Epic Charting

newvillemom said:

I need to know if its possible to delete someone else's chatting. When I gave report to a nurse coming behind me, I told her I had given a med she didn't give. It showed up as overdue. She became very irate and argued that she had. The next day I was called into the managers office, and fired because I hadn't documented on that patient. She showed me where it was missing. The weird thing is, I'm compulsive about my charting. I double check. I would swear I charted on that patient.

Can someone delete my charting in Epic, without it being noticeable at first glance?

I've never tried to delete someone's charting, so who knows? EPIC is set up different ways by different facilities. It's not the same everywhere.

This sounds like an "icing on the cake" thing, though. I've never heard of anyone getting fired for forgetting to chart on a patient. I would have been fired a bunch of times over the past eight years!!

Epic is a base platform and versions vary widely by facility/organization, but I've yet to see one where you could delete or alter another nurse's charting, typically it's grayed out when to try and do anything with it.

Getting fired for missing charting is not typical however, either there's something else going on or it's not the type of facility any nurse should work at anyway.

Any editing would be tracked. I haven't used EPIC in a couple of years but I think you can only edit someone else's note if the original author shared the note.

Our version of EPIC allows you to alter other's charting, but it leaves an audit trail that is clearly visible. There would be a red triangle in the upper right corner of the cell. If I clicked in that box, I could see what was charted, when, and by whom, and when, what and who changed the charting. The IT department/computer people should also be able to track who was in the chart.

When I teach EPIC to the new hires, I tell them the only reason they should ever change someone else's charting would be an obvious error and they aren't around to correct it themselves. My example is when my CNA mixed up the HR and RR. I called the aide to confirm and then changed it. I specifically tell them that if they try to alter someone's charting for the purpose of getting another person in trouble, it won't work.

We have learned that in our facility, we have to click "file" in order to save flowsheet data after entering. Otherwise, very occasionally, something charted will not be saved. I have noticed several times that a previous nurses did not chart a complex assessment on her shift. I brought it to the attention of one nurse one day and we were both puzzled that there was no assessment on that date. Her because she was sure she had charted, and me because I know her and know she wouldn't forget to chart.

Another day, I saw that my charting was missing. I clearly remembered charting.

I think it has to do with wifi signal issues. It's very disconcerting when it happens.

On our Epic version, we can chart over another persons entry in the flow sheet area... it does leave a black triangle in the corner with the previous entries as the previous poster said, so it's obviously edited. So your suspicion that the other nurse deleted your entries would not be possible...

The modules we share on with the floor are trackable in a manner others have suggested. I will say - some meds will let you override and enter a time without clearing the overdue/scheduled time. Depends on the med, your facility's pharmacy and Epic settings.

It may depend on your location within you facility - certain areas are sometimes able to override some of the security depending on the situation. Example - in our version of Epic, MOST patient care areas are unable to chart (flowsheets) on patients unless the patient has been transferred onto their unit and their location assigned to that unit. They can "see" (have read only access) otherwise but can't chart unless the patient is physically and within Epic located in that unit. I think they're able to put a note in but otherwise that's it. I work in the OR, and we have access to chart on any patient currently admitted. It's difficult to find patients who are not on the OR schedule or OR bedside schedule. We can chart on any patient, without changing their location to the OR. We're a level 1 trauma center and while rare, we have had instances where we've had about 5 minutes notice for arriving trauma patients. We also sometimes get emergent crash through the door cases (bring backs for hemorrhage/status change) and/or life threateningly emergent trach placements (failed intubation during codes usually). We do urgent/emergent trachs that get posted with notice, but crashing through the door is a new to facility patient or a code they don't want to cric at bedside.

In my specific area - nothing is "saved" permanently until we verify the chart (end of a case). I *could* change someone else's charting. But there's no real reason to do that. Even though it's not "saved" permanently until we verify the chart - it is probably possible to track who was on what screen/edited which item/area. With EMRs, everything is trackable and audited.