Just imagine: It’s the 17th of the month and the MAR’s and TAR’s have been sent to the pharmacy to be printed. In the 10 days before they come back, I have at least 100 new orders that will have to be manually written on the new orders sheets – ugh! I also have to do a double check on each and every resident’s orders just to make sure that they are correct. And how do I accomplish this? By pulling paper charts, one at a time, painstakingly going through each and every order, writing them in on the new MAR, plus calling the physician, because, hey here’s 2 orders that he didn’t sign. That in addition to documenting in the nurses notes, faxing the new order to the pharmacy, and writing the new order on the PO sheet. What a lot of paperwork!
And did I mention that last month’s MAR is full of holes? If you’re lucky enough to work the night shift, you probably have the dubious assignment of checking for holes, who left them and writing little notes that you leave on the nurses time card to come and correct their error. That is, if they’re not on vacation, or they don’t work for an agency and moved with no forwarding address. My PRN followup? Not usually done as they are on the backside of the MAR and nobody looks at that. What about allergies? Overlooked. Someone spilled water on the MAR and the allergy isn’t legible anymore. Drug interactions? Well, who has the time to dig out the PDR and check. Alerts? What are those? New admission? All those admission orders, hand written, one at a time …
Fast-Forward to Automated CPOE with Optimus EMR
Today, I can enter my order one at a time within the Computerized Physician Order Entry (CPOE) module. It automatically goes over to my eMAR, my physician module so he can review and sign off and because I have a pharmacy and lab interface, those orders are sent to them automatically. Lastly I can view my QuickView screen to see all of the new orders that have been entered, DC’d, on hold and pending. I quickly go to my new progress note, click a little box that says new orders received and, guess what? That information just did 2 things: completed my nurses note and flowed to the MDS – in just a few seconds. Efficient, complete and intuitive!
That allergy I missed on my paper record? It pops up on my screen, letting me know that I may not want to give this med as the resident is allergic. I can now add a monitor to my order and require my nurse to document things like blood sugars, or hypertension, or perhaps I want a med side effect checked before I give an anti-psychotic or a blood thinner. I can now set these up – all customizable, of course, in a matter of seconds.
Those long, dreary admission orders? I set those up in an admission profile. My orders that I use most frequently-things like Tylenol or milk of mag – all set up in my standard orders. I can virtually enter in 20 or 30 orders in just a few minutes. That is a real time saver in itself. What about the physician reviewing his new orders and signing his 30 day review? He now has the ability to log in, either on-site or remotely, view his orders and sign – and it lets him know when the next signing date is. End of the month is no longer necessary as all of your orders are current, correct and legible! If I’m not sure what a med is used for, I click on “view med details” and immediately can see indications, precautions, side effects and drug classification. The time saved both in documentation and error reduction is time you can now spend with your resident, And that’s really what it’s all about, isn’t it?