Again, unless you had a very top notch and accurate audit system, this could cause a lot of medicolegal implications. The easiest and still best way to do this is either via an addendum or even a message which is better for me.
Just pull up the message, write correction to progress note on 9/21/09, type the correction and save to the chart. It will then always be right next to the note.
With paper, it was obvious when you changed something as you struck through it with one line, wrote error and initialed it. What you would want to do may entail actually deleting the error and correcting it. It may be possible to correct the error by striking through and initialing, but even the big boys EMRs don't seem to have that feature as I have never seen it on progress notes sent to me.
IMO, and this is just my opinion, even signing them off the next day would raise some eyebrows if there were ever issues with that visit. The EMR should document when the note was finally finally done. It would seem easy to see a patient who then does not go to the ED that night when the fever suddenly spikes (just an example), and there is a bad outcome. I would be tempted (wouldn't do it) to go back and write (patient was informed to go to ED for fever spikes -- and change the 103 temp in the Vital Signs to 100.1. This is just a thought.
I wish I was able to finish every note everyday, but for me, it's just not possible. Many of my patients are on a lot of meds and have multiple problems-over half the visits at a 99214 level. With doing "modified open access", I often get slammed at the end of the day.
While most notes are closed on the day the patient is seen, sometimes it's just not physically possible. Adding stuff like details to an exam, critical parts of the history that didn't get in on the first pass, are too hard to ever recover in AC if they are relegated to an addendum. That's one of the weaknesses of the program.
I allow myself some time each morning before jumping back into the fray. I use that time to review the patients I will be seeing and anything that might still be pending from the day before.
Barb, you'll eventually find a system that works for you.
PS Wouldn't it be nice if we didn't have to practice defensive medicine. I went to medical school with a gal from Austria. When we got to the floors, she asked a profound question, "Why do we waste so much time writing things down instead of caring for the patients?"
