I am missing something here. Or maybe I am stepping way over the limit. But, no worries here.
My nurse does EVERYTHING.
When the patient comes in to be triaged, she figures out the shots and draws them and gives them after. Sure, I glance at them. I used to be the best with shot schedules. Not anymore. She does all of it. She even decides with the patient when they will what or none if the patient doesn't want it. She just documents it in the HPI so I read it.
Now, it just so happens when it is a one Hib after 15 month rule or 3 after 4 and 4 after 4 for IPV and DTaP respectively, she comes to me at times.
Labs. All her. If I see a patient in the room that needs a CXR or CBC I go right to the "Other" sesction -- don't bother with ANY of the other columns except referrals -- and I print it off. Done, documented in the chart and I can save it to visit history as well. But, U/As, cultures, strep or any test that we do, she does the req or sends it out. If I am in the room and I know the patient needs an MRI and an abdominal U/S, I message her while I am talking, and she prints out the reqs, schedules the procedures and an appointment card is waiting when I get out. When she prints on the req or faxes it, I get a message in my inbox. I don't touch a thing. Referral. Quick letter with my system, click on the specialist, type headaches in the comment section and send it to my receptionist. I am done thinking about that. The letter is usually faxed when I get to the front if I don't do it from the room.
In the six or seven years I have used AC (even with this HM nightmare), I have never sent an order via AC to do anything. Either verbal or via instant message. After hours or when there are messages in my inbox, I will send messages with lab results via the message system. I remember posts a year or so ago (which is fine -- everyone has their own workflow) where the ENTIRE chart would be forwarded to the MA for an order. She/He would then do their thing and send the chart back. Then it would be sent to billing.
I don't do any lab reconciliation. I am not sure if people are doing that now because of v5 or they just felt compelled to do that. (Certainly not knocking anyone who does). I guess I just trust the lab and radiology like I trust my MA. I know. They aren't even close, but we get 95% of our labs and x-ray results back. And, our patients know to call. Gotta give 5% of responsibility to them.
My MA pretty much triages what she needs to and schedules the rest. All refills and a lot of meds are ePrescribed. EVERYTHING is documented in the message and sent to me. I see them while I am working. Worst case scenario, I tell her...know I don't think we should call in that med or we need less mLs or we should see the patient. If she ever left, I would have to give it all up.
And, even things I haven't mentioned are done by her. She reads my mind. She has the prior authorizations done before the patient leaves the room. She knows what I will probably write for, so she has the Strattera PA ready. The Nutramigen samples are out.
But, it isn't about that. It's about what is all this about the login?
I guess if you do everything the way AC wants things to flow, it would be impossible. If I could tear out the order section, I would be pretty much happy with it. Figured out the template thing. It's fixed. Still waiting if the ghosts are going to start multiplying the templates. Don't use them much anyway.
Oh, and I forgot. She does most of my letters.
