Do you write orders?

[Deepa100]

Hi,
Where I work they have electronic system so, once you create an order, you have to sign it. Hence med students can not try and write orders. The hospital is also introducing scribes in certain areas like ER and I feel it is taking away a chance for the students to learn. I learn a lot when I have to write the admit notes etc. Just want to hear your thoughts on this. Does anyone of you able to write orders and such as a medical student?

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[PTPoeny]

Two out of the three inpatient EMR's that I've worked with had a way for students to write orders and some way flag them for a resident or attending to sign and nobody else (like nurses) could see them until the residents signed them. In both cases it was fairly easy to overlook the student orders so the residents frequently just wrote duplicate orders unless they specifically remembered that we had written orders on a given patient.

The one place I have rotated with paper charts lets students write orders, but not all of the attendings are a fan because there aren't students here a lot and the nurses frequently take the orders off the chart without bothering to look at who signed it.

So in all cases I most frequently write orders while standing right next to the resident and we are both writing a bunch of orders all at once and they sign them right away when they finished their own.

 

[da8s0859q]

Does anyone of you able to write orders and such as a medical student?

At my home institution (EMR / paper hybrid): not really, unless I'm writing and bringing it to someone to be signed. Our order sheets don't even lend themselves to being countersigned -- there's no point to putting a med student name on them. Have had residents on other rotations who would literally hand me the order sheets because they wanted me to write and learn something from it -- dosing, etc -- which is nice.

At the VA: sure, because CPRS is designed in such a way as to allow us to send orders to our residents, who then countersign them electronically. As it was explained to us, the nursing staff never even sees our "orders" until an MD signs off on 'em.

 

[sanityonleave]

Our EMR system allows med students to write and sign orders but they don't show up for the nursing staff / lab / etc until they're countersigned by a resident or attending.

Fortunately whenever one of the residents / attendings logs into that patient's chart it pops up for them to sign or reject the orders, which is good because they're less likely to miss that we wrote orders and end up duplicating them. That said, for whatever reason as a med student once you've signed an order you can't remove it (even before it's been countersigned), so if you put in something really stupid the only way to get rid of it is ask your resident to remove it for you. 😳

 

[bleeker10]

At my home institution (EMR / paper hybrid): not really, unless I'm writing and bringing it to someone to be signed. Our order sheets don't even lend themselves to being countersigned -- there's no point to putting a med student name on them. Have had residents on other rotations who would literally hand me the order sheets because they wanted me to write and learn something from it -- dosing, etc -- which is nice.

Yea a similar situation occurs at my hospital. I've had the residents tell me what to write on the order sheet just to get used to writing orders and then they co-sign it for me. I've also been at a couple hospitals with Epic and I was never allowed to do anything outside of just reading the charts.

 

[drno31]

Yea a similar situation occurs at my hospital. I've had the residents tell me what to write on the order sheet just to get used to writing orders and then they co-sign it for me. I've also been at a couple hospitals with Epic and I was never allowed to do anything outside of just reading the charts.

At my hospital EPIC let's us write notes, but they need to be signed by an attending to enter the medical record. We can't write orders, though.

And about the OP's comment on scribes in the ED: they are the worst. I absolutely hate it when the attendings are taking time to talk to the scribes away from teaching the paying students. They talk to the scribes about the cases and about the medical field in general, while I get scutted doing DRE's.

 

[OveractiveBrain]

Hi,
Where I work they have electronic system so, once you create an order, you have to sign it. Hence med students can not try and write orders. The hospital is also introducing scribes in certain areas like ER and I feel it is taking away a chance for the students to learn. I learn a lot when I have to write the admit notes etc. Just want to hear your thoughts on this. Does anyone of you able to write orders and such as a medical student?

Every medical student on my service writes orders. In CPRS (the VA Epic Equivalent), they use my log in (with me over their shoulder, and dont tell the VA staff) and at the hospital where hand written notes are still the way, I sign them. The earlier you get involved the easier your residency will be (and the more time you will have to get your students involved).

Pay it forward.

 

[da8s0859q]

Every medical student on my service writes orders. In CPRS (the VA Epic Equivalent), they use my log in (with me over their shoulder, and dont tell the VA staff) and at the hospital where hand written notes are still the way, I sign them. The earlier you get involved the easier your residency will be (and the more time you will have to get your students involved).

Pay it forward.

👍

 

[Deepa100]

At my hospital EPIC let's us write notes, but they need to be signed by an attending to enter the medical record. We can't write orders, though.

And about the OP's comment on scribes in the ED: they are the worst. I absolutely hate it when the attendings are taking time to talk to the scribes away from teaching the paying students. They talk to the scribes about the cases and about the medical field in general, while I get scutted doing DRE's.

Exactly. So, I am going back in August to the ER and made it known to the attending that I will only come back if I can do his notes and no scribe👍

 

[TheLesPaul]

I've never been in a hospital where there are scribes -- what exactly do they do?

 

[olemissbabydoc]

We just switched to EPIC. The rules used to be that 4th years could write orders, they had to be signed by a resident.

In EPIC, we have "pending" privileges to pend our orders to be signed by someone else.

Third years do not have ordering privileges at all. They do, however, write notes that stay in some special medical student hidden section of the chart (back on paper I'm pretty sure they just pulled them out/threw them out)

 

[da8s0859q]

Third years do not have ordering privileges at all. They do, however, write notes that stay in some special medical student hidden section of the chart (back on paper I'm pretty sure they just pulled them out/threw them out)

Some of our services did that blatantly -- as in, it was seen by others, and med students knew they were being ripped out. Especially so on ob/gyn.

Others, they ended up being sent to medical records with the rest of the chart.

Is Epic any good?

 

[olemissbabydoc]

Some of our services did that blatantly -- as in, it was seen by others, and med students knew they were being ripped out. Especially so on ob/gyn.

Others, they ended up being sent to medical records with the rest of the chart.

Is Epic any good?

I'm not really sure yet. I loved it when I was doing my family medicine away rotation, but the U just "went live" on June 1st - and i'm on "studycation" until July 1. I'm looking forward to not chasing charts around but who knows if i'll actually enjoy it once I'm working with it everyday.

 

[DISCOSTEW]

Exactly. So, I am going back in August to the ER and made it known to the attending that I will only come back if I can do his notes and no scribe👍

i've been a scribe for 2 years and can see why you feel the way you do. The Drs. see scribes differently than the med students b/c they are the one's doing the chart. I would not want to work with a scribe if i was rotating either. But on the other hand. I've done thousands of H&Ps as a scribe in the ER and learned quite a bit from it.

 

[mimelim]

I found writing orders in paper charts, Epic and Power chart to be among the best learning experiences of my time in medical school. The actual writing wasn't that important, but the forced, thinking through exactly what we wanted to happen did a lot to help me think through things.

 

[ZagDoc]

every medical student on my service writes orders. In cprs (the va epic equivalent), they use my log in (with me over their shoulder, and dont tell the va staff) and at the hospital where hand written notes are still the way, i sign them. The earlier you get involved the easier your residency will be (and the more time you will have to get your students involved).

Pay it forward.

scut! 😉