why is it that every time relieve someone,

[leaverus]

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the vitals have already been charted for the next 15 - 30mins? how is that possible? are these people really that prescient? if i was, i wouldn't be a doctor.

 

[Gern Blansten]

It sounds like you didn't even tell them thanks.

 

[IlDestriero]

This is one of the big pluses of the electronic anesthesia record. Imagine, accurate vitals. Dare to dream.
In the .mil I would see some that didn't reflect reality in any way, not even close. I'm sure that they wouldn't feel comfortable documenting some of those vitals and not treating the tachycardia, significant hypotension, etc. It was sad how frequently it happened.

 

[Sonny Crocket]

Because thats how good they are! They know even future vital signs.

 

[pgg]

This is one of the big pluses of the electronic anesthesia record. Imagine, accurate vitals. Dare to dream.
In the .mil I would see some that didn't reflect reality in any way, not even close. I'm sure that they wouldn't feel comfortable documenting some of those vitals and not treating the tachycardia, significant hypotension, etc. It was sad how frequently it happened.

I see it everywhere paper charts are used.

.mil should be electronic everywhere now, even deployed locations.

 

[countingdays]

I don't get it. If you have to chart 30 minutes at a time. At least chart the prior thirty minutes and not the next thirty minutes.

 

[leaverus]

i just feel like if you're gonna chart that far in advance, why not just do the whole record and save even more time?

 

[pgg]

i just feel like if you're gonna chart that far in advance, why not just do the whole record and save even more time?

Some people do.

A number of times I've gone in to relieve someone at my moonlighting gig, only to find the record already has words to the effect of "extubated and transported to PACU, report given to PACU RN" written on it. It's not just vitals they're pre-charting, but events.

I've often been tempted to tell them, you've charted the whole case, so you can do it ... but they pay me to relieve people, and I like getting paid. So I just put a line through the predictions they've written, and go from there.

 

[gasp]

the vitals have already been charted for the next 15 - 30mins? how is that possible? are these people really that prescient? if i was, i wouldn't be a doctor.

Next time, tell them that you will come back in 15-30 mins as you obviously came too early based on their last vital. I guarantee you they will stop.

 

[IlDestriero]

That's a good idea.

 

[Arch Guillotti]

A number of times I've gone in to relieve someone at my moonlighting gig, only to find the record already has words to the effect of "extubated and transported to PACU, report given to PACU RN" written on it. It's not just vitals they're pre-charting, but events.

I see that all the time with the nurses I work with as well.

 

[psychbender]

.mil should be electronic everywhere now, even deployed locations.

...except for where it's been down for months. I think the last time I used Innovian was in early September.

 

[leaverus]

This is one of the big pluses of the electronic anesthesia record. Imagine, accurate vitals. Dare to dream.

i'm not aware of any hospital within my state that has electronic anesthesia record. many places are currently converting to computer order entry, but no record-keeping.

 

[Arcan57]

i'm not aware of any hospital within my state that has electronic anesthesia record. many places are currently converting to computer order entry, but no record-keeping.

I don't understand why this hasn't been made standard. I've been at multiple hospitals that have full EMRs, have spent MILLIONS upgrading their tele system, and not one of them had the new tele system (which was usually fully wireless and would be able to produce a continuous record in their own program) communicate with the chart. That seems like such a no brainer and that it would save tons of unnecessary manual input.

 

[RxBoy]

Some people do.

A number of times I've gone in to relieve someone at my moonlighting gig, only to find the record already has words to the effect of "extubated and transported to PACU, report given to PACU RN" written on it. It's not just vitals they're pre-charting, but events.

We had a provider get into serious trouble for having a filled post dated Post Op note on a patient that died the same night of surgery.

 

[DrN2O]

i just feel like if you're gonna chart that far in advance, why not just do the whole record and save even more time?

Do you rather it be empty for the last 30 minutes?

 

[leaverus]

Do you rather it be empty for the last 30 minutes?

given the choice, yes. assuming the patient is still alive when i arrive, i can at least look in the monitor, review the previous vitals and chart them myself if i have to; or if i'm only there for temporary relief, only chart during the period i'm actually there. but what's the point of your question? neither situation is preferable.

 

[Oggg]

99.999% of extubations go fine. What's wrong with precharting extubation and transport? If a problem occurs, as long as you cross out your "prediction" and document accurately, you're fine. If the extubation goes fine, you've saved yourself from having to chart it later when you're busy watching the patient, getting the patient out and the room turned over.

 

[leaverus]

99.999% of extubations go fine. What's wrong with precharting extubation and transport? If a problem occurs, as long as you cross out your "prediction" and document accurately, you're fine. If the extubation goes fine, you've saved yourself from having to chart it later when you're busy watching the patient, getting the patient out and the room turned over.

i dont think there's anything "wrong" with it specifically but for me it raises two questions. 1) it takes all of 20 - 30 seconds to write a brief extubation/transport note - is your practice really that busy that you can't spare that much time to write that in the pacu? 2) what if you wrote that and something did go wrong with patient and you forgot to amend your note?

 

[Arch Guillotti]

i dont think there's anything "wrong" with it specifically but for me it raises two questions. 1) it takes all of 20 - 30 seconds to write a brief extubation/transport note - is your practice really that busy that you can't spare that much time to write that in the pacu? 2) what if you wrote that and something did go wrong with patient and you forgot to amend your note?

seriously dude how long does it take to scribble an extubation note?😛

 

[pgg]

99.999% of extubations go fine. What's wrong with precharting extubation and transport? If a problem occurs, as long as you cross out your "prediction" and document accurately, you're fine. If the extubation goes fine, you've saved yourself from having to chart it later when you're busy watching the patient, getting the patient out and the room turned over.

Mostly it annoys me because it always appears in the context of smoothed and/or predicted vital signs, too. I take over one of those cases and I can't trust anything on the sheet. Then I see one of that guy's patients in PACU when I'm floorwalking or just being an innocent bystander and that guy is back in the OR, and I start to wonder, did he really use 30 mg of roc or did he give it all, did he really reverse this patient?

I agree that precharting "extubated [...]" is not as big a deal as fabricating vital signs, because at least the extubation note is going to be accurate most of the time. But what's the point, really?


And I'll say this - if ever a wakeup doesn't go easy, and you have to cross our your prediction and write something else, the plaintiff's attorney is going to be delighted to point to it as evidence of a trend of general bull****tery on your record.

Lawyers love messy charts and they love omissions and they love anything that suggests impropriety.

You could play tic-tac-toe on an anesthesia record and get away with it so long as the patient did fine, but that doesn't make it a good idea. 🙂

 

[PeepsLove]

Better than no vitals recorded on paper nor saved in the computer because the attending didn't bother to start the NIBP 1 hour into the case.

Also if a likely routine extubation note was written and then there were complication, that provider just lost credibility by having to mark error over a paragraph. That's why documenting future events is the #1 pitfall in Morgan & Mikhail (Ch 46)