From A Scanner Brightly:
“Health care currently consumes 16 out of every 100 dollars in the USA, but electronic health records are next to non-existent. The few that are in existence don’t talk to any of the others.
If we ran banking like that we’d be… oh wait a minute, we did run banking like that. About a million years ago. Well, thirty anyway.
16% of the US economy runs on scrawly, handwritten notes.“
I would like to expand this thought to computerized physician order entry systems and here’s why:
I made a mistake yesterday. I didn’t just miss one order. I missed A WHOLE PAGE OF ORDERS.
Why? Because the doctor wrote them on a separate page and stuffed them into the side pocket of the binder, rather than putting them in the proper place.
I looked through the chart five different times, looking for an order and I couldn’t find one. There was nothing but blank orderset sheets, and a blank order page. I wasn’t too surprised though. This kind of made sense to me because there was no fellow in the case, and usually the fellow writes the orders. In fact, if you ask an attending to write an order they kind of turn away in a huff and say “I don’t do that. Get the fellow to do it.” In this particular case, I just followed the basic (unofficial) protocol for this procedure (Vital signs Q 15 minutes x 4, then q30 minutes x2, then Chest X-ray after 2 hours, then page the physician after the CXR has been read.)
I did all of that and paged the Radiology attending. He never responded. So after about 20 minutes I paged the urology attending. He called me right away and asked, “What about the CBC?”
“I didn’t draw a CBC.”
“Well I ordered one hours ago.”
“I’m sorry but I didn’t see any orders in the chart.”
“Well I ordered it.”
“Okay, well I’ll check the chart again, and in the meantime I’ll draw the CBC.”
I went back to the chart and low and behold there was an entire page of orders, stuffed into the side pocket, where miscellaneous patient info usually goes.
Fortunately no one was harmed, although the patient did have to stay in the recovery room for an additional hour because I didn’t see the order.
This was my mistake and believe me, I owned up to it. I apologized to the patient for creating this delay and I apologized to the attending for missing his order, but I know that this mistake could have been avoided if the recovery room used a computerized ordering system.
So this brings me to reason #2 I am thinking about leaving nursing: Being a nurse in the hospital is essentially about carrying out orders. You can sugar coat it all you want, and talk about how there’s a big difference between nursing care and medical care, but in the end, physicians write orders, and nurses carry them out. (And by the way, my BSN program did their best to convince me that this is not the case, but after three years of working in the hospital, I’m pretty certain that this is the case.) And yet there is such a lack of standardization in the way that doctors write their orders, so it can be difficult to carry them out. Do the recovery room nurses care about this? The answer appears to be no. Whenever I ask the nurses about this situation their reply is this, “Oh we’ve been fighting this battle for years. Nothing ever changes.”
How do you get beyond that kind of apathy?