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Discussion in 'Anesthesiology' started by trinityalumnus, Jul 30, 2011.
Current good/neutral/undesirable thoughts about electronic charting.
and the pressure on your A-line rockets because the transducer was mounted to the side of the bed. Are you going to have to explain in court three years later when you don't remember when you rotated the bed why you didn't treat the acute hypertensive episode?
Why would it "rocket" (ie. not just a small change) from airplaning the table? If it did, why wouldn't you adjust the transducer to compensate? If you couldn't, why wouldn't you document the reason for the falsely elevated pressure recording?
The electronic charting system I used allowed the anesthetist to add text into the chart if needed a la your extreme example.
I usually manually enter why there was a change in BP.
Overall very useful. Especially for those door busters when it just starts charting.
All your paper charts must be train tracks.
This is what I read:
All your charts are belong to us
That's right- it's late, the coffee buzz is on, and Aug 2nd can't come soon enough. I'm tired of all this studying.
Just remember fetal heart monitoring hasn't done jack for OBs except give lawyers documentation to sue.
I am a techy and absolutely hate computerized anesthesia charting. U get busy in a case and sometimes forget to add things to the record.
Cam you imagine if lawyers had to account for "billable" hours via computerized charts. They would say hell no. I know lawyers who charge for their time on route to courts...heck they charge for the 20 minutes they sit in the restroom playing on their iPhones/smartphones.
You're forgetting how it has ushered in the Renaissance era of C-sections.
I've been floored at times by the amount of pre-charting and vital sign smoothing some people do.
I've taken over cases with hours to go yet and seen the extubation and PACU turnover notes written already - I'm sure everyone here has had similar experiences.
I like electronic charting if for no other reason than it keeps those people a little more honest.
A well-configured system can be a great timesaver for fast cookie-cutter cases like the 15 BMTT and T&A days. For cases that are very busy it's nice to not have to go back and spend 20 minutes transcribing vitals from the monitor history.
It's not hard to put in an artifact note when a BP of 190/182 gets recorded because the surgeon won't stop leaning on the cuff.
You could even set it up so that you could just click "approve" for a set of vitals to go into the permanent record, if there's an erroneous reading, but yes, I think it should be put into electronic format.
I had a case where a patient had a STEMI after an inguinal hernia repair, and the lowest BP recorded was in the low 80s, but I overheard the CRNA commenting on the systolic of 72 as they were giving vasopressin. It would be nice if that sort of value were included in the chart...
While most of us do seem to have medicolegal-type fears (myself included) I think that scenario is pretty far-fetched and I wouldn't concern myself over it. Anyways if there is an erroneous measurement, just correct it yourself.
Rotating the bed/transducer won't effect the art line reading. If you change the zero point it will. If you zero at the stopcock at the wrist and the drop the transducer/second stopcock on the floor the art line will read the same. In our e charting system I can delete values as artifact, like when drawing an ABG.
Well said. It saves me time when I'm solo and keeps them honest when I'm not. Though you could change the vitals manually for that period. Unlikely but possible. Of course that change is noted in the "complete" record. That's damning evidence, unlike making a 10 second note explaing an erroneous reading.
I admin our system (Innovian) and there's an option in there to permit users to edit vital signs. Edited values are bolded so they're apparent on the paper printouts, and of course there's an electronic log of all changes.
We decided to disable that feature. Seems safer to force people to write the artifact note. I wouldn't want to defend a case in which machine-recorded vital signs were edited without a text explanation.
We had a problem for a while with the MRI vitals being dropped and recording some very off numbers. We had to edit or enter about 1/3 of the data. It's fixed now. It's hard to believe someone would take the time to edit vitals to cover not paying attention and a period of hypo/hyper tension, but I'm sure it happens somewhere. I do wonder what some of the people I used to work with will do now that would chart SBPs in the 90s when they were 80. If you're going to ignore it, now you've got to own it.
Again. I am very opposed to computerized charting unless I manually put everything in myself.
My buddy is currently involved in a lawsuit. The lawyers are trying to point the fingers on anesthia after neurosurgery settled the case.
Guess what they were are using as evidence? The electronic anesthesia medical records are off by 7 minutes from nursing charts and lawyers are saying anesthesia didn't react in time to vital sign changes when patient was coding on table. Its a mess since surgery settled the
Patient got revived but had stroke.
We solved that problem by having the nurses chart times off our computer clock. We tell the nurses what times to chart.
I've been told that the defense lawyers prefer to defend cases with AIMS because the plaintiff can't accuse of a coverup.