortizing, etc. My charge nurses are doing better job of following up for the nurses also and helping out as necessary when have low staffing. I still have a major problem when patients are not fullly cared for, I do not take a break etc, but the aids are in the office chatting it up, eating snacks, and taking multiple breaks. This is the root of the majority of our problems, call lights going off, nurses in procedures or in patient rooms already, yet one or two CNAs in office ignoring a call light and having to be told to help out. I really see this happening on super busy short staffed days. It's like they are overwhelmed and just have to stop for a moment. But who hasn't felt the need to do that sometimes, right??? I have also noticed there are one or two nurses who can't seem to ever help a patient to the potty, change a linen or anything else. Perhaps they are the real problem by taking up all the CNAs time by doing all their work for them. Hhhuuummmmm. Anyway, things are going better. Thanks for the advice!

I am a new grad going into my fifth month working on a general surgical floor, day shift. Of course time management is still something I struggle with. I have days that everything seems to go as planned and on time and I feel like super woman and fulfilled. However, I have more days that go by in a blur and I spend an hour or more after shift catching up on documentation and finishing tasks. On those days, when I try to figure out what has caused my delimma, I can only truely answer that I have spent more time taking care of what should be CNA patient care tasks than actual nursing tasks. I did not work as a CNA prior to nursing, but I have full respect for them and am aware of what they do and that they are short staffed as well. My floor has 29 beds and is almost always full. We are to have 3 CNAs with a full house but lately rarely do. Lately we start with one and end up pulling another. I am too new to get CNA care and nursing care done. I am a firm beliver that everyone should be treated with respect and kindness, but now I'm starting to think I'm a pushover and being taken advantage of. Does anyone have any advice of how to professionally get the CNAs to do what they are getting paid to do? We fill out task sheets for CNAs each morning. I also verbalize which patients need special attention such as turn q 2, special equipment like drains, tubes, etc and personal/family concerns like who gets mad if don't have fresh ice water etc. But rarely do these tasks get done. When I ask what was last time room #... was turned, I am flat out lied to or I get "I've been doing CBGs and I'll have to turn that one later"! What do I do? I've had several patients in my section lately who have been here for weeks and oral care has not been done to the point of tounge, oral cavity starting to peel; I'm catching stage I pressure ulcers starting to form and patients who have not been bathed in a few days and never had hair shampooed! The other nurses on my floor, including the charge nurses just shrug their shoulders and say, yep, gotta stay after them or make derogatory comments without actually adressing the problem. I have expressed my concerns to my nurse manager and she understands my concerns and seems to have talked to the CNAs, but not all of them, and she explained that due to budget cuts we are having to run shorter on aids. The more experienced nurses that I work with I guess are just turning and getting drinks, helping with toileting and bathing also - or are more convincing to get the CNAs to do all of that for them, leaving me doing all of it for my patients. I have realized that at the end of the day, I have missed some major nursing actions simply because I have been answering call lights all day. Does anyone (nurse) ever have a CNA ask them if they need help, or what needs to be done next, or anything proactive? Not me! I am the one asking the CNAs what still needs to be done and how I can help them!!!! How can I stop this?!?!?!

More questions... How many of you document 2 assessments one initial and another focused, resolve care plan problems, resolve teaching problems etc. on every patient every day? I am also looking for advice on adding/deleting care plan items and teaching items. Before, I really was awesome doing all this for each patient (fewer pts though). Now, I'm not. How bad do I suck???

Yes Yes! I totally forgot about the wrenching tool! Thank you for reminding me of that. Hopefully this weekend will have a slow(er) day and I will work on my flowsheets and overall set up to customize more. I helps so much just to hear that everyone really does have their own way and I'm not doing it 'wrong'. I am definately double charting my initial assessment details and I've got to stop that. Another question: Should I be adding in an RN progress note, similiar to the Drs and other diciplines? I have seen some nurses do this and I have to admit, I like having the note especially if its something out of the ordinary, but wondering if I should be doing it. Is it helpful or just annoying???

Thank you so much! This will help me. I love the hiding part. That is the one thing I have figured out. If there is an empty patient room, You can find me there trying to get documenting done, lol.

I am looking for some EPIC documentation advice, tips, hints, etc. EPIC is new to our hospital. I feel we had the max training time allowed and overall I really like it, just unsure how best to approach it. I am mostly looking for the best possible time management advice. I've found that if I document assessments in the patient rooms as supposed to, I become too distracted by patient or other person talking to me or it just simply takes too long in general. Here's what I'm doing now. I begin my 7am shift by checking on each patient and doing initial assessment. I then start by passing meds, and then doing dressing changes and fulfilling other orders. I find myself not documenting until around 2-4 pm when seems to be the most common time I'm "caught up" and am doing Is and Os. I take notes and just go back and enter what I did in the correct time slot. This also is time consuming and if anything at all goes wacky, I'm still trying to catch up way after my shift is supposed to end. I also find that I am not getting to resolve care plan problems each shift; mainly due to simply forgetting to click on it. I charted very well and often on paper and I just am scared of not doing enough on this system. I've only done one direct admission assessment and all the documentation is done in the room at that time of course. I must get faster with this also. If anyone has developed a "system" that works well for them and timing and reducing errors, etc. please share advice. Plus, I am a new grad from May 2010 and recently off orientation so time management and getting a "routine" down is still not something I have mastered yet.