# Writing at speed



## ttoude (Sep 13, 2009)

Any tips for maintaining good penmanship in the back of a Ambulance AKA Buckboard!!!!!!!!!

Boss just got on me for my hand writing


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## DV_EMT (Sep 13, 2009)

abbreviate and rewrite later??


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## medic417 (Sep 13, 2009)

Do patient care while in back of ambulance with patient.  Brief notes.  Then at hospital do the report.  

If you are doing your report with patient in ambulance you are not doing patient care.


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## JPINFV (Sep 13, 2009)

Practice. One thing I found that helped was wearing a seatbelt because with a seatbelt on I could relax and take bumps instead of having to tense up and trying to suppress movement.


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## JPINFV (Sep 13, 2009)

medic417 said:


> If you are doing your report with patient in ambulance you are not doing patient care.


Are you suggesting that all patients need care during the entire transport? I'm not saying just completely ignore the patient, but it is possible to keep an eye on the patient while writing up the report.


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## medic417 (Sep 13, 2009)

JPINFV said:


> Are you suggesting that all patients need care during the entire transport? I'm not saying just completely ignore the patient, but it is possible to keep an eye on the patient while writing up the report.



I'm not suggesting I am saying being distracted by doing the actual report is asking for a bad outcome in the future.  Write down the vitals and quick notes about the care, meds given etc, but do not get engrossed in writing the report,  Plus if they have a drastic change your report will seem very odd as it jumps around rather than organized.


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## ttoude (Sep 13, 2009)

medic417 said:


> I'm not suggesting I am saying being distracted by doing the actual report is asking for a bad outcome in the future.  Write down the vitals and quick notes about the care, meds given etc, but do not get engrossed in writing the report,  Plus if they have a drastic change your report will seem very odd as it jumps around rather than organized.




Good point


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## Dominion (Sep 13, 2009)

medic417 said:


> I'm not suggesting I am saying being distracted by doing the actual report is asking for a bad outcome in the future.  Write down the vitals and quick notes about the care, meds given etc, but do not get engrossed in writing the report,  Plus if they have a drastic change your report will seem very odd as it jumps around rather than organized.



When I was on IFT, I got in the bad habit of doing this and the exact thing happened, my reports would jump around sometimes.  On some patients you can still start writing,but save the end of the report for the end of the run.  I'm guilty of that one too, it's easy to get into that bad habit, especially when 90% of your IFT runs start, play out, and end the same.


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## JPINFV (Sep 13, 2009)

Meh, if something happens and you need to rewrite your narritive for clarity, why not just pull out a new PCR and rewrite it from the start and shread the partially completed one?


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## Sasha (Sep 13, 2009)

I write my report during transport, never had a patient suffer for it. I don't ignore them, but honestly they don't require you staring at them the entire trip. My reports flow fine, I have a basic format I write them all in and that helps maintain "flow".


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## medic417 (Sep 13, 2009)

JPINFV said:


> Meh, if something happens and you need to rewrite your narritive for clarity, why not just pull out a new PCR and rewrite it from the start and shread the partially completed one?



Altering a medical document?  I am shocked.:sad:


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## JPINFV (Sep 13, 2009)

Since when did starting over an uncompleted document become "altering." You know, on those electronic records the backspace key still works. This isn't breaking into the records after you turned it in and changing what's written on it. Until the document is completed, signed, and turned in (i.e. copy to the provider taking over care), it's a work in progress and subject to revision.


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## Akulahawk (Sep 13, 2009)

Sasha said:


> I write my report during transport, never had a patient suffer for it. I don't ignore them, but honestly they don't require you staring at them the entire trip. My reports flow fine, I have a basic format I write them all in and that helps maintain "flow".


 I do something similar for stable patients. At an appropriate time in transport, I'll write the report to the point where trasnport is initiated. This way, all I have to do is write about what happened during transport and at arrival at the destination. My reports, once at destination, take only a couple minutes to complete. 

I do, however, take notes and such during transport so that at the end of transport, it's easier to complete the report. 

The more unstable my patient, the less I write on the PCR during transport... and the more that strip of tape on my leg gets written on.

I've also developed a basic script for each general type of patient that I use that allows me to kind of "plug in" the pertinent info, and also keep the report organized. 

As to the OP's question: I learn which seat in the ambulance provides the least movement during transport and use that seat while writing... I use a clipboard, and press my forearm aganist the board so that bumps don't change the alignment of the pen to PCR. I also don't fight the bumps... I kind of roll with them fluidly.


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## Akulahawk (Sep 13, 2009)

If you're re-writing a document that isn't complete for clarity's sake, it's not altering. You're not changning the data or other info... you're re-writing it for legibility. That's perfectly acceptible and legal. Now changing info AFTER the report is submitted... that's what requires special handling to prevent illegal alterations of the report.


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## medic417 (Sep 13, 2009)

JPINFV said:


> Since when did starting over an uncompleted document become "altering." You know, on those electronic records the backspace key still works. This isn't breaking into the records after you turned it in and changing what's written on it. Until the document is completed, signed, and turned in (i.e. copy to the provider taking over care), it's a work in progress and subject to revision.



Sorry used wrong smiley.  Was only yanking your chain on altering.  I do disagree with doing the complete report though.


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## mycrofft (Sep 13, 2009)

*Big enough clipboard to brace your arms on, tuck in elbows.*

Make your services indispensible and they will complain less.


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## SurgeWSE (Sep 14, 2009)

On stable patients, I often finish my report on the trip (granted, averge transport is 30-45 minutes to a community hospital and 45-1:15 the "real" hospitals).  It is quite possible to watch a patient, write a report, and carry on a conversation at the same time.  Even on critical patients that do not require constant managment, I'll try to knock out as much as I can (obviously I'll never let patient care suffer at all for paperwork, but there are plenty of situations where that's not the case).  My rig covers 300 square miles by itself, with the next closest being an additional 10 miles away, so any improvement in turnaround time is benefitial to our citizens.

One thing that helps is your report's design.  We have a section for procedures/treatment/response that is done in time-line form and is seperate from the rest of the narrative.  I have all of the information to finish the HxPI section within 5 minutes of being on scene, and I document any changes in the "Transport" section.


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## medic417 (Sep 14, 2009)

SurgeWSE said:


> My rig covers 300 square miles by itself, with the next closest being an additional 10 miles away, so any improvement in turnaround time is benefitial to our citizens.
> 
> .



LOL.  Thats city man.  Come talk to me when your the only ambulance for 3500 square miles and an hour and a half to the nearest band aid hospital with flight more than an hour away if they can even get to you.


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## SurgeWSE (Sep 16, 2009)

medic417 said:


> LOL.  Thats city man.  Come talk to me when your the only ambulance for 3500 square miles and an hour and a half to the nearest band aid hospital with flight more than an hour away if they can even get to you.



Then you should certainly be able to complete a report during transport   I suppose I would describe my working environment as the sub-sub-suburban boonies.  You must be in the actual sticks.


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## thatJeffguy (Oct 28, 2009)

I'm curious, is it a violation of protocol or privacy regulations to take "notes" while doing the transfer, then do a PCR off of those notes?  My handwriting is literally "worse than a doctors" and I've always had to do things like this to compensate.  I can scribble in my scrawl, legible to me, while working at a quick pace, then get back to the station, sit down with a cup of coffee and translate in to human.  Is that usually a no-go or is it an ends justify the means situation?


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## JPINFV (Oct 28, 2009)

As long as there's no patient identifiers on the notes, it shouldn't be a problem. If there is, just keep it with the rest of your PCRs until you can properly (i.e. shred or document destruction bin) dispose of it. 

My one problem with your plan is that if you do it at base, then who ever you are handing over care to won't get a copy of your PCR.


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## emtfarva (Oct 28, 2009)

JPINFV said:


> As long as there's no patient identifiers on the notes, it shouldn't be a problem. If there is, just keep it with the rest of your PCRs until you can properly (i.e. shred or document destruction bin) dispose of it.
> 
> My one problem with your plan is that if you do it at base, then who ever you are handing over care to won't get a copy of your PCR.


That is what they made faxes for.


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## emtfarva (Oct 28, 2009)

It took a long time to learn how to write in the ambulance. I find that if you go with the bumps and stay loose it is a bit better. What killed me was the turns. But, I don't have that problem anymore, I have to re-learn how to type in the ambulance. Along with typing, balancing the lap top on my lap. As for doing my report in the back, if it is a stable discharge or Dr's appointment, I will do most if not all of the report in the truck. If it is a hospital to hospital, most of the time the Pt is stable, and I can bang out most of it. On 911 calls, I tend to do everything at the hospital. I will take notes and shred or destroy them after.


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## JPINFV (Oct 28, 2009)

emtfarva said:


> That is what they made faxes for.



No. That's what they made chairs in the nursing station for. What would happen if you were at a nursing home and the nursing home staff said, "Don't worry, we'll fax you the patient's chart later"?


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## medicdan (Oct 28, 2009)

On 911 runs, per MA OEMS, I have 24 hours to get my PCR to the ER after dropping a patient off, provided I give an adequate transfer of care report. I dont think i have ever seen ER staff read my report, it usually just goes into a box, or into the patient's file. That isnt to say I dont usually finish my report at the ER, because I do. 

H+H takes full advantage of this. When they finish their report, sometime later in the day, they submit it via cell, and it is faxed to the ER. They do have printers at each ER, but I dont think I have ever seen them used.


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## RyanMidd (Oct 28, 2009)

I skimmed the 3 pages of replies, and didn't see the strategy that my co-workers and I use.

Duct tape is always plentiful and available, so most of us en-route to a call will take a 6-9 inch long strip and put it on the front or inseam of our pants (lengthwise, or width-wise).

Also in abundance are sharpies, which work great to jot down call details on said duct tape. I find that I understand my own shorthand well enough that I can piece together a good PCR after dropping off PT. 

I originally began writing details on gloves, but I found that I change gloves frequently during "wet" calls and had a tough time remembering what the bariatric patient's 3rd BP reading was. With the duct tape, I have ample room, and I can just peel it off and chuck it after the call.

Yes, bumps do sometimes make your marker slide off the tape, but our uniforms are dark navy pants, and the marker blips don't show.
I'm all in favor of a future EMS where smart machines record any vitals spoken aloud. But I guess that's more sci-fi than anything.


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