Friday, June 1, 2012

EMR Starts. Hilarity Ensues

Writing orders on paper charts used to be so simple, if labor intensive. First you have to hunt down your patient's chart. It could be located anywhere: in the patient's room, at the nurses' station next to the room, at the nurses' station at the other end of the ward, in the nurses' break room where a consultant took it while getting his coffee and didn't bother to bring it back. Once you find it, you write your order and put the chart into the orders rack where the secretary will take it down and inform the nurse about the order. Most medical charts also have little color coded flags you pull out depending on the type of order: green for a routine order, red for stat order, yellow for discharge orders, etc. It was tiresome, but effective.

With the advent of electronic medical records, the days of searching for a patient's chart are over. The chart is nothing more than a plastic binder with next to nothing inside. All information are conveniently found within the nearest workstation. What can possibly go wrong?

As it turns out, many doctors are still stuck on the old ways of doing things. We recently got a memo from the hospital's chief of staff admonishing physicians for improperly entering orders into the computers and communicating it to the nurses. It seems that some doctors were writing computer orders without letting anybody know about them. It was up to the nurse to serendipitously discover the orders hours later, orders that can be time sensitive or vital to the patient's health. Some of the examples he cited include:

"Hold heparin until after cardiac biopsy"

“Call the Code Blue team to assess the patient.”

“The patient may take her own sugar packets from Starbucks, if she falls into a coma from hypoglycemia”

“Please ask family for doses of diovan, cardizem and amiodarone, then start immediately”  

These were actual orders entered into the computer by doctors and not verbally relayed to the nurse. Obviously no names have been attached to them to protect the innocent, or the ignorant. You can imagine the outrage of the dumbfounded nurse who stumbles across such orders hours after it was placed by the physician. 

So the hammer has come down on the doctors at the hospital. If an order is important, it is imperative for the physician to find the nurse and let her know about it. Otherwise the nurse cannot be held responsible for delay in patient care. Are we having fun with EMR's yet? 

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