Reply To: Chart preparation

  • Alexis Lemke

    February 11, 2020 at 10:38 pm

    The process of chart checking we utilize in our outpatient clinic involves the mid-levels, not staff nurses.

    We have one PA & one NP as well as four oncologists. Our PA & NP rotate each week who is responsible for checking charts/entering appropriate orders and delegating to the¬†physicians when necessary (sedation medications). The mid-level in charge of chart checking for that week has an “administrative day” (no scheduled patients) in the afternoon that Thursday to catch up on chart checking for the following week, although they should be doing so throughout the week/as needs arise. This works well for our mid-levels and our clinic flow, as we schedule most oncology patients in the morning and all hematology patients in the afternoon so our afternoons are generally lighter.

    We, as staff nurses, will review the patient chart and orders the day before they are scheduled to be in clinic to verify that everything was entered correctly against the roadmap and if not, call the appropriate provider to make sure this is done.

    I hope that makes sense.

    Alexis Lemke BSN, RN
    Corpus Christi, TX
    Original Message:
    Sent: 02-11-2020 09:18 PM
    From: Allison McNeil
    Subject: Chart preparation

    Hi everybody,

    We are doing some overhauling and looking closely at time utilization and roles in our outpatient clinic. Currently, our infusion nurses rotate between being an infusion nurse, sedation nurse, phone triage nurse, and chart preparation nurse. As we continue to brainstorm, I’m curious to see how other clinics handle chart prep. Here’s a rough outline of our current process: we have a team huddle on Wednesday or Thursday for all the patients on that team (basically, just how we divide providers) coming the next week. The nurses present during huddle have a sheet where we’ll designate what the patient is coming in for, what labs they need, and what infusions/meds they’re getting (if any). We stick these sheets in the chart, and the following week, the assigned chart prep nurse will enter in orders and look over roadmaps the day prior to appointments. This nurse is also responsible for making the next day’s assignments.

    Since this can be a lengthy process, we make sure the chart prep nurse can be out of patient care by 10am (we are open from 8-4:30). In periods of short staffing or on especially busy days, it’s hard to give someone up for 6 and a half hours to do this task. There’s no question in my mind that a chemo provider RN needs to be reviewing the on-therapy roadmaps and charts the day before, but I’m wondering if other institutions utilize MAs/LPNs in putting in lab and other orders to save time–especially for off-therapy and general hematology patients that aren’t following a roadmap, since the providers are already designating what they want ordered the week prior.

    Patient safety and adherence to protocols will always take priority….but I can’t help but wonder if there’s a “work smarter not harder” solution here that would allow our RNs to spend more time in patient care and keep acuity more reasonable for the other infusion nurses.

    Thank you in advance!

    Allison McNeil, BSN,CPHON,RN
    Oklahoma City, OK
    United States