Center for Mental Health Orientation, Chart Packs, & Epic Electronic Medical Records

          After hospital-wide orientation, Crisis Prevention and Intervention training, and Epic electronic medical records training, I had unit specific orientation as a Behavioral Health Worker at my new job last month on the Center For Mental Health and Wellness, and I was glad that my preceptor was a pretty cool woman who was gentle with me. We started with the assumption that I didn't know anything, which was what I preferred so I could learn the ins and outs of how they wanted things done. The duties and responsibilities were thankfully very familiar to me since they were what I was doing before I got laid off, and was a stark contrast to my brief foray into the assisted living job. The only problem I had was having to wake up at 4 a.m. so I could work out before what was supposed to be 4 day shifts. Well my body isn't quite used to that since I've been working nights for three decades so the body rebelled and my stomach was in knots. So much so that my preceptor and I requested our director to put me on night shift orientation after just 2 day shifts. After that I got three more nights of orientation from three different preceptors on the three psych units of the hospital. Then I was released to fend for myself.

          One of my first projects was learn how to make admission chart packs. The forms were significantly lesser since the hospital started using electronic medical records on September 1st. What used to be about 40 to 50 forms were down to 14 (even lesser than what I used to handle at the job I was laid off from). On my second night post orientation, I made 60 chart packs even though the supervisors only required 5 each night. Well I'd rather make a lot more during nights that are not busy rather than scramble to make them when there are numerous admissions or when patients are acting out. Later, I was surprised to learn that nobody ever made that many before. Before electronic medical records, I probably wouldn't have either. I just lucked out by being hired there at the time that I was. A couple of weeks later, I made 70 more. Apparently I made so many in such short time frame that the psych units ran out of some forms and welcome folders. To add to that, between the time I made the first 60 charts and the next 70, there were four changes in what forms were needed because they were trying to sort out what they can include in the electronic medical records system. After about three weeks, it appears like they have settled that issue.

         One of my coworkers, upon seeing that I was new, asked me how I became a behavioral health worker. I said I used to be a psych patient, and having observed what BHW's did, I figured I could do the same as well, so I applied for the job. My new journey has began.

Questions and Concerns at College Medical Center (formerly Pacific Hospital of Long Beach)

The old Pacific Hospital had a similar sailboat logo. That ship has sailed.

          Oh boy, it looks like transitioning from Pacific Hospital of Long Beach to College Medical Center is going to take some major adjustments (I'm trying not to say that it's going to be a mess). The electronic medical records system has to be reprogrammed to the needs and procedures of College Hospital and even the paper forms may have to be replaced. Hopefully the learning curve won't be too great once the new system is in place. For those who have resisted in learning the former system or were not using them enough, they may have a more difficult time to learn the new one.

          Based on how many people they haven't rehired, one can assume (mistakenly or correctly) that either College Hospital is going to bring in their own staff, hire replacements, or reduce the number of floor staff from the numbers that Pacific Hospital used. That would mainly affect the Behavioral Health Workers who monitor the patients closely on the units and possibly the Licenced Vocational Nurses or Licensed Psychiatric Technicians who pass out the medications. The Registered Nurses shouldn't be affected since there is a legal requirement for them to be assigned only a certain number of patients (patient ratio).

Having not even been interviewed much less rehired, I will only have to be there for about 3 weeks to see all these changes. Already some of my soon to be former coworkers mentioned that I'm going to be missed because I was the only one assembling charts for new admissions. They never took the time to learn my streamlined system. But it's not rocket science and easy for them to pick up.

          When PHLB transitioned from strictly paper charts to the electronic medical record system, I had the foresight to retain the old paper charts in case of computer down times. Those papers were the only backup system the hospital had which were already preassembled, although separate sheets still existed in cabinets. I also have about 200 chart packs already made which goes with the EMR system, which would have tided over the unit I work in for about 6 weeks before the retained staff would have to make their own. Of course all of those old and new charts would be useless if College Hospital opts for their own forms. They will have to sort out which papers are needed and which are not so they can work together with the EMR without duplication.

          Communicating and taking care of psychiatric patients are ongoing learning processes because no two patients are alike and even a patient behaving a certain way during one hospital stay may not behave the same way next time. Paperwork remains more or less the same and this happens to be my specialty. I'm sure that the retained staff and the rest who will be newly hired will adjust to the new system sooner or later but they will have to take more initiative in doing so. I just take pride in thinking that I learn them sooner than most and find the most efficient way of applying them during the course of my work. Will they really miss me? Perhaps only for a couple of weeks, they they'll adjust and it will be business as usual. Thanks for thinking of me that way though. If only the staff recruiter knew...

p.s. My other posts regarding this matter:
Questions and Concerns at Pacific Hospital - Part 1

Questions and Concerns at Pacific Hospital - Part 2

Questions and Concerns at Pacific Hospital - Part 3

Questions and Concerns at Pacific Hospital - Part 4

Questions and Concerns at Pacific Hospital - Part 5

My Looming Unemployment

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A Computer Problem At Work Which Became a Gift Later

Three weeks ago, our IT department scheduled some updates for the electronic medical records system from 2 to 4 a.m. and we couldn’t use the computers for charting. By 6 a.m. they were still not done updating. Well, that went on all day until they discovered that it was not a software problem but a hardware one and it didn’t get fixed until about 10:30 the next night. It didn’t really affect me personally because I was off from work the next several nights. When a computer outage happens at my job, the backup plan is to use our old paper charts. Those papers are being kept under lock and key  and unassembled so that the doctors are forced to use the computers rather than get a form to chart on with their illegible writing.

When I came back to work after my weekend off, the unit secretary approached me and pulled me aside. I thought she was going to tell me about the shelves that were rearranged in the area where I make chart packs. She said that she has been very appreciative of what I’ve been doing with the charts because I made her job easier. She further clarified that during the daylong computer outage, she was about to assemble charts from the cupboards that were under lock and key (she had the key) so they could admit patients. Before she did that, she decided to check the shelves and see if there were old charts left there. Sure enough she found the old charts that I had leftover and kept from the time before we used electronic medical records. I still had about a hundred left. She said she was so relieved to find them and as a token of her appreciation, she handed me a TGIFridays gift card. I was stunned by her offering and was further shocked to see the amount of the gift card! Wow, I get to eat very well for several meals! I haven’t been to TGIFridays in a long time. It was way back when I was meeting chicks from AOL (America Online) IRL (in real life), and we would have lunch or dinner at Fridays. Ooops, perhaps that’s TMI (too much information). Anyway, it was sure nice to be appreciated and rewarded. Hmm, I wonder who I can take out to dinner?

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Random Work Thoughts Plus A Senior Moment

Ever since we started the electronic medical records system in our hospital two weeks ago, it seems like all you see in the nurse’s station are the nurses with their noses pressed against the computer screen for hours. They have become like moths attracted to the glow of the LCD monitor. Other than initially talking to their patients, the rest of the time they are seated in front of the computer.

As far as mental health workers are concerned, we no longer have access to patient histories, legal status, or a place where we can do narrative documentation in case we observe anything extraordinary in a patient’s behavior. All we could do is report it to the nurse. If we were accused by a patient of abuse for example, there is no way for us to defend ourselves by documenting our own version of the patient’s complaint. When we were using paper, we could still do that.

Speaking of charts, we don’t use an addressograph machine anymore to label whatever papers we still use. We now have preprinted stickers. When we first started, we had to go to the nurse’s station, open each patient’s chart to get the stickers. I wondered how we could do this more efficiently but couldn’t come up with an idea. Somebody else did however and it works beautifully. He took an empty binder, put in dividers with room numbers, and placed the stickers in the dividers. Now why didn’t I think of that?!

I remember the time when the midnight shift workers were left free food by the hospital. Where have those days gone and do some hospitals till do that? The food were leftovers from the day’s meals and rather than let them go to waste, they were left for the night shift. I wonder what they do with the leftover food nowadays?

I had a pre-senior moment at a store a few days ago. I took out some discount coupons from my wallet when I got there. After I found the products I was looking for, I reached for my wallet from my pants but couldn’t find it! My first thought was “Darn, I left my wallet at home!”. Then I realized that the wallet was still in my hand from when I took out the coupons minutes earlier. DUH!

On that note, Happy Easter To All!

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Finally, Electronic Medical Records Class Completed!

Well I finally got through electronic medical records training on March 24^th after the original class was cancelled four weeks ago. But first I had to wake up at 5 A.M. even though the class wasn’t until 8 o’clock, so I could fit in a slightly shortened workout on the spinning bike. The class itself, for me, wasn’t too complicated, but maybe I’m only saying that because there were instructors there to guide us. In a couple of days, I may have already forgotten the steps to access those medical records.

 I was wondering why they scheduled a whole day class for it and when we started I found out why. Despite the proliferation of computers and access to the internet in homes and workplaces, would it surprise you to know that there are still a lot of people (probably mostly middle aged and above) who don’t even know what a double click, a right click, or a left click is, much more even opening internet explorer? And that’s not even mentioning what maximize, minimize, or close a window are. So that was the first part of the class which took slightly more than an hour. I’m glad the instructors were very patient in teaching the more computer challenged among us. That didn’t bode too well for the next two sections we had to learn and those were entering data into the computer using a dedicated electronic medical records program, then learning to use a similar technique while using a hand held device similar to the scanners grocery and store workers use to scan products. If one already uses an Iphone or Android device, the interface is pretty similar and you have to use a stylus (although your fingertips would work as well in most cases where the icons are not too tiny). The device also has a numeric and alphabet keyboard a la Kindle, although not in QWERTY layout which makes it slightly more difficult for experienced texters, but maybe easier for non-typists. And just like the store devices, it has a bar code scanner on top to be used to scan patient’s ID bracelets and medications (to make sure the right patient gets the right medication). If I lost you at this point and even bored you, my apologies for the detailed description, but I find devices somewhat fascinating. I just hope that we learn how to use them quickly and I’m sure that by just mere repetition, we would get the hang of it soon, and maybe even find some shortcuts as we learn to navigate the menus that the program has to offer. If not, well then at least the newbies now know how to right click, left click, and double click the mouse. With a little cheese, the mouse just might cooperate.

Well, after all that description, I found a picture of the hand held device. Would you believe how much that thing costs? About $1,600 each! I hope no one drops it.

I thought I finished writing about this, but I remembered asking one of the instructors at the class if the electronic medical records were also accessible from home and she showed me the item to click on the company website. So I was messing around with the website in the evening and was indeed able to access the EMR and thus was able to practice what we learned earlier in the day. High five to me!!!

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Power Outage, Long Walk, Electronic Medical Records, and UPS

          Well, so much for being away from home during the scheduled blackout. On Thursday, the  electric company was in our neighborhood to upgrade their facilities so there was an 8 ½ hour window from 9 a.m. to 5:30 p.m. when the power was supposed to be off. On the same day I was supposed to be attending an electronic medical records class at work from 8 a.m. till 4:30 p.m. So that should taken care of  the problem, right? You know, the problem of having nothing to do for 8 or so hours. Did I mention that I was also expecting a delivery from UPS that same day? Of course I would have missed that if I was at the EMR class and UPS would have had to redeliver the next day. Not a problem because I could have waited another day for this computer I’m writing on. More on that some other time.

          The previous day, I received a call from my supervisor telling me that the EMR class was cancelled because ironically, the electronic program crashed. That spared me from having to wake up at 5 a.m. so I could workout before leaving for work. I try not to get out of bed before 7 o’clock on my days off. So now I had to readjust my schedule to try to fill the time while without electricity and while waiting for UPS to arrive. I started walking on my treadmill until the power went out, which took me halfway to my goal time, then continued walking outdoors around the block (so I don’t miss UPS) until I finished 2 ½ hours. Incidentally while circling the block I encountered a barking dog inside the fence of one of the houses. The first time, he was barking ferociously at me. The second time, by the time I passed him, he stopped barking. On my third go-around, the dog just boringly laid on the ground not even acknowledging my presence. That made me chuckle.
The power outage started about 10 o’clock and when I got home from my walk at about 12, still no electricity. That meant no TV, no internet, not even good old radio. Oh my! I would actually have to read something on paper if I can find a book or magazine. I considered digging up a book I haven’t read since the early 80’s : Dr. George Sheehan’s “Running and Being”, because one of my Facebook friends quoted him the previous day. Well, it didn’t have to come to that because at 2 p.m. the power went back on. I did have to rediscover my oven to cook my lunch though (baked tilapia) and the stove to heat water for coffee. I even heated precooked rice in the oven by sticking the metal container inside while the fish was cooking. That made me realize how much we have taken something like electricity for granted because it’s usually there on demand. I even had to hurry and take a quick shower before all the hot water from the heater ran out. Thankfully, even though the power was out for 4 hours, I only had to endure 2 hours of it.
After the power came back on, the rest of the day was spent watching videos and waiting for UPS to deliver. The package didn’t arrive until about 6 p.m. Rereading Dr. George Sheehan will have to come another day.

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Odds and Ends – February 2011 Edition

I’m scheduled for electronic medical records computer class on Thursday, February 24^th which would take about 8 hours (actually as I post this, I may be getting ready to leave for class). Last Tuesday, I received mail from the electric company that they will be having a scheduled blackout for the same day as the computer class to upgrade their equipment in the area where I live. Good timing, huh? On the other hand, I’m expecting a delivery from UPS so I won’t be home. Darn! I have to wait another day.
Ok, I need to update the first paragraph above. The EMR computer class was cancelled because the program we were supposed to learn crashed yesterday. The blackout happened as expected and lasted about 4 hours: from 10 a.m. to 2 p.m. so I was almost bored to death without TV or internet for at least a couple of hour,s since I couldn't leave in case UPS showed up. As I update this at 3 p.m., I'm still waiting for UPS.

Yippee! I finished doing my federal and state taxes last Thursday, February 17^th I’m and getting a little bit of money back. It seems like I’ve achieved balance in my taxes, meaning I’m not paying anymore at the end of the year and not getting too much of a refund because deductions from my bi-weekly paycheck are just the right amount. The refund is just enough to pay for the annual car insurance, maintenance, and registration payments so it’s practically a wash.

Here is one entry I found amusing on the California Tax Form:
Check the box below if all of the following are true for you (and your spouse/RDP) - - Are not deceased. That means I don’t have to check the box if I’m deceased, right?

While assembling forms to make charts at work last week, we ran out of paper clips so we had to check all the drawers in the nurse’s station. By the time we picked the drawers clean of all the paper clips we found, they would have been enough to fill about 4 or 5 boxes which meant we found 400 to 500 of them lying around. And we still had to untangle them  afterwards.

Ever noticed on the TV show House, how the doctors leave prescribed medications on the patient’s bedside? They take too much cinematic license when they do that because that will never happen in a hospital in real life.

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