I had my EPIC meltdown. Two and a half weeks in. I was told it was inevitable. I had watched others crumble. I had been irritable, but I'd avoided the complete show. Until yesterday.
On my first day with EPIC, I had two patients and triaged someone. It was very stressful. I did okay, and ploughed through a delivery. The system went down at midnight. On day FOUR of Go Live. What kind of planning is that? Whew.
But yesterday, bad communication, disappearing orders for magnesium sulfate, not having what I needed to able to take care of a patient after an hour in the PACU? I understand that as a team, we are all learning, but I felt that the MDs were treating my patient like we were still in what we call the "playground," where it's about practice--but my patient was real! Very real. In pain, and on critical meds. Medications would come and go from the administration record. It was frankly unbelievable. Two RNs by my side were equally astounded. I threw up my hands and apologized to my patient. "I am so sorry. I cannot take care of you properly like this."
I went to the hallway, took a breath, and began to cry. Shit. That was the second time I've ever cried publicly at work; the first was when I heard that my uncle died. I felt so unprofessional, but I was so profoundly ANGRY. I work in a tightly knit unit where there is a great deal of support, but I hate the atmosphere right now. HATE IT. It's poisonous. Everything that's awful is magnified.
I hate that we have the cheapest model of EPIC, and that it doesn't mesh with our fetal heart-rate monitoring software. I hate that you cannot look at the chalkboard and get a quick overview of what's happening with each patient. I hate that our unit is being punished for being activist. I hate that I feel I cannot be the best RN I can be with all the new constraints. This is not why I changed careers to serve others.
After I collected myself and gained counsel from the wise, I decided to focus purely on my patient and chart what I could, and to say the hell with the rest, filing a Technology Despite Opposition form from the union. My charge RN said she would run interference with the MDs, one of whom said she is so fed up she is in "bitch mode." Okay. And that makes communication easier...how?
I get it. We're all fried. But the patients are being sacrificed. We Plus You? LOL
One more day, one more day, one more day. And thus into battle go I.
Before the Charge
The night is still and the air is keen,
Tense with menace the time crawls by,
In front is the town and its homes are seen,
Blurred in outline against the sky.
The dead leaves float in the sighing air,
The darkness moves like a curtain drawn,
A veil which the morning sun will tear
From the face of death. -- We charge at dawn.
Patrick MacGill
5 comments:
Sorry you are having a bad day, but thanks for the lovely poem.
Ohhh do I have stories about EPIC for you. That is what my HealthCare System uses, and I worked as a SuperUser for three separate hospital go-lives. We implemented our first hospital about 3 years ago. I am doing yet another go-live this June for a newly acquired hospital.
I have not yet had the pleasure of working in STORK (the is the name our System gave to the OB application. Is yours called STORK as well?). My understanding is that the OB application is not EPIC's most user-friendly.
I work on the Ambulatory side now, and EPIC is all-consuming to the staff. Almost every process in the Primary Care office has been redesigned to accommodate our friend EPIC. I am sorry Sutter purchased the cheapest version of EPIC. My employer did too, but we get upgrades all the time.
Unfortunately, we would not be able to meet all of the new ObamaCare requirements if we did not have Electronic Health Records. There are way too many reporting requirements. If we don't report, we don't maximize reimbursements. However, I do believe that all this hassle will eventually result in higher quality and safety.
Wait 'til they start making you offer flu and tetanus shots to your OB inpatients. The day is coming...
Crying is normal the first week of EPIC, as are physicians who refuse to document things that are needed so that clinical staff can do their jobs. Some docs truly believe that if they make things difficult enough, the hospital will eventually abandon the EHR and go back to paper. Sorry, not going to happen.
Orders and progress notes do sometimes disappear in Epic. Shit happens. In my experience, this happened a lot when the clinician was in the Outpatient Context when they should have logged in with their Inpatient Context. In the case of Mag Sulfate, maybe Pharmacy saw the order and grabbed it. Crazy.
I feel for you, I really do. It does get better though. I hope your hosptial has a little cart with chocolate, fruit and pretzels they circulate around to the clinical staff. Ours did.
Megan, I survived my weekend on (minus my birthday) and would love to discuss EPIC Go Live with you, since you have been through it more than once. I wish that Sutter had goodies for us. Really wish they did. That would be humane and supportive!
Each shift seems to be a bit easier, although I still have never been through the entire OR sequence. I need to encourage myself to take a surgical patient (the one time I did, the surgery was canceled) or a patient who seems likely to go back. I've now had a few deliveries and a few admissions.
Yesterday I was really shocked by all the new questions on the admission screens: asking the fathers how much they make? Judging whether I believe they'll be good fathers? How far they live from the hospital? That's not my business. I left those blank. Having the patient describe herself in three words and asking her if she likes herself? That's an essay question. I am too busy. These things went on and on and on. My patient and her partner were attorneys. We were laughing about it. They said the look on my face was priceless. I guess I failed at pokerface.
My charge nurses said that I only need to chart what we used to chart. If I charted everything that's in there, I would never be finished.
With the mag, no, it really was the MDs playing around with the patient's chart "to see what EPIC could do." Verified by multiple witnesses. Awful. Not okay. And then not making sure that things were left as they had been, or checking in with me? GREAT communication. Awesome.
Our fetal monitoring software is GE Centricity/Citrix. We used to have a great chalkboard where patients would be in different colors, depending on status. Now it's all gray and a glut of information. No one can get an immediate overview and know that LDR1 is a demise, LDR 5 is going for section, and LDRs 7, 8, 9, 10 have delivered, etc. It's all text, small text. I think they're working on it. Our unit is large: 24 labor rooms; 8 bed triage; 3 ORs, 4 bed PACU. It's frustrating not to be able to have a quick overview.
I recall our OB unit having a surrogate birth, and our Credentialed Trainer had to go over there at 1am to separate the baby's chart from the birth mother's chart. She said since the mother was not genetically related to the baby, they couldn't be linked together in EPIC. She had to do it at 1am, couldn't even wait until the morning to separate the charts. I didn't say anything, but I felt sick inside...
Megan,
I would have been completely triggered to see that happening. Sick to my bones. Of course they had to do it immediately, just in case...
I remember during training when they taught us how to pend babies before delivery, they emphasized, "For adoptions, do NOT click the button that populates the baby's chart with maternal information. Do NOT click that button. Do NOT. They share last name, and that is ALL." That was hard to hear.
And there are many fields in the Well Newborn Care Doc Flowsheet or whatever its called where you can click that the adoptive parents are doing whatever this and whatever that. I usually avoid the adoption cases because they are too hard for me emotionally. It's more evidence of the "new normal" with the PAPs right there on the unit, but of course they're not called PAPs: they're called APs in the program and by pretty much everyone but me.
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