Technology taking over

PMFB-RN, RN · Feb 16, 2012

Electronic medical records and charting has the POTENTIAL to benefit everyone. However as it is now every electronic charting system I have ever used, and that includes all the popular programs, are designed to make it easy for those who must draw the data out. Little to no thought has been given to those of us who must input the data. Computer charting systems we have now are silly and require a ridiculous amount of charting time for nurses. An RN in a busy ICU with two critical patients should be able to accomplish all their charting in 15 min or less per patient on a system that they can learn to use in an hour, like we could do easily when we used paper tri-folds.

babyNP., APRN · Feb 16, 2012

Newer nurse here (3.5 years experience) and have done some agency and couldn't believe the hassle with paper charting. My biggest pet peeve was when the docs would take your chart and you need to chart your own stuff or check the MAR! Plus I felt like I was constantly crossing things out. And it took about 10 minutes to do each patient...not to mention the progress note, ugh. Writing all of that out in long-hand is very time-consuming when I type 120WPM plus I'm left-handed, so I'm always trying not to smudge the paper and I'm constantly lifting my writing hand up to make sure I'm in the right box because my hand is covering it!

At my home hospital where we have electronic, it takes ~5 minutes to chart a detailed assessment.

Esme12, ASN, BSN, RN · Feb 16, 2012

18 years ago I was on vacation 3,000 miles from home (stick with me here). I ordered pizza, gave them only my name and they said "Oh, would you like your regular order?" (Lg pepperoni and olive). That was 1994 and a national database of my pizza eating history had already been established. I think the fact that here we are in 2012 and we are still working on achieving the same level of technology in healthcare that Round Table had in 1994 is a national embarrassment.

And a frighting implication of "big brother", the government, and whomever else able to be in and follw your business everywhere.....I am not so sure about the "good nature" of everyone who will have access to my personal information and won't use it against you to discriminate against jobs, loans or whatever else they can think of to hurt their fellow man.

I'm concerned..... :nono:

Esme12, ASN, BSN, RN · Feb 16, 2012

i've worked with electronic charting in one form or another since the late 80s. there's wonderful software out there, and there's software that can make you rip your hair out while wishing you had an axe to take to the hardware. currently, we're using some of the latter thanks to a recent "upgrade." change comes slowly, if at all, and administration announced from the outset that "we're not changing our programming just to make the nurses' jobs easier." meanwhile, i'm discovering new "bugs" almost daily. in taking care of my first vad patient since the "upgrade," i discovered that the software won't let me enter in any values outside of the "normal range." so as my patient slowly circles the drain, i'm forced to enter most of my vad parameters in as "comments." that means that the providers who are trying to follow my patient's trends can't just follow a graph . . . they also have to click in every little cell and read the comments. it's frustrating and time consuming for all of us.

i no longer miss my paper charting, and the electronic chart does most of the calculations for me that i once did by long division on a paper towel. (cardiac outputs, indices, svrs, drip calculations, i & os.) i've stopped carrying a calculator in my pocket. it's convenient that i can be putting my vital signs into the computer in my patient's room, and the provider can be reading them in his office down the hall . . . or in his hotel room across the country. although there are plusses and minuses to that, too. (more than once, the attending has been presenting a paper in california having signed out to a partner, and i'll get a long distance call wanting to know what the )(&^% that #(&^% thought he was doing when he started this drug instead of that one. what i'd like to ask him is why he doesn't call the covering provider to blister his ears instead of mine.)

despite the fact that i'm sure i qualify as one of those crusty old nurses -- i prefer to call myself "seasoned" -- i've adapted very well to electronic charting. and email . . . although i wish there was a way to "unsubscribe" from the fury of emails requesting switches every time the schedule comes out. there are some colleagues that want to switch every single shift they're scheduled for! i'm excited about our unit website coming out this spring, because it will allow us to post policy/procedure changes, updates on equipment, research etc. perhaps we'll be able to see the bathroom walls again.

well said ruby dear!

PMFB-RN, RN · Feb 16, 2012

not to mention the progress note, ugh. Writing all of that out in long-hand is very time-consuming

*** Nursing progress note? I thought those went the way of white caps for nurses. I haven't worked at a hospital that still did nursing progress notes for 10 or 12 years.

At my home hospital where we have electronic, it takes ~5 minutes to chart a detailed assessment

*** Thats great! Mind if I ask what program you guys use?

ertravelnurse · Feb 16, 2012

I had a job working at the VA hospital in 2003 and their computer charting was great. It is all interlinked so you know the pts ENTIRE history from the time he/she spent overseas 50 yrs ago to the present lab results from the nursing home. I loved it. I also loved the fact that the nurses NEVER took a verbal order from the MD. Wherever the MD was, they put the order in the computer and it was sent to respective departments whether nursing, lab, radiology, respiratory, etc. The funny part was in talking with the seasoned nurses, that system had been in play for approx 20 years. Question is - Why has it taken the private sector so long to get on board????

PMFB-RN, RN · Feb 16, 2012

I had a job working at the VA hospital in 2003 and their computer charting was great. It is all interlinked so you know the pts ENTIRE history from the time he/she spent overseas 50 yrs ago to the present lab results from the nursing home. I loved it. I also loved the fact that the nurses NEVER took a verbal order from the MD. Wherever the MD was, they put the order in the computer and it was sent to respective departments whether nursing, lab, radiology, respiratory, etc. The funny part was in talking with the seasoned nurses, that system had been in play for approx 20 years. Question is - Why has it taken the private sector so long to get on board????

*** Well it must have worked very well cause last year (2011) the went to a new computer system for charting VS and assessments that is very difficult to learn and use. ICU rooms in our VA now have two computers and a nurse must use at least 4 different computer programs (each with it's own user ID & password) to care for a patient plus a seperate email program. A nurse must chart medications and PRN effectiveness in BCMA (bar code medication administration). A system seemed desined to drive you madd with frusteration with meds frequiently not able to be read. Then assessments & VS must be charted in CIS, then notes and orders must be charted in CPRS. Alerts must be looked up in DOS (yes DOS) based VISTA program. It is truely a nightmare requiring 2-4 hours of charting for an ICU nurse _IF_ you don't have to do an admission or discharge.

Nurses take telephone orders all the time since physicians at home can not put in orders.

xoemmylouox, ASN, RN · Feb 16, 2012

We use EMR in our clinic. It is wonderful. We have all of their labs, xrays, and office visit notes. :up:

Guttercat, ASN, RN · Feb 16, 2012

Electronic medical records and charting has the POTENTIAL to benefit everyone. However as it is now every electronic charting system I have ever used, and that includes all the popular programs, are designed to make it easy for those who must draw the data out. Little to no thought has been given to those of us who must input the data. Computer charting systems we have now are silly and require a ridiculous amount of charting time for nurses. An RN in a busy ICU with two critical patients should be able to accomplish all their charting in 15 min or less per patient on a system that they can learn to use in an hour, like we could do easily when we used paper tri-folds.

Agreed.

There are wonderful things about the concept and application of e-charting...when it works.

When it doesn't (like our Cerner programming that has bad code written on top of bad code, ad infinitum) you will see RN's spending a great deal of time nose to nose with a computer screen hunting and pecking their way through multiple pages of redundant data entries and ten thousand indecipherable icons.

Whoever thunk up that blood transfusion data should go under "Lines Tubes and Devices" (besides making blood transfusion administration itself take twice as long...) should be thrown into a Russian Gulag in Siberia and forced to use their own programming sixteen hours a day all while fending off a pack of angry Yetis).

sonja77 · Feb 17, 2012

I can't wait!

I can type a whole lot faster than I can write! :cheers:

Ruby Vee, BSN · Feb 17, 2012

i can't wait!
i can type a whole lot faster than i can write! :cheers:

often it's not a question of how fast you can type. it's how fast you can click on the little boxes -- and then wait for the screen to refresh so you can click in the next little box. no way that i know of to make the screen refresh any faster, so the faster you can type, the more frustrated you're going to be.

HouTx, BSN, MSN, EdD · Feb 17, 2012

I had a job working at the VA hospital in 2003 and their computer charting was great. It is all interlinked so you know the pts ENTIRE history from the time he/she spent overseas 50 yrs ago to the present lab results from the nursing home. I loved it. I also loved the fact that the nurses NEVER took a verbal order from the MD. Wherever the MD was, they put the order in the computer and it was sent to respective departments whether nursing, lab, radiology, respiratory, etc. The funny part was in talking with the seasoned nurses, that system had been in play for approx 20 years. Question is - Why has it taken the private sector so long to get on board????

That's an easy one - FUNDING!!!!! I agree, the VA system is wonderful, because they got $ from our taxes. You're welcome.

The rest of us are not so lucky. Implementing these systems cost an unbelievable amount of money and takes a very long time. In the meantime, congress is continuously slashing reimbursement & gleefully doling out unfunded mandates.