More
war
stories
June 14, 2016 --
Here are some more war stories, focused on issues with the EMR. My
friend Pat works in a peri-op unit, so her stories relate to peri-op
workflow. Here are four.
War story 1: The patient's chart says NKA (no known allergies), and
that it's been reviewed by another RN. However, at admission, the
patient says yes, they do have allergies to several meds. So Pat
asked the RN who had left the allergies field blank why. That RN
said, allergies weren't relevant at the time; "I was working on
something else and had to click through that screen to get to the
part where I could do what I needed to do." In other words, the EMR
did not model that nurse's workflow. A serious medical error was
narrowly averted.
War story 2: When you scan a document, a stripchart, or an image
into the EMR, you must name it. What name should you use? Into which
folder should you store it? There is no standard. Different
departments use different conventions. Thus, it is often difficult
to find a document or image scanned by someone in another
department. You must call and ask them what it is called and where
to find it in the EMR.
War story 3: HIPAA rules create obstacles. For example, a patient
recently had an EKG at another site and didn't sign a release. The
RN at our site needs to see the EKG in preparing the patient for the
OR (operating room). So she gets another (redundant, expensive) EKG.
This is quicker than attempting to obtain access to the existing one
and enables Pat to get the patient to the OR on time.
War story 4: Reconciling a patient's meds must be done in
preparation for an OR procedure. It takes an hour to do. Shortly
thereafter, the doctor or the patient decides to delay the procedure
by a week. A week later, when the RN re-does the admission process,
she cannot find the existing medication list and must repeat the
one-hour reconciliation process though nothing has changed. The
information is in the system somewhere but the RN can't find it.
It's a war out there... but with whom are we fighting? Often, it's
our own tools and processes.
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