Yeah, I had to do the notes thing, the rounding reports were not helpful for basing presentations off of
If you have an official list as your census in EPIC, you can copy that to a new personal list that you can create with your own category headings, this didn't help me so much for presenting but just having some answers at my fingertips when I was prerounding and running around and trying to think
You can search and see what categories you want this list to have.
I had a list that was meant to just help me pre-round, (so it would have like Mg and K on it)
and a list that was my "printing list" that was minimal (meaning it just had like room number and name so and then a bunch of space next to it to write to do's, if they accurately list the nurse for the shift at that point that's nice too depending on your system so I could quickly figure out which nurse I wanted when I called the floor nurse) code status (good to know at a glance when they crump unexpectedly!)
Then I had a list that wasn't necessarily my pre-round list but it had a **** ton of data that it helped me to just have on hand while I wasn't in epic, my "data list"
So you can mix and match these categories for what you want
they may or may not exist in your institution's Epic version
(also, you can add any category to you list if the list has patients in it and it will put in the data that it does and you can see if that's what you want)
Keep in mind these are categories for the print to-do list:
Pt name
Room number
patient location (this can be different than room, let's say know they're in xray, it would show that)
Code Status
Attending
PCP
2nd list that was my basic working list in EPIC, I would use through the day to help me keep track of stuff without always having to dig through an individual chart
Mg and K values, that way when I sat down in the am I knew at a glance without going in the chart who needed repletion so I could get that little chore out of my way asap, there was even some heading I had where all I had to do was click on the list in a certain heading to get to where I could throw the orders in, which would work anytime I just wanted to click on patient in the list and go directly to entering orders menu, save me a few clicks
Cr (so made it easier to keep track of my AKI/CKD people so I'd keep that in mind while throwing in orders)
Crit (to watch my bleeders/anemics)
WBC (could watch and write trends, like the list would say today's was 15 and I would write that yesterday's was 12)
Culture or culture results (sometimes it just showed they had a positive culture, then I could write next to that the bug)
antibiotics (and I could write next to that what day # they were on or start/stop dates)
anticoagulation (it would show if they were on heparin or warfarin, good to know)
PLTs (to watch for HITT in my heparin peeps w/o really having to think about that too much but not forgetting it either)
New note (if you use the time mark feature on some of the categories, then just looking at your list you can see if that new imaging report or consultant note or lab value had come in yet without having to go into the chart just to see if it was there)
New consult note
New lab value
New imaging/rads
IV or PO meds (so at a glance I knew who was still getting IV stuff and that would help me to stop and think we I could switch to PO cuz that's always a good thing)
Glucose if you want
EKG maybe (so you can see that pop up or just get right to it by clicking on that box
Resp therapy (it would actually list all the respiratory stuff they were on)
Tele (so I never forgot who was on it and knew just looking at a printed list while I ran around who to ask about when I went to the tele people
The possibilities are endless
There are tabs below your list running horizontally that I had set up that made prerounding a breeze because I would only have to go into the chart itself just to read nursing notes, look at certain details of I/O, or certain labs that didn't come up from the tab
The tabs are never as detailed as when you go in the chart, but man this made my life easier, especially since you can only have so many charts open at a time
All of this without going into the chart unless I needed to investigate further, and a loosely recommended order of importance for pre-rounding:
1) The minute I sat down, I looked at the current vitals only on everyone, that way I would catch any current particularly scary thing, something someone told me that always stuck in my head "vitals are vital". If did all prerounding from start to finish one patient at a time, then I would get to like patient 5 in the census only for the senior to be like "hey, did you see that patient 8 has this ****ty scary vital and you've been sitting here pre-rounding for 10 min and didn't see that, that lesson only happened once and this was how I saw to that) so w/in 4 seconds of being at work I could rest assured at least based on vitals no one was in the process of dying right away while I went about my prerounding
2) the tab that has all the vitals recorded for the last 24 hrs, I would go through that for everyone first too to catch any really scary vitals that happened overnight
3) now I could just start with my first patient to do the whole pre-round bit one patient at a time
4) Comp (comprehensive) this let me see a lot of stuff, like what time the patient spiked their fever, nurse notes that give perspective like why did my patients w/ HR 80s get to 140s, oh I see, they were being helped up to the toilet or whatever, I/Os, a lot of stuff, good luck
5) CBG (tracks at a glance their glucose values and matched with the insulin units they were given)
6) I/O tab (has more detail then the comp view, there was one value there I needed that had to be gleaned from the chart, can't remember but it was useful)
7) Weight tab (where I was didn't always track I/Os well, so this could help me see how my CHF'ers or whoever were doing with diuresis)
8) Cx (let me see what the latest report was, you have to watch those for days sometimes to see how that progresses in detail)
9) Imaging (would show the latest report, you have to go in the chart to look at the image yourself if it hasn't been read already, and obviously you're supposed to look yourself at whatever image they've read, but always good to see what rads had to say)
10) Cards - it had some view that was useful I can't remember what was in it, I think like Qtc from last EKG at a glance, cool huh?
11) Phillips is the name of the tab to look for, I named it "tele" (a link to tele, I don't know, some institutions you can look at tele live from your computer, and some have a link to look at what the tele monitoring people noted, still important to interpret what they say yourself, but it helps you know what time something was noted so you can find an event on the strip, sometimes you can review the whole darn strip at whatever time from your computer, cool! I think it's called Philips the tab for this) Before people bust on me, you have to use judgement, a lot of patients you're going to look at tele before you do some of the stuff above
12) MAR - this tab is useful, but the view is more detailed in the patient's chart under MAR tab, for PRNs like narcs and even the other expected drugs, you don't want to be caught looking stupid that you can't understand their HTN given that you've scheduled a good dose of antiHTN med, only to see that the patient was refusing all the scheduled doses, don't assume because you wrote it the patient is getting it, and PRNs you're not going to know if they needed unless you look
After doing all of the above (obviously skipping like CBG if a patient wasn't diabetic, etc, changing the order depending on what I needed to see first) then I would stop and move to the next patient, this last I leave for last as clean up on each patient as I go through again:
13) Notes (I looked at these last if I was only expecting to see nursing notes, obviously you look sooner if there's a consult you're hoping to see, ideally you should read all nursing notes but if you're short on time that may be the one thing you skip on some patients if their clinical picture makes you think they mostly slept all night)
While in a patient's chart a lot of the following tabs you can put in on your toolbox
Learn dot phrases
Make templates with helpful dot phrases
Your started note if it has the right dot phrases pulling in what you need can be printed and while you do the above stuff you can write that in
Using that system above I could do all my prerounding completely, systematically, and jot what I needed down like wicked crazy fast, and I write slow
Using my above list categories and horizontal tabs and corresponding tabs in each chart, I could see everything I needed to see on all 10 patients in like 15 minutes, it would take me longer starting notes and on particular things and writing it all down
I was like the slowest little intern that could, so spending my off time learning epic like the back of my hand and customizing my lists and tabs and dot phrases was like giving myself all the help I can get. From any view or in any chart I could put my hands quickly on anything I needed to know within seconds
There's probably some Epic support team you can call for help at times and they can be your friends
I know this response isn't totally on point, but I hope it helps interns pre-round and get data faster for their presentations and notes
