It's been 2 weeks. In that time, I've worked 8 shifts, which is just about enough time to become comfortable analyzing the system.
The first few days were insane. Everyone was freaked out. Our shift especially, since we were the first to do *everything* paperless. The tail end of the day shift caught the beginning of the "cut-over" so they had done a couple things, but they were mostly on paper. Since we didn't have access to the paper charts, a *lot* of things were missing. It was hard to find the previous assessment info. The UA was confused about where things were supposed to go, and kept forgetting that there was no paper.
Thank god they only gave us 3 patients instead of 4, so we could spend some extra time getting acquainted with the system. We had roving experts to help us figure out where certain things were located when we were panicking.
I managed fairly well.
The 2nd day I got my first admission. It came at a very inopportune time, right around 1800 med pass. Not only that, but dialysis wanted her to come down right away. I barely got the admission work done and sent her over. She came back 10 min before end of shift, with all her meds flagged as "overdue" on the computer. I didn't want them to get forgotten by night shift, so I didn't resolve them. Because when you resolve them they go *poof* I still don't quite know how to reconcile the situation.
Since then it's been fairly smooth sailing. I'm still a little sketchy on sending people to procedure. I had the honour of figuring that one out during the first 30 minutes of my shift yesterday when one pt had to go to the cath lab. Apparently there's a procedure protocol or something. I hope I did it right. I haven't heard anything back, so I'm guessing it's all good.
And now, for your enjoyment: A list of good stuff and bad stuff!
The Good Stuff
- Time Saving! My shift assessment goes like lightning, just clicking through the applicable items. And I can finally click "No change from previous" for my 2nd assessment of the day without looking lazy like I did on paper.
- New Orders in Real Time! I can call a doctor and ask for an order, and it will be put in the computer within minutes. No scanning/faxing things. It's just there. *poof* like magic
- No More Annoyed Calls to Pharmacy! If there's a problem with a medication, I can click on the med's profile and sent them a note about it. Like "He got this medication in ED. Please change administration time to reflect" or "Med not in either Pyxis or cassette. Please send." Missing medications are figured out much more quickly
- Orders don't get "thinned" out like they did on paper. If it's still active, it's still there to see. So if you're wondering "Is there really an order for this?" you can look through for it.
The Bad Stuff
- The Amazing Capacity for Mis-Charting! You should *not* be able to put the charting for a chest tube's output in the same flowsheet as the results for fingersticks. But with this system, you can add a "Line/Drain/Airway" anywhere you damn well please. I think a lot of people go "Oh right! He has a ______" and then add the thing, no matter where they are charting at the moment. And people, for the love of god, if it's a piggyback medication, add the Piggyback/Bolus group! Not Maintenance fluids! Same goes for actual boluses of fluid. Makes me crazy when it looks like maintenance fluids have been charted, but the MAR says it was a one-time fluid bolus. AAARRRGH!
- Dealing with Labs! Say a bunch of labs have been ordered over the course of the last day or two or three. They all show up in the "Lab Orders" section of the report. Even if they've been drawn and sent days ago, they still show up. So it makes you wonder if it's been done, so you have to hunt thru the lab results to see if there's evidence of its existence, or call the lab to see if they've received the sample but the lab's not done with it yet. There needs to be a "complete" button next to the lab orders. I've been adding notes at the top saying things lik "MRSA swab sent 7/3 @ 1900" just so the next people have an idea what I've done and haven't done.
- Dealing with Lab! If the doctor puts in the wrong kind of order, it looks like we are supposed to draw routine scheduled labs when it's actually more suited for the Lab to do. And I haven't figured out a way to switch things from unit-drawn to Lab-drawn. And man do the Lab people get annoyed when you come up to them with a label asking "Can you pleeeeease draw this for me?" Sometimes the stickers print up on the unit, sometimes down at the lab. I still haven't figured out how the Lab clipboard works in terms of getting things drawn in a timely manner. Bad blood is brewing, I think.
- Having to constantly leave the area you're working in to find other things! Doing an admission is a pain in the ass. You go through this "Admission Navigator" which makes you switch out to other parts ("Go to Orders," "Go to Patient Plan," Go to MAR") of the program, then come back to where you were. Can't they just make it show up all in one spot?
But really, it's all been pretty positive. As I go along, I'm sure I'll get even better at it and it'll feel like I never used paper charts to begin with. Fingers crossed... :)