Pros and Cons of Computerized Charting

RNperdiem, RN · Oct 17, 2013

What works:

Enough computers to go around- computers in each patient room, several at the nurses station and some "cows" or computers on wheels. The doctors like to have a couple of portable computers to take on rounds so they can put in their orders right there.

Tech support available for password reset. We have about 5 or 6 regularly changing passwords for various programs.

The realization that there is always a trade-off. I spent less time charting when we used paper. I find computer just takes longer even if it is only boxes to click.

classicdame, MSN, EdD · Oct 17, 2013

Nurse input on how the screen is worded. Single sign on so that once you sign in for the day you do not have to do anything but flash the barcode on your badge to get in to any company computer or program. Colored flags to alert nurse that test results are in or new orders have been entered.

Editorial Team / Admin · Oct 17, 2013

Going for everything at once, and if one area is using a computer system, evaluate it for use everywhere. My facility did a staged implementation: first the floors used the computerized system for a year, but had to enter hand-written orders. Then a year later, the docs started entering their own orders. Soon, all of the interventional units will begin using it (OR, cath lab, IR, etc.).

My biggest beef with how my facility did it was that there were a few units already using the same computer documentation, with my department being one of them. However, the facility went with a completely different system. Currently, I have to have 3 programs up and running for each patient I care for: the old computer system that we are still using, the current computer system so that I can look at my patient's hospital chart, and the system used to communicate with the waiting room as to where we are in surgery (in the OR, incision made, procedure finished, left OR). Having to switch between the three programs is quite a pain.

gcupid · Oct 18, 2013

Pros of CPU charting-u can type faster than u write. Legible notes to read. Increases patient safety, especially if an eMAR is linked along with doctors entering their own orders.

Cons of CPU charting-it slows the nurse down in other areas.. If not enough CPUs or it takes forever to load up, it can be frustrating. CPU charting is catered to whomever has to audit the chart as oppose to being user friendly for the bedside nurse depending on what program is being used.

SubSippi · Oct 18, 2013

Not sure if this is the kind of opinion you're looking for, but it drives me crazy on my floor so I thought I'd mention it...

If you put a computer in each room, have them on the side closer to the door. It's very cumbersome to try and roll the med cart to the other side of the room to be able to scan everything. Also, one time I was in a patient's room charting and he suddenly started threatening me and swinging and trying to jump out of his bed (apparently didn't appreciate me asking him when his last bowel movement was). The computer being on the other side put the patient between me and the door. Which I didn't like.

imintrouble, BSN, RN · Oct 18, 2013

I don't like our system. It's slow, therefore it takes longer to do just about everything. We don't have computers in every room. We wheel our computers from room to room between 5-7 patients.

It's created alot more work for us.

I think if our system and equipment was adequate I'd like it more.

NicuGal, MSN, RN · Oct 19, 2013

Do you know the system they are going to

Implement? Each have their own bugs.

That Guy, BSN, RN, EMT-B · Oct 19, 2013

The problem is, you have to work with it for awhile to see what the bad areas are. We went to EPIC recently and it was sold to us as the next best thing. We all hate it and have been working to make it a fraction better for the last few months.

akulahawkRN, ADN, RN, EMT-P · Oct 19, 2013

Disclaimer: I'm a Student Nurse...

I've done both paper and computer charting, and there are clear advantages to each.

Since the OP's going to go to computerized charting, here's my experience with EPIC. Other systems will have similar issues, though the format may change....

1st, make sure there's enough workstations, mobile and otherwise, to go around. If there's going to be a computer in each room, make sure there's a computer mounted on the wall for each patient in that room. If you go with a mobile hand-held system to scan and enter meds, make sure that there's enough so that everyone giving meds can have a device in hand all at the same time. If you go with that system, more fixed workstations than wheeled workstations should work OK. Otherwise, you'll need a mobile workstation for each nurse giving meds and is actually scanning the meds as documentation. If no meds will be scanned, just have enough workstations for each provider likely to be on the unit at one time.

If you're used to spreadsheet entry, you'll take to EPIC pretty easily. Also, with computer charting, it's probably easier to switch to CBE (Charting by Exception). However, your facility will have to be VERY specific as to exactly what's considered "normal limits" so that anything else is an exception. Another thing to do is to create a cheat-sheet that tells you exactly where to chart things. For instance, you might not have a place to chart IV site findings in the tab where you do most of your data entry, rather it may be part of it's own tab for Lines and Drains...

Make sure that nursing has a LOT of input as to how each input sheet is laid out, what's on each sheet, and the like. You want it to be as intuitive as you can make it for the way your facility works. It won't be exactly like charting on paper...

Also, get everyone trained in using the system. When you go live, you want everyone on the system. Orders need to be entered, acknowledged, updated, and so on. Use paper as a LAST RESORT for order writing.

Have a competent IT person/company set up the system to fail safely. If the network goes down, you want to have at least a few computers to be able to still function and do data entry stuff until the system can be brought back up.

Make sure that each unit has a person or two that really understands the system and can help others... and expect some resistance from the nurses that aren't computer savvy or can't type very well. I can type much faster than I can write, but I also can't draw on the screen like I can on paper to physically illustrate something.

Something else that just hit my brain... when giving meds, if you're used to doing paper charting, it's easy to verify your patient, and just give the meds. When you transition to scanning the patient and the meds, you pretty much remember to scan the patient and then you want to just give the meds... you have to scan them before you give them because sometimes opening the packaging destroys the barcode enough that it won't scan. :no: That's one thing I have to remind myself to do so that I don't make that mistake... and I've been using a computer system for much of the past few semesters.

And always remember: To err is human. Really fouling things up requires a computer...

roser13, ASN, RN · Oct 19, 2013

Whatever system you implement, certain MD's (SURGEONS) will refuse to enter orders. If I identified the problem group of MD's out loud, I apologize - I meant to just say it in my head.

At the 1-year Anniversary of EMR implementation, fully 50% of Orders & H&P's are still on paper. Be prepared for the hold-outs and have a plan to address them. Peers need to address the issue - none of the lower life forms have any impact.

NicuGal, MSN, RN · Oct 20, 2013

We use EPIC and it has it's bugs. It took us one year to build all the flow sheets. Of course NICU is the problem child because we don't fit in anything lol We had to do a lot if modification. The I/O's sheet gave us fits for the longest time and it still has it's bugs about certain gtts and boluses.

We also had each unit build their own care plan sets and order sets.

We had a dedicated full team, many of us went to Wisconsin for training, for 6 months after it was rolled out. Then it phased down to half that number.