What are your pros and cons of computer charting?

Editorial Team / Admin · Mar 5, 2015

It would be helpful to know what you think. It starts the conversation a little better and gives us some insight into what you're looking for.

Jewelsforme · Mar 6, 2015

It would be helpful to know what you think. It starts the conversation a little better and gives us some insight into what you're looking for.

Watching paper charting convert to computer charts over the last decade or so has brought some real pros but also very real cons. For example, the current hospital has implemented a system that went online over the course of about 3 years, with the lab being the very last dept to get on board.

Some of the pros are simply basic: We know the patient's basic information already when they present for care. We have some of their current meds, allergies and physicians listed, as well as family / emergency contacts, AMDs and health hx.

But here are some of the serious cons I am seeing: Not every department has access to the same patient's information (huge glitch). Example is dietary allergies. Patient is allergic to shellfish and up comes shrimp cocktail (leading to "WAIT, don't eat that" and swiping it from the tray, call kitchen and find out this allergy is not showing up there). This info is in all (I hope) depts but doesn't show up in the kitchen. It was an original allergy, input during first patient admit. How does this information not get entered simultaneously across all depts? No one has been able to explain this part to me.

Here's another one. Patient comes in who is alone, poor historian or some form of mental disability, unable to offer important new information, whether it is new address, new physician, different insurance, new allergies or change in meds. This throws a huge monkeywrench into the admitting nurse's day as she tries to do all the contacting last known family or contact to find any and all new information. This could have been performed by the new physician having access to a system to update the hospital's information for the patient. This happens more frequently as the population ages and families may not maintain close contact with the elderly who might still be living on their own. How do we address this situation?

Thank you for inputting your experiences that could resolve these types of issues.

Editorial Team / Admin · Mar 7, 2015

Pros:

History easily accessible without having to call medical records only to find out the op record you need is stored in the warehouse and requires 24-48 hours to locate.

No more trying to decipher poor handwriting.

Popup alerts (such as medication allergies to a slightly related med- like giving Ancef to someone with a PCN allergy) that improve patient safety.

Cons:

The steep learning curve, especially for nurses that aren't tech-savvy.

Reliance on technology. We have had issues with our OR documentation program going into downtime- it's like no one remembers how to do the downtime non-computer charting anymore.

I feel like the computer is more my patient than the person on the bed.

So much more documentation required and takes more time. When we used paper documentation, I could complete most of it within 5 minutes. Now, if patient positioning isn't pre filled based on the surgery, it can take me 5 minutes just to document the positioning alone. Also, there are about 20 different screens to go through compared to what used to be a three page document containing a lot of simple check boxes.

psu_213, BSN, RN · Mar 7, 2015

My issue with paper charting is the potential to lose what was charted. I realize that electronic networks are not 100% foolproof, and data can still be lost; however, it seems to me to be much less likely. At my one job, we started will all paper charting and then implemented electronic charting while I worked there.

I worked night shift. For each day, there was an initialed flow sheet (for example, the nurse would initial for each block of time "side rails up," "SCDs on", etc. On the back of this form was the place for nurses notes. On night shift, the nurse would take the previous day's form from the patients' clipboards and put the into the patients' charts (i.e. the large plastic binders). If one of these sheets got lost, we could have a problem. Suppose something happened with the patient, the nurse charted on it (including a call to the doctor and a statement that the doctor did not add new orders). If that paper was misplaced, accidentally thrown out, etc. it now looks like the nurse did nothing if there was a poor outcome for the pt. Electronic charting does not solve all problems, especially is the system does down for a period, but I think it is better than paper charting, including for the reason above.

psu_213, BSN, RN · Mar 7, 2015

And one more plus for computersâ€¦I like the fact that I can chart info, peruse the chart, review orders, etc., while a doctor or other staff member can review the chart at another location, and we don't have to fight over the paper chart.

OrganizedChaos, LVN · Mar 7, 2015

The con of paper charting is it can be easily lost.

At my last job every detainee who came in got a chart & medical was still on paper. That was thousands of charts! It wasn't uncommon for charts to go missing (medical records didn't do a good job of keeping tabs of things). So we would spend a good amount of time looking for charts.

At the county jail I worked at it was all on computer & easy to pull up inmate information. But there were times the system would go down, but it was far & few between.