Guilty

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I am pretty rigid. 

I like my space. I like my control. I like to think that I don’t need any help taking good care of patients. I think maybe it borders on a bit of snobbery.

I am vocal and opinionated.

So when the powers that be told me that I had to push a little tiny button on the medication list that says I reviewed that patient’s medication list I was scornful.

What difference is that going to make? Clicking a stupid little button is not going to improve my doing something that I already do during every visit. It just adds more gosh darn busy work!

And so I fumed. And I swore under my breath. And I was passive aggressive. And I promised myself that I would stop clicking that stupid little button as soon as they were done tallying for our clinic application for recertification as a Patient Centered Medical Home.

I will only do what actually helps improve patient care.

What I have discovered, as my hand has been forced, is that I am not nearly as good at updating and reconciling the medication lists as I thought I was. 

That being said, worrying about clicking that button and all of the other little buttons in order to meet all of the criteria is distracting. I am more prone to forget to document or address other important things.

So my doctor snob self is going to swallow my pride and keep the medication review button clicking. 

But the rest of it? Nah… Maybe not so much. In the meantime I resolve to be a bit more flexible and open minded!

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77 thoughts on “Guilty

  1. I’ve actually read the studies that show how helpful those checklists are for improving patient safety, particularly in hospitals. So I’m a believer.

    Just wish there were better checklists for life …

    Liked by 1 person

    • Theses are not true checklists. They are tiny button clicks sprinkled throughout the EHR at random places that do not always make intuitive sense. A checklist with all of it in one location would be frickin’ awesome. It is this hopping around all over the chart to make sure all the required buttons are clicked that kills everyone. In fact, there is a reviewed meds button that is not located with the med list that can be clicked for credit but I am forcing myself to use the one on the meds list itself as that forces me to actually look at it. Flow. We need better flow!

      Liked by 1 person

      • When you talk about checklist flow – that has been studied and the experts work for NASA. There have been a number of fatal plane crashes over the years because of the lack of flow in checklists caused critical items to be accidentally missed. The FAA went to NASA and had the pilot checklists for planes redesigned with intuitive flow. The crashes for this reason stopped. Big difference when a checklist has flow. Good luck!.

        Liked by 1 person

  2. Oh, stuff like that drives me nuts – spending more time documenting than actually tending patients is nuts. The dialysis nurses here had to do that for a few years – they called them bubble charts – each nurse had to color in little hollow bubbles for each unit of time spent at an activity. The list of activities was about 8 pages and covered everything up to consoling an emotional patient. It was hard to get the attention of the nurses during dialysis because they were too busy bubbling. I told them they should have bubbles for bubbling as they spent many units of time per day just doing bubbles. The management eventually figured out that they had to hire more nurses because the nurses they had were busy doing paperwork. The bubbles stopped then.Never to be seen again.

    .As far as medication review is concerned – they supposedly have those in dialysis quarterly. They hand us all advisory sheets the session before telling us to bring all our medication the next session. At first I dutifully brought it all but no one checked. After a few times, I started asking nurses to check as I had the medication as requested. They made excuses. In 8 years of dialysis I have never had my medication checked even once by nurses and yet 4 times a year we are told to bring it all in. Everyone ignores the advisories now.About once every 5 years the pharmacy dept comes around and checks – saying they doing it yearly, Ha! – I’ve seen them once in 8 years.

    Good luck with the buttons Victo. πŸ˜€

    Liked by 1 person

      • Oh, I believe it. Over the years as a manager. I declared war on paperwork and lessened my employee loads considerably., Once paperwork is instituted, it never goes away even when it no longer serves a purpose..I believe in checklists – but they have to add value not subtract value.

        Liked by 1 person

  3. So, I was real chill about medication, pretty compliant, then this happened:
    New to pre op and one day get assigned a blood transfusion . Peer says ” she’s here all the time, has sickle cell. Just needs her two
    Units packed cells” . Young girl, 22. Two hours later she has a seizure. Wakes up well-sent to the
    ER – I m filling out the incident report and a coworker says ,
    “Oh yeah , I knew she had seizures.”
    Aggh – will always do med reconciliation now😁!

    Liked by 1 person

  4. It also probably has something to do with their malpractice insurance. By clicking the button, it documents that you took the appropriate and necessary steps for each patient. As a patient, it can be confusing. When I was going (well, I still have to go every three months) for follow up from my surgery, they kept asking me if my medications were the same. I would say yes and they would click the button. Then I realized that they probably wanted to know if I was still taking everything that was prescribed, not just if there had been any new medications added. So last time, I clarified it. Yup. That’s what they wanted to know…what am I still taking! I wish they had asked it that way!

    Liked by 1 person

    • Actually, it has nothing to do with malpractice. They can track if I have touched and reconciled the meds (updating and deleting). It is a regulation for PCMH certification that I click that specific button.

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  5. I was like that with student reports. The office staff didn’t understand about the students – except that they did because they had feedback from all the teachers and had a good collating system that worked better than mine. In my case it was my laziness that put me on my high horse.

    Liked by 1 person

  6. Doc, Doc, Doc :::shakes head::: do the friggin med rec….I know it is a pain in the ass. Can’t your nurses do it for you? The whole point of the STUPID button is so you attest to the fact you did the med rec and verifies and time stamps it….. isn’t nice to know how much the government trusts you do to do your job?
    I firmly believe that CMS looks for ways to make things impossible to complete so they can toss your documentation back at ya and take the money back. Too bad we can’t bill the government when they screw up…..like when some knucklehead recorded my social security number wrong. I went through hell for that one. Couldn’t pay my taxes and then they tried to penalize me. ggrrr
    Press the button, we all are in this together πŸ™‚

    Liked by 1 person

    • If it were one button, no problem. It is so, so much more, as you know. I will click that button not because CMS says I have to, I will click it because it can potentially help patients. (It probably takes me from 90% to 95% on the updating the med list at each visit.) πŸ™‚

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  7. Reminds me of getting used to software and user interfaces. For this task, apply this routine. For that task, apply that routine.

    You get used to it until you reach that “computer says no” moment. Then you want to punch the system knock-out with a supreme control-alt-delete or hard reset while you count to eight. Routines…

    Liked by 1 person

      • Routines can be fun. Think of Christopher Walken in SNL, “Needs more cowbell!” On the website Ars Technica they like mixing up jargon in titles and subtitles. Sometimes when something went seriously wrong they go “Whiskey, Tango, Foxtrot” and I have a chuckle. The pythonesque “Knights Who Say Ni!” really make my day.

        Whenever you have to check saying something silly like “indeed, ni” is enough to keep the mind going having gloriously pushed a button to its doom. People complain and you demand that they buy you a shrubbery and cut down a tree with a herring.

        Sorry, pythonesque silliness leads to more…

        Liked by 1 person

    • It IS annoying! You know what else is annoying? Providing a print out of all of the meds you believe a patient is taking at the end of each visit, beg them to please double check it against what they have at home and call you with any discrepancies, only to have them toss the paperwork in the garbage can in the lobby. Sigh. So I make patients bring their meds in ziplock baggies, too. πŸ™‚ I really wish there were a better way. Like a scanner that I could touch to a patient’s wrist that would tell me what medication is actually in their blood stream, hence being taken as prescribed. OR better yet, NO meds at all. Some sort of implantable device that administers it instead having to have patients remember to take these complicated med regimens….

      Liked by 1 person

  8. we just talked about this today, after ICD-10 training. You don’t get “credit” for spending time with the patient who hurt her ankle. You can’t diagnose her with a sprained ankle. You must specify a million things about the sprain for billing purposes if you want to get credit for that diagnosis. It’s all about clicking the right things, the right number of times, clicking that you reviewed all her previous meds, diagnoses, past history etc… who cares what you actually DID at that visit, the time you spent etc..

    Liked by 1 person

  9. Maybe they should add a lollipop with that button pushing. They can get a taste of all that busyness, too! Of course, that might be a lot of lollipops and then you might get tired of them. I think everyone has room for improvement, no matter what!

    Liked by 2 people

  10. Pingback: My Article Read (7-23-2015) | My Daily Musing

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