E-medical records – a complaint!

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This nurse really needed to get something off her chest.

Do you share her frustrations?

I worked my first shift as a ward registered nurse yesterday on a busy surgical ward in a public hospital. When I finished my degree I decided I loved theatres and went straight into a scrub scout positon in a private hospital. Now, don’t get me wrong, I still love theatres, but I decided that to be the well rounded nurse I want to be I needed to gain experience as a ward registered nurse as well. So I applied and got a casual pool position at the same hospital I worked at as an undergraduate assistant in nursing. It felt like I was coming full circle and, in a way, coming home because I had received a lot of support and encouragement throughout my studies during my time there.

I’m stating the obvious by saying that theatres and the wards are like chalk and cheese, but the things I struggled with were not what I thought I would. It was not the patient load (because to be honest my first shift was supernumerary), medication rounds, S8s, the injections or the IV-giving sets singing me the song of their people or the fact I had miscalculated my measurements when ordering my uniform and looked like I was wearing a blue hessian sack with pockets. No, not even close.

The thing that got to me was  the E-Medical records. Lauded by administrators at orientation and trainers during training as the one-stop-shop for access to patients’ clinical information and an advancement to help us provide better care. My first experience was anything but advancement – or even access for that matter. It has increased the workload for nursing staff fourfold. And that is just when the computer is not frozen.

This system has so obviously been pushed for and implemented by people who have never had to work a nursing shift in their life. Just to do observations and document them took the patience of a saint and when I had a sick patient who I feared was about to deteriorate, I couldn’t even look up her observations from the previous shift because the computer on wheels had frozen. What’s more, just to enter the baseline observations, including neurovascular observations, took a stupid amount of time due to the amount of clicks it took to just get a yes or no answer! Gone are the days when you can just flick open a folder and find the form you need.

I had alerts that were not pertinent to my patient, such as IV cannula assessments and urinary catheter assessments, as they were four days post-op and didn’t have a cannula or catheter. It was a waste of time to stand at a computer and click through on every patient that these things had been done like a child who was clicking off homework tasks. What’s more, some things were on the computer and some were still in paper form.

Honestly, this system has potential. But it needs a lot of ironing out and very genuine ongoing consultation with clinical staff who use it every day. Plus, every single bed should have a dedicated tablet or something, because having to write my observations and things in a notebook and transfer to a computer – when I could get one that worked or wasn’t occupied by someone else, also about to have a conniption about how slow and how un-user friendly it is – in between answering buzzers, medication rounds and while short staffed, was bombastic to say the least. And then when I did get one and get to put my information in, it was slow and froze halfway through what I was doing and I had to start again! The more people on them, the slower things were. In this ‘computer age’ that is a completely avoidable and unnecessary issue.

In the time it took me to document the observations of two patients, I could have done two whole four-bedded rooms in my AIN days. In its current format it is an accident waiting to happen. It saddens me to think that no one will listen to us until a deadly mistake does happen and then we will more than likely be the scapegoats.

Cartoon credit above: Working Nurse www.workingnurse.com

4 COMMENTS

  1. They recently implemented an electronic system where I am working as a RN. At first, it was very stressful and time consuming trying to navigate it and get used to it. Now, it is a blessing as we are not having to try and decipher scrawl which has made progress notes completely illegible in the past. Having computers that continuously freeze would be awfully frustrating. If you are going to have software like this you definitely need the hardware to support it!

  2. Overall, I like eMR2. Legible! Looking forward to med charts online. Soooo much time spent chasing incorrect and/or illegible orders. I’d have killed many patients by now if I didn’t double check charts.

  3. If my hospital tried to put on the electronic record all the pieces of paper the ‘let’s justify my existence’ managers keep inflicting on us, our already slow internet would blow up!

  4. I feel that our ward transitioned smoothly to EMR2 and that it has been viewed favourably over the oldwritten records. I’ve heard people justify the frustrating aspects of the user interface as ‘teething problems’ which will no doubt be rectified in future versions. Indeed some things have already shown signs of improvement. Having spent the fifteen years prior to becoming an RN working in many IT roles from software programmer, web developer to technical IT support officer, I agree with the poster and believe that EMR2 has a truly awful user interface.

    Unfortunately EMR2 and I suspect many other EMR systems are the product of ‘one size fits all’ software which tries to do everything but does nothing well. I used to write this type of software using Microsoft’s Visual Basic. It was easy to build software which achieved the stated aim without having to think too hard about the user interface. Unfortunately this often resulted in things like:

    * Looking like an uncomplicated bargain to management but becomes a complex burden to everyone.
    * Require unnecessarily powerful computers to run what is essentially a simple data input program.
    * The interface is a maze of widgets many of which work in unexpected ways.
    * Some sections or dialogue boxes send users into ‘cul de sacs’ in which a decision must be made whilst blocking access to other sections.

    Due to the way humans work we become used to these idiosyncrasies and they become invisible to us. This is why it is important for those who implement EMR systems to listen to new users. Luckily I believe we are being listened to. Let’s just hope someone up there knows how to drag EMRs into the future. Perhaps we could have a discussion about what we as nurses think that future could be?

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