Home Forums Discussions Problems Nurse's input lost when I close the chart

Hello
When my nurse intakes a patient, she enters complaint and vitals. Then she sends the chart to me, and I retrieve it from the inbox. A couple of times when I opened the chart from the inbox, I closed it by mistake before entering anything myself. The software didn't prompt me to save what's been entered by the nurse. When I opened it again, her input had gone. Is that a bug or a feature?
Thank

Not really a bug or a feature, you just need to know how AC handles messages.

When you open the message from your nurse with the chart attached, a dialog box pops up, asking if you want to keep the message you are opening or delete it from your mailbox. That is your "moment of truth". If you think you might close the note by mistake, click "NO", and don't delete it. The message will stay in your box, and you are viewing a copy.

After you open the message, the program will only ask if you want to save the message/chart back to your mailbox if you have made changes -- even just clicking in a section of the opened chart is enough. Otherwise, if no changes, it will disappear if you close it, without a warning window.

However, even then -- all is not lost! You can find the deleted message/chart in the "Deleted Messages" part of your mailbox, until you log out of AC.

Perfect answer!

Unfortunately, it isn't quite "until you log out of AC," it's until ANYONE logs out of AC.

What do you think John? Personally, I think it would make much more sense for them to stay in until the individual computer logged off. But, maybe that isn't possible.

I have discovered how to retrieve the chart and so the nurses information but this issue has a second implication. The nurse opens the chart, selects "New Note" and puts in the vitals. If I decide - after s/he has done this - that I want to use another visit as a stepping off point, I think I lose the vitals again. The nurse doesn't know what visit I want to use and I don't know until I get into the room and find out that it might be the same ol' thing. I'm thinking that the nurse needs to do the vitals on a sticky note and then let me enter them later. (I tell patients that I used to be a doctor and now I am a typist or data entry clerk)

Also, the vital sign notes carry over from appointment to appointment so if the nurse checks the BP more than once and records it, the same note comes up the next visit - yikes!

I'm glad to hear you found what you needed. If you can verify this you should consider this a bug and send a bug report explaining with a short description of: how to reproduce the behaviour, and why the behaviour is incorrect. One of Amazing Charts QA people will see it and add it to their bug tracker. Bug reports should be in the main windows _help_ menu.

Bert: I did not know that. Thanks for that info.

I also wasn't aware that the Deleted only stayed until anyone logs out.

I tried the solution above. While it is true the deleted message stays in the "deleted" folder, the chart attached to it is gone. So I still can't retrieve the nurses note.

Also, is there a way to save a partial note without signing off on the note? I can forward it to myself, but then if anyone starts a new note and forwards it to me, what would happen?

Thanks

This is not what happens to me. Once I pull out the note plus chart from the deleted items into the Inbox again, I can open the chart by double-clicking on the note. I have done this dozens of times, including immediately before I typed this response.
Try to send a message with a chart attached to yourself, open it, and close without forwarding it, and retrieve it from Deleted Items. Then double click the retrieved message--what happens?


Nothing permanently happens to the patient's chart until you sign the encounter. Your forwarded note is saved to your Message Inbox until you reopen it or delete it. Anyone else opening a copy of the patient's chart can open it and make edits, which then only exist in their Message Inbox. If they send you the message with their edited chart attached, you will have two copies of the patient's chart in your box, one with your edits, and one with theirs (not a desirable situation). So the best policy is to open the chart, make entries, and send the chart as a message to the next editor. The final stop is the physician's message inbox, where the encounter is reviewed and finally signed off.

My experience is that any chart deleted will go to the deleted folder. You can then retrieve it and any information which had been added is still there.

@Khaled

I am rather confused, and I think maybe there is some confusion, which may be the issue here.

Your first question was specifically about what happens after a chart note is forwarded to you by your nurse, you then open it, and delete it.

The answer as given a couple of times, is you can retrieve that chart note from the deleted items folder.

Now the question changes from forwarding a chart note to a message in the deleted items folder and an attached chart note.

I guess I am confused by the "note with the attached chart." Not only is this a different question, but I think I am missing something very basic here that maybe I have never known. I am not sure what "a message with a chart attached" is.

My understanding of AC is that there are charts, messages and addendums. A chart can be opened, edited and signed by a provider. A chart can be opened, edited and forwarded to one's inbox. A chart can be opened by a 3rd party and forwarded to your inbox.

Messages are sent by highlighting a patient in the Patient List and clicking on attach or dragging it to the message area. These are then sent to users using the drop down list. While one can get to a patient's chart by clicking on open chart or double-clicking on the message header, I would consider that simply opening the chart because the message is basically a shortcut to the chart. I don't think of it like the chart is attached to it. Maybe it's semantics, but if I delete a message that is sent to me, I am not deleting a chart.

Ok. I think I was inaccurate in my wording. Let me rephrase this:

What I wanted is a way for someone to start a note, save it without signing it, and then for someone else to reopen the note and add to it, until eventually the MD signs it. I now understand that cannot be done in AC. What can be done is to forward the chart to someone's inbox and that temporarily saves it. Now if another person opens the chart of the same patient and starts another note, then we have 2 instances of of the chart at the same time which, as described above, is an undesirable situation. This, in my opinion, is defective way to handle notes, because forwarding the chart to someone else's box can still cause problems. There should be a way to save a note within a chart without signing it and without having to forward the chart to someone's box.

(Saying "a message with a chart" was inaccurate. I apologize.)
I hope I made myself a bit clearer.
Thanks for everyone's willingness to help.

This behaviour drove me crazy at first, but let me explain how I have adjusted. My MA sees a patient. She records CC and vitals etc and forwards chart to me. I see patient, put orders in plan section and forward back to her. She records results and sends back to me. I open chart and can read for example Spiro results or strep screen results. Or if she did immunizations, they are recorded. I can finish the chart and sign it, but if time is tight, I forward the chart back to MYSELF (I have a verbal dragon macro to rapidly do this). I finish all my notes by the end of the day. Any rare leftovers are dealt with via addendum. I would love for someone to compile various ideal patient flow scenarios to compare and I can fill in details of mine, but AC is a good tool compared to paper. It pays to spend time with staff to smooth out routine procedures.

Much like mkweiss, I have also adjusted to AC's handling of encounters. I think the intent was to have the chart travel the same route as a paper chart.

I like to go through the chart (if I have time) before the patient arrives, even the prior night, and update the PMH and any other sections, based on documents received (ie: labs, x-rays, consult notes) since their last encounter. I open a copy of the patient's chart, make my edits, and forward the edited chart to a "phony provider" Inbox (named Reception in our practice). There it sits until the patient checks in, when the front desk person (logged in as "Reception") opens the chart, updates the insurance info and demographics if necessary, and then forwards it to my MA. She then puts the patient in the room, opens the chart, adds the CC & vitals, and then forwards it to me.