use of hand held devices

[JPINFV]

JP, I kinda like how my company does it now, paper quick sheet dropped with the facility and a complete ePCR faxed within 24 hours.

Just curious, would you accept that quick sheet from a SNF or hospital transferring care to you in light of the patient's complete packet?

 

[usalsfyre]

Just curious, would you accept that quick sheet from a SNF or hospital transferring care to you in light of the patient's complete packet?

Yes, because often what I'm given from a SNF is a "transfer sheet". Would I prefer a full packet? Of course.

Quick sheet may be a bit of a misnomer, it contains all of the patients demographics, chief complaint, reason for transfer, check boxes and a space to write comments about you exam, procedures and meds and a narrative. The amount of info is not all that different than what's found on a T sheet, minus imaging and labs.

 

[Handsome Robb]

they want the entire chart complete. our average transport time is less than 10 min. the way ems charts is set on the xoom is not user friendly for times. the xoom also is not mounted and rewuires looking down. a few employees are requiring serious motion sickness - and the older employees are having difficulty with half screen being a touch keyboard. if the charts are done in 24h i dont see the big deal. our company is not known for the safest drivers, unfortunately - infact, the insurance carrier dropped us for recent accidents (not by me - lol)

So they can ride in the box with a PT and not get motion sick but they can't type a chart?

Driving an ambulance is like driving a uhaul...it's not rocket science, it doesn't take two people to drive it. Big rig drivers drive a big 18 wheeler alone all the time without problems. Drug test for traffic infractions? I would sure hope so. I think you are exaggerating for a curb bump, that's not economical for the company and :censored::censored::censored::censored: happens every now and again. With the driving record of your company though it sounds like they need a restructuring of their standards and training practices if it truly is that bad.

If we didn't do our charting while our partner was driving you'd be late getting off shift every single time.

Technology is the wave of the future, the oldies gotta catch up. Sorry mycrofft

We use toughbooks so we have a full keyboard but it isn't mounted anywhere and the screens are touch screens.

We can't leave until all our paperwork is finished. You wont be able to accurately document a call 24 hrs later. Ok maybe some people can, but I definitely couldn't do it and feel confident about the chart.

Our transports are <10 minutes usually, what's your point? Get your *** in gear. I can finish my entire chart besides the narrative in the back while still providing pt care and carrying on a conversation. Now if something is keeping me working then so be it and your management should understand that.

 

[RocketMedic]

I can get the paper chart done in about 2-3 minutes and the charge sheet in another, but my agency is Dark Aging it with the ePCR (We use a semi-preformatted MS Word document) and that takes me a bit longer.

 

[exodus]

The way I do it, is assessments, treatments, hx, allergies, etc go on a paper PCR that I can leave with the ER if we get another call right away. If I have time during transport, which I usually do, I'll put in the patients demographics into the ePCR. And while we're waiting for a bed, I will fill in the rest and do the narrative after the turnover. We're required to leave *something* when we turn over a patient to the ER, so the paper PCR with foresaid info satisfies that. But once we transmit our PCR, the ED has access to that patients transport / previous transport records and the ability to print them out for themselves.

 

[Handsome Robb]

I'm lucky in the fact that I don't have to leave anything at the ER. Give the RN a verbal report, get the registration people PT's first, last and DOB then wait for them to give me a sticker then go waste the rest of our allotted 20 minutes doinking around with other crews or finishing my ePCR if I haven't already.

 

[Anjel]

I'm lucky in the fact that I don't have to leave anything at the ER. Give the RN a verbal report, get the registration people PT's first, last and DOB then wait for them to give me a sticker then go waste the rest of our allotted 20 minutes doinking around with other crews or finishing my ePCR if I haven't already.

Ditto. But we have 2 hours from leaving the ER to finish our epcr.

Any info I need is on a data sheet I give the hospital and keep a copy for me. And then my pager.

 

[18G]

So, if a SNF nurse told you that you didn't need the packet to take a patient to the ED and that they'd fax the patient's packet to the ED by the end of the day, that would be fine?

Same for your discharge?

Same for a CCT?

Oh, wait. Not getting a paper report is only OK if it's EMS not providing the paper report.

I'm not seeing the relevancy of your post. The SNF and hospital have more than a blur in time to complete the documentation and get it prepared so that it is complete and accurate and ready at time of transfer. In fact they have hours to get it prepared in most cases and have some support staff to do it for the nurses. And again, hospital staff are not typing on an awkward tablet PC while bumping around. So huge, huge difference.

An EMS PCR (least in my system) is not utilized by anyone at the completion of the call so it makes no difference if its completed prior to completion of call or completed by end of shift. And these providers who are claiming to have a full report done by the end of your call, I'd love to see the quality of your documentation and how many details are being omitted.

A PCR isn't just a clerical part of your job. Patient care documentation is an art that unfortunately isn't taught well at all, but is every bit as important as the care you provide. It is essentially your own insurance policy and how well you write your report will dictate how good your insurance is. And not to mention your PCR is a direct reflection of YOU as an EMS provider. You don't want someone reading your report that is filled with grammatical and spelling errors or that contains pretty much nothing of what you did or what happened on the call.

To the OP, it sounds like a sucky policy but it is the expectation so your just gonna have to adapt and find a way that works for you and doesn't compromise your documentation as much.

 

[rmabrey]

Were lucky in the aspect that we have till 3pm the next day to turn in our reports, although that is quickly turning into sometime before the next end of shift. One of the Sups nightly duties is to run carbon copies to the hospital. With 100 plus runs a day split between 10-13 ambulances, we don't often finish in a timely fashion

Sent from my Desire HD using Tapatalk

 

[JPINFV]

I'm not seeing the relevancy of your post. The SNF and hospital have more than a blur in time to complete the documentation and get it prepared so that it is complete and accurate and ready at time of transfer. In fact they have hours to get it prepared in most cases and have some support staff to do it for the nurses. And again, hospital staff are not typing on an awkward tablet PC while bumping around. So huge, huge difference.

An EMS PCR (least in my system) is not utilized by anyone at the completion of the call so it makes no difference if its completed prior to completion of call or completed by end of shift. And these providers who are claiming to have a full report done by the end of your call, I'd love to see the quality of your documentation and how many details are being omitted.

So it's the hospital's fault that the company you work for is using a crudy system and doesn't give you enough time following a call to complete a PCR? How do you know when your PCR is utilized once you leave the room? Do you think that your verbal report is going to be remembered and passed on verbatim?

Who is to say that the hospital's documentation system isn't cumbersome? How many patients are the staff taking care? It certainly isn't a 1:1 ratio most of the time. Similarly, while there may be clerical staff that can print out and assemble a packet (among other duties), if it hasn't been entered into the chart it can't be copied anyways.

If I could send you a PCR, I'd love to. The call isn't over until I clear, and I never cleared before the PCR was finished. Depending on the call, it could be 10 minutes or 3.

 

[DrParasite]

So, if a SNF nurse told you that you didn't need the packet to take a patient to the ED and that they'd fax the patient's packet to the ED by the end of the day, that would be fine?

Same for your discharge?

Same for a CCT?

no, and no.

Oh, wait. Not getting a paper report is only OK if it's EMS not providing the paper report.

oddly enough, I been told by quite a few nurses and techs that the copy of an EMS chart (for a stable BLS patient anyway) for a patient goes one of two places: the back of the patient's chart, or the garbage. More often than not, its the garbage.

A full report is usually given, involving a summary of what happened, allergies, history and meds, vitals, and any abnormalities. more often than not, this gets written down on scrap paper by the nurse before she enters the information into the computer.

My former employer had a policy: once you arrive at the hospital, you are available for the next call. doesn't matter what the call was, once you arrive at the hospital, you can be dispatched for the next one. If a crew is delayed (waiting for a bed, finishing the chart, cleanup, etc) a supervisor can be sent, and the crew can be written up for delaying a job. Management wants it that way, the staff agree it's BS, but management makes the rules.

My current employer gives people 10 minutes at the ER, 20 if they are busy. you should have your charting all done.

we have tough books, and I like them. much better than paper, and it helps with people who have poor handwriting. and you can get the bulk of your chart done before you get to the hospital. once you upload your chart, do the rest of the 20%. Every hospital can log onto EMS charts once the chart is completed, and download the copy of the chart. and we have to complete all of our charts before the end of our shift.

If you are supposed to get out at 3pm, and you are charting until 6pm, just make sure you are paid for those last 3 hours.

And if you don't like the equipment you have to use, try to convince management to change to something else, or find another job. electronic charting isn't going away, and if the bosses want you to use it, than you better find a way to use it, or seek employment elsewhere. sorry to be so harsh and blunt, but that's what the reality is.

 

[18G]

So it's the hospital's fault that the company you work for is using a crudy system and doesn't give you enough time following a call to complete a PCR? How do you know when your PCR is utilized once you leave the room? Do you think that your verbal report is going to be remembered and passed on verbatim?

Who is to say that the hospital's documentation system isn't cumbersome? How many patients are the staff taking care? It certainly isn't a 1:1 ratio most of the time. Similarly, while there may be clerical staff that can print out and assemble a packet (among other duties), if it hasn't been entered into the chart it can't be copied anyways.

If I could send you a PCR, I'd love to. The call isn't over until I clear, and I never cleared before the PCR was finished. Depending on the call, it could be 10 minutes or 3.

You make some good points. We use laptops with touch screens and do not have the capability to print so we don't ever leave reports at the hospitals. It is the receiving nurses responsibility to write down what I am telling her during the transfer of care. Just like I write it all down when I am receiving the verbal transfer of care report. In the hospital, charting is done over a much longer time span in most cases so don't feel that is a fair comparison at all.

I realize some places do require a paper report to be left at the hospital but that doesn't sound like the OP's problem. A short paper summary is simple but that doesn't constitute a full PCR or at least I hope it doesn't.

 

[JPINFV]

no, and no.

So EMS expects that they get documentation for the patient, but also expects that they shouldn't have to leave their documentaiton with who ever they're transfering care to? Interesting double standard.

oddly enough, I been told by quite a few nurses and techs that the copy of an EMS chart (for a stable BLS patient anyway) for a patient goes one of two places: the back of the patient's chart, or the garbage. More often than not, its the garbage.

I imagine that's true, especially for the 3 times a week dialysis patient. However, and especially for emergency patients, is the EMS chart ignored because often they're not written properly (as touched on earlier by others) or because the treatment EMS provides is relatively unimportant in their view?

Similarly, if the facility wants to file it in the back of the chart, the trash can, or actually use it, shouldn't that be their choice? By a system refusing to deliver a PCR at time of transfer, then you're effectively eliminating any ability for the facility to refer to the PCR in any sort of timely manner. It's akin to refusing to give the ambulance crew a packet because it's being faxed over.

My former employer had a policy: once you arrive at the hospital, you are available for the next call. doesn't matter what the call was, once you arrive at the hospital, you can be dispatched for the next one. If a crew is delayed (waiting for a bed, finishing the chart, cleanup, etc) a supervisor can be sent, and the crew can be written up for delaying a job. Management wants it that way, the staff agree it's BS, but management makes the rules.

I'm always slightly amazed that people work for companies that pull this sort of shenanigans. "Opps, sorry, we have a call waiting. What do you mean a bed wasn't immediately ready and you had to decon the ambulance? Sorry, you didn't respond immediately, so we're writing you up."

My current employer gives people 10 minutes at the ER, 20 if they are busy. you should have your charting all done.

Completely agree. 10 minutes should be more than enough time to finish charting the vast majority of calls (which can be worked on if holding the wall), transfer the patient, reset the gurney (2 person crew after all), and go back in service.

 

[Melclin]

We're actually not allowed to use our tablet computers in a moving ambulance anymore. Two reasons that I know of:

1. The passenger air bag is rendered less effective if it has to go through a lap top to protect you. The laptop may also then cause injury.

2. It has been suggested that cranking the neck downward to look at the tablet in a moving truck for long period of time can cause neck injuries.

 

[DrParasite]

So EMS expects that they get documentation for the patient, but also expects that they shouldn't have to leave their documentaiton with who ever they're transfering care to? Interesting double standard.

yes and no. I guess our verbal reports are supposed to be sufficient, as we are pretty thorough. I don't understand it, and don't say it's right, just saying it is how it is.

I imagine that's true, especially for the 3 times a week dialysis patient. However, and especially for emergency patients, is the EMS chart ignored because often they're not written properly (as touched on earlier by others) or because the treatment EMS provides is relatively unimportant in their view?

actually, I think in my 10 years, I have transported a 3 times a week dialysis patient to the ER three times, two of those time the patient was in cardiac arrest. We have IFT services that handle the dialysis runs, 911 typically doesn't.

Similarly, if the facility wants to file it in the back of the chart, the trash can, or actually use it, shouldn't that be their choice? By a system refusing to deliver a PCR at time of transfer, then you're effectively eliminating any ability for the facility to refer to the PCR in any sort of timely manner. It's akin to refusing to give the ambulance crew a packet because it's being faxed over.

again, not saying it's right, only that it happens. when we redid out paper charts, the question of carbon copies for the ER came up, and one of the committee members (the idiot who worked as the tech) said that the ER throws out the copies, so why waste the money?

As I said before, the demographics are given to registration, and a full report is given to the nurse. so they should have all the info they need, and for any follow ups they can (and have) called dispatch and requested the medic or EMT crew call them and clear up and questions they have.

I'm always slightly amazed that people work for companies that pull this sort of shenanigans. "Opps, sorry, we have a call waiting. What do you mean a bed wasn't immediately ready and you had to decon the ambulance? Sorry, you didn't respond immediately, so we're writing you up."

it was a hospital based system, paid pretty well, and used to be one of the premier agencies in the region. I brought it up to the director (who is also a paramedic) during a mini-management meeting, and he didn't want to do it, and no one was willing to actually grow a pair and say to his face that this is bad for our careers and bad for patient care, and if someone did happen, the employee would definitely be hung out to dry.

it was one of the reasons why I left (one of many).

Completely agree. 10 minutes should be more than enough time to finish charting the vast majority of calls (which can be worked on if holding the wall), transfer the patient, reset the gurney (2 person crew after all), and go back in service.

10 for most, 20 if it's busy. let people take some extra time, socialize with their coworkers, and take a quick break (maybe hit the little EMT's room) if they have been hopping, but it shouldn't be abused.

BTW, cops have been using computers in their cars for years.

 

[JPINFV]

actually, I think in my 10 years, I have transported a 3 times a week dialysis patient to the ER three times, two of those time the patient was in cardiac arrest. We have IFT services that handle the dialysis runs, 911 typically doesn't.

To clarify, I meant taking the patient to/from dialysis, not the ED.

10 for most, 20 if it's busy. let people take some extra time, socialize with their coworkers, and take a quick break (maybe hit the little EMT's room) if they have been hopping, but it shouldn't be abused.

Agreed. The first company I worked for the "rule" was 20 minutes to clear. If we needed more time or was holding the wall we called in and it was treated as a c'est la vie situation and not the crew's fault. The only time I've ever started cracking down on my unit's clearing time was the one time I was stuck with a partner who decided his mission in life was to use all of the 20 minutes, even if it was just sitting in the ambulance listening to the radio.

Want to chat for a few minutes? No worries.
Need to stop by the restroom? Go for it.
Want to stop by the cafeteria for some food? I'm all for it.
Want to sit around and do nothing "because we have 20 minutes?" Screw you.

The second company wasn't busy enough to require anything even semi-formal.