Sunday, February 24, 2013
First week done
so I am just going to dig right in...
School - Should be able to see the schedule starting tomorrow to see what classes are going to be available for the summer. I can not register until April, so its going to be a challenge to get the ones I want. But I will keep my fingers cross. I also don't know if I will be able to get financial aid. That's going to suck if I cant... :(
Work - So I had my first 4 training shifts last week, and it was a roller coaster. Each shift was with a different doctor, and a different trainer, who all liked things a little bit different. My feet were killing me, and I was just thinking to myself. OMG I cant fail at this...
By my last day, I felt a lot better about what I was doing, and it was kind of slow in the ER. So that really helped. I was off Fri - Sat and return tomorrow. I hope I can continue the upward trend and have a good shift. :)
"The Plan" - so far on track. I decided not to keep working on the online pre-cal class, I was just too far behind and last week really drained everything out of me and I could not catch up. The good thing is it was free and I didn't loose any money or damage any grades. It was more or less to freshen up on Pre-cal before taking the actual class.
I still have not found a place to volunteer. I have a few days off during the week next month, I am going to work on that.
My Rug rat - she is well, her second competition went very well, and she won another scholarship at the last dance convention she went to. School is a bit of a challenge. She has a bit to much mouth and character for the strict structure. She recently auditioned for a performing arts school, which she felt went really well. If she gets accepted there she will probably start 6th grade there. There is also a bit of a shift in her evening life now that I work in the evenings. Grandma is taking her to dance, and bringing her home for homework, baths, dinner, etc. And of course GM has "looser" standards than I do. So that stresses me out , and I start to get concerned about going after my goal, instead of just staying at my "steady" "predictable" job, where I could make sure I was the one doing homework, baths, dance, cleaning.. etc...
Life - not much interesting to say here. I feel like I have lost a bit of structure due to the changing of my job. Previously with the M - F 8 to 5. I did certain things at certain times. Laundry on Saturday, groceries on Sunday, cleaning on Friday... etc. Now that my schedule has changed, I have not gotten on a good "taking care of home" schedule and I feel like my house is turning into a hot mess. I really need to take the time to find my groove, to take better control of my health, my house, my child, and my progress...
ok, so I feel like this post is starting to get depressing... LOL so I am going to call it a night...
~~~~ I believe that if life gives you lemons, you should make lemonade... And try to find somebody whose life has given them vodka, and have a party. ~ Ron White
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Hey i randomly came across your blog and I am actually starting scribe U tomorrow. One quick question: How hard was the first exam? The one over SOAP and medical terminology? I'm kind of nervous about it. My name is Andrew btw :)
ReplyDeleteHey Andrew,
DeleteSorry just seen your comment. Hope you did well on your exams in ScribeU this weekend. Will you be working in Tx?
No I will actually be working in Florida :D. Yes I am doing alright on the exams and charting. Just have to make sure I do well tomorrow for the last charting exam.
ReplyDeleteI finished Scribe U today and i start residency sometime next week. In your personal opinion, which do you think is/was more difficult?
ReplyDeleteOk, so if 3 different responses randomly show up, I apologize. I responded twice already and it never shows up when I publish...
DeleteAnywho. I would say they are both equally challenging in their own way. ScribeU because its new, and intense and long. But once you get into the hospital, you have to apply all your learned in a fast paced, high stakes environment. Also each Dr. is different and what you learned on your last shift may not apply to the next.
If you can try not to put too many off days between training shifts that will help. I am on solo shift 2, and I am finally feeling like maybe I can do this... :)
Did you take a picture with the rest of the Scribes on the last day, I noticed they had a picture up on their Facebook page.
Good Luck!!!
Haha it only showed up one time.I did great on charting during ScribeU. But my only problem was making my HPI flow. It was so hard to trying to follow the template given and jot down all the information given by the physician. Yes we did take a picture at the end.
DeleteWell HPI construction is a challenge for everyone I believe, and I have consistently heard that it comes with time. ALSO.. most of the docs I have worked with so far, don't like "wordy" HPIs.
DeleteSo where we learned.
33 y/o F presents to ED with HA onset 3 days ago s/p bumping head after falling off bicycle. Pt c/o +vomiting, +LOC, +ST. Pt denies Diarrhea, ankle pain, rash. Pt reports taking OTC Tylenol for pain with no relief starting 2 days ago. ...
some docs are wanting "less" words. like..
33 y/o F in ED with HA onset 2 days ago s/p falling from bicycle. Pt +vomiting, +LOC, +ST. No diarrhea, no ankle pain, no rash. OTC taken without relief.
its basically the same, but for some reason those few extra words they don't want to see. but like I said before its ruff until you have worked with the same doctor a few times and know what they want. If you guys have doc notes on your blog use them!!! we didn't have them, so I have been keeping a small log of each doc I work with to know the likes and dislikes. :)
Also if they have discharge notes, look over them prior to your shift so you can quickly sort through them to anticipate what notes you will need based of diagnosis.
If they don't have them, I suggest you make notes in Word through out your shift, because they are probably going to repeat a lot of the same notes for Return to ED and see PCP, etc... and it cuts a few seconds of your chart time to have that ready, and it keeps them from having to repeat themselves... :)
Also keep studying, and prepping for your quizzes prior to starting your training shifts. Because after a 10-12 hour shift you aren't really going to have any mind power left to study up for the quiz, so if you come into the shift ready for it, its a lot easier at the end.
Good luck, if you feel like it I would love to hear how it goes.. :)
Okay thank you! Less wordy HPI's gotcha. Is it easy for you to obtain all the information said by the Physicians? I know it all depends on who it is because some speak faster than others, but on average how easy is it catch everything they say without needing them to repeat themselves. Yea i have been reviewing the quizzes. The only section that might get me is the medication portion.
ReplyDeleteThank You! I will definitely let you know how my first shift goes.
Hi, yes it is a bit of a challenge, to hear the physicians especially if you are not where you need to be in the chart. Ie. if you are still in HPI, and they are giving you PEX results.
DeleteYou have to work on Knowing who you are with. If they give Pex findings in the room, then know to be in PEX when they are starting giving the exam, to catch what they say.
Because they don't always say. "For ENT, she had bilat TM erythema". Sometimes, they are just giving off findings and you have to know where they go and if there is a "pre written" word or something you have to type into other.
.
Also a lot of the terms will be new, so you are trying to process what they said, how to spell it, and where it goes all at the same time. But that just comes with time.
I would definitely keep Notepad or Sticky Notes open, just in case you are not ready, but you need to capture what they are saying. But if you do put it somewhere other than the pt chart you HAVE to remember what patient it refers to, and not forget to put it in the chart.
I personally open up an excel doc before every shift with
Pt Rm#, Name, CC, Chrt Level, Billed, comments. as headers.
That way I can keep a dynamic pt list, keep track of what level the chart is, and if I have billed it or not. Also If they shout out a diagnosis, or lab result, for a pt who I am NOT even in their chart ( we can only have so many open at a time) I put it in the "note" section of that pt in my excel table and then add it to the chart as soon as I can.
I still have to ask them to repeat themselves, sometimes. I really really try not to, but I think they would prefer to do that then to have their legal documentation wrong. On one of my training shifts, a doc did tell me it slows them down to repeat themselves. But on the other hand I have a doc who , wants you to ask him any questions or clarification when you get out the room, and then he just waits for you to get the chart cleaned up and ready for him to sign while he puts in orders ( in a reasonable time frame of course.)
so long story short... yes I ask questions, but I try my very hardest not to. I also keep a session of google open. so when I hear a pt or doctor name a drug or procedure I am not familiar with, I look it up while in the room or finishing up the chart to make sure I have it spelled correctly in chart.
So just try to stay as agile, prepared as you can. Try and know the flow of your physician so can anticipate their next moves.
Hey! so my first 2 shifts were okay because I had a trainer helping me majority of the time. Today (3rd shift) was hell. I lost track of patients cause it was difficult to write Pt info on my active patient list when they physician picked up like 4 patients at a time lol. I was overwhelmed almost the whole entire shift. I know you got to get thrown into it to learn faster but its still frustrating at times. Don't they know 90% of men cannot multi-task :/. Anticipating the physicians next move was definetly a challenge. It was tough to focus on the orders sent it and when they are ready, to the multiple patients the physician picks at a time and then quickly d/c the patients that dont need to be in the ED with like a total of 10 charts to do. Im ready for the challenge though but I wish the shifts were a bit shorter for trainees.
ReplyDeleteI hear ya, and I think 3rd shift was one of those, where I was like. WTH am I doing... Keep at it, speed and organization comes with time. I am on my 4th or so solo shift and I was really thinking I was getting a hold of things, but today was Super ruff.. I felt like I was jacking stuff up all over the place. Also some docs I feel more comfortable communicating with and some, I just get a rough vibe.
DeleteWell I hope you see/have seen some improvements with your next few shifts. And keep at it. It really helps when you get that doc that you just really flow well with and you can finally think.. Yep I can do this...
Also if you have screen shots of your system from training, spend a little time familiarizing yourself with the flow of information, so you spend lest time looking for where to put the information and more time hearing and taking in what the doc is saying.
Good luck!!!
What were your weaknesses around your 3-5th training shifts, if you remember? What are your weaknesses now working solo?
ReplyDeleteThe trainers discussed with me that my typing is up to speed but its hard form me to get my HPI constructed well and ROS in the room. It is also hard for me to anticipate who is being d/c right away and who is being admitted. I think that is the main reason I lag in completing charts. I go to d/c the patients and forget to go back and compete the charts for the pts being admitted. My active pt list looks horrible cause i write all over it lol. I have not gotten used to keeping track. Especially when more than 3 pts are being picked up at a time and you have minimal time to prep the charts and write down the pt info on your active pt list.
One other thing I have problems with I think is constantly observing the track-board, orders being put it, when the Physician is admitting or d/c (time stamps). The Physicians dont tell you anything, they just d/c or admit secretly. I know its something you have to get used to and I will over time but when the trainers are talking to you saying this is your fourth shift and that I should be having no problems with my HPI-PEx. That I should only be semi struggling on the discharge and admits. I feel as if i wont survive. Im doing my best but its like their saying my best isnt good enough :(.
Hey, so I would guess my weakness 3-5th really depends on the doc I worked with. But over all I would say it was communication, and spelling. I was expecting the Doc to tell me (consistently) what was going. And without those directions, I wasn't performing as quick. Also familiarization with terms and the chart layout were a big weakness.
DeleteI think now I still have some of the above and CONFIDENCE is a big problem. I think confidence in yourself, your charts, your actions really go along way ( still working on that) I am naturally a "risk avoidance" person so I always want to double check or make sure and that takes time away. You almost work independently(using term loosely) of the doc. You basically just need to hear their PEX, diagnosis, and d/c notes. The rest is up to you to get the chart complete.
So things I find are working to make me better.
Prep:
I get to work 15 min early get my computer loaded up, -- open up 2 instances of chart software, one with my tracker , and one I can look at the different sections.
- Open up my MS Excel pt list
- Open up docs d/c notes if they haven them
- Go over those docs preferences ( how they like HPI, PEX, etc)
- Open up an instance of Google, to look up things I have not heard before or not sure how to spell
- Open up sticky notes to catch things
- spend a few minutes getting my head in the zone
PT list..
I couldn't do the stickers or writing it down. having to pull the paper out, and write on it and update it, took to much time for me. I use an excel spreadsheet I keep open on my desktop. with RM,name,CC,level,billed,notes.
- this helps me because if I'm not sure which room we singed up for , I can quickly type while I am walking to a room ,and document the number in the sheet and fill in the rest later, also if I get a call from a nurse for a different room, while I am working on another chart I can jot it really quick in the note section of that pt, and just copy/paste when I get back into that chart. (SAVE OFTEN)
DC vs Admit
I treat every chart as if it is an admit. I try very hard to make sure all the minimum information is filled out in a chart before saving it.
I do as much prep work as I can on the way to the room, or as soon as I know we are about to go in, I am trying to spend less time on the HPI. Trying to actively listen, not just dictate. sooner I get HPI I go into the other sections that have to be completed and PMH, ROS, etc.
ALso you have to listen to the doc in the room, if its something that's not going to require labs, x-rays, or something you see is normally d/c I take note of that.
for example, if a lil one has R TM's bulging with purulent, and no other problems like trouble breathing or something requires labs, I know that's going to be a simple one, and look for his d/c notes on otitis media, get those in while he is talking to pt. Also you have to listen to them, if they are talking about what the pt needs to do at home, or to return to the ED if such and such happens, than its most likely a d/c. If they are talking about needing labs and x-rays you are going to have a lil bit more time with that chart..
------- have to break up in to 2 responses LOL to many words ---------------------
--------------Part 2 --------------------
Deletelabs
- on our systems the labs turn white when they are ready, and I just go import them between any activity I can find, even if we are not in that room, or on that pt. ALso before I save a chart, after I have been given diagnosis by doc, I have a checklist of things I check, Labs, PMH, PSHX, etc. (whatever is req'd for your charts) and I don't save till I know I have done everything. (not always perfect at this but improving)
HPI.
Practice Practice Practice. don't wait till you are at work to do this. read over your training materials do the sample ones in there. Write out your skeleton structure on a sticky on your desk top before each shift if you have to.
Age,Sex. Chief complaint. c/o , denies, modifying factors, associated signs & sxs, context quality. try and keep the idea of those things in your mind. Its sometimes hard to pick those things out of what pt says when they are talking about the ingrown toenail they had 6 years ago when they are in there for vomiting. ( hint when they are talking about the ingrown toenail, you can be doing ROS, PMH, or SHX) and you have your sticky pads open just incase they happen to throw in they had a Fever of 103 last night while vomiting pop it in your sticky, finish your ROS, then go back to HPI copy past +FeverTmax 103. You have to get confident enough not to just to hang out in HPI section hanging on pt every word. you loose precious time. ( it takes practice) One of my trainers was recommended to get out my laptop during commercials and type and try and get everything you can about that commercial. ( not very easy, but it helps to make you think while you type and catch more things).
Don't give up. Just do what you can to improve between shifts. It's not easy at first, you have a lot of new terms, and working in charts and scenarios you have not worked in before.
You really have to WANT this, and if you are a Type A personality which most of us are you , are probably used to dominating things quickly and efficiently and don't like feeling like you are being defeated. You have to get over that REALLY quick, and just attack it like you would do Physics or Biochem, find your area of weakness and fix it... :)
Also, don't know if you are a spiritual person, but sometimes I just spend a few minutes trying to get my mind right before I even walk into the hospital, asking for strength, confidence, clarity, organization, and understanding.
Keep at it, also you are going to have to tell me which student you are in the Florida ScribeU. So was it you guys first class there?
Yes we were the first ScribeU class in Florida. Im the tall skinny black guy lol to the far right.
ReplyDeleteSo today was my 5th training. I think it went much better than my first 4. We did 16 patients in 1 hr :/ . My trainer had to do the last 5 out of the 16 because that was too much for me at the time. I could have done it but the Physician picked up 5 pts at a time.The doctor didnt have to wait on a single chart (27/28 total). Not many but i still felt like i accomplished something lol. They are still saying i need more training shifts cause they feel as if im not ready to work on my own. Im trying my hardest but if they dont feel that I am able I guess there is nothing more I can do. I get all the info down in the room, complete my HPI's. Majority of them say my weakness is not being able to multitask. Like hearing the nurses communicating amongst each other about one of my patients, picking my head up to see what the doc is doing. Its like i pick my head up and he isnt doing anything, the moment i put my head down the trainer is like "look the doc is putting in orders, you should also be attentive -____-". But it will take me a while cause multitasking to this extent i have never had to do in my life. I work at express also and multitasking there (assisting multiple customers at a time, while trying to complete your task) is much easier.
But true with time and practice i will get better. I just wish I could get better now! I am a spiritual person. I say a prayer every morning. With those morning shifts, there is no one else to talk to but God when your almost alone on the road lol.
Wow 16pts in 1 hr that is Cray Cray!!!! So when you did your first training shift and shadowed a trainer , what did they different? That is a lot of charts to go through. How is the dr even communicating with that many people in such a short amount of time?
ReplyDeleteAre you going to take the extra training shifts? I hope you do, you have hung in there this long. Just spend a shift watching, scoping out how they are managing that,
I decided to take the extra shift. Today the trainer said he didnt think I needed one and it was quite busy again today. Looks like majority my training shifts have been hectic lol.
ReplyDeleteMy first day of training i really just watched. I probably only did 4 charts really and just the HPI and ROS section
So when will you have your extra shift, and if you have had it how do you feel?
ReplyDeleteI had the extra shift yesterday. Honestly I just feel slow. The trainer didnt come into the room with me for any patients except the code (Im still not comfortable doing those). I asked the physician what she thought and she said Im not bad I just write too much in the HPI which takes up most of my time and makes me slow. Also its still difficult for me to complete the physicals at a fast rate especially when they say stuff like. "no laxity to Lachman's, posterior draw, valgus, or varus stress" But as she stated that is obviously going to come over time when i get used to everything.
ReplyDeleteTowards the end of the shift though the doc didnt have to change around anything to my charts (HPI's). I started getting the hang of shorter sentences but thats when I sit back down and go over it.
Tuesday shift I have one of the most pickiest physicians -____- for my first solo shift. Terrible planning lol. She is fast and Im slow (we do not make a good match). But as long as i dont sense her frustration Ill be okay. Im nervous but i realized if they drown the scribe they dont leave on time and it just ends up being a tacky job with the charts. plus its a 7p-7a shift so I hope its a slow night lol.
Well glad your training shift went well. There are a coupe of doc I pray don't show up next to my name on the schedule for a long time. Lol
ReplyDeleteOk so trying to update comments from my iPhone is No Bueno, lol. I am sure you will o well your first solo shift, just have confidence in yourself, and if there is anything you can do before your shift to calm yourself down , or relax that may help. I find that if I am anxious before a shift I am more likely to get frustrated or mess up. Also if your comfortable let the doc know this is your first shift, and you want to do your best and ask her what you can do to make things quicker and smoother. She may appreciate you being upfront and be willing to be more clear in her communication and actions. I think they prefer smooth shifts as well. Lol.
ReplyDeleteGood luck I am sure you will so well. :)
The shift went well I think. We saw 30 patients and had 1 signed over to us. After having this doc I think I can definitely handle a few others. It was much easier with the trainers not over your back. I felt as if I tried to please the trainers while they were there instead of the doctors and that's when the stress and overwhelming feeling came over me. Im not as nervous now but I still havent been around all professors yet.
ReplyDeleteGlad to hear it went well!
ReplyDeleteHey so I ended up quitting the scribe job :(. It wasnt going well for me. Apparently the last shift didnt go as well as I thought. Guess the Physician felt a certain way and didnt want to tell me to my face lol. Ill never know what she said but whatever it was I was put on another training shift. I prayed after the first extra shift that if I am to be a scribe I will get it this time. It didnt work and I still had faith and the second extra shift didnt work out. I then thought that it wasnt the position for me so I left. I miss working there honestly, got to meet great people and gained a great amount of knowledge.
ReplyDeletewow... I'm sorry to hear that especially since you are missing it. Have you thought about looking into clinical scribes vs. ED scribes? A chic who currently scribes in the ED is going to work for a GI clinic as a scribe and she will actually be making twice what I make, and she gets to work with the same couple of doctors and M-F from 8-5. So if you enjoyed the job, but just didn't care for the ED, there may be an alternative.
ReplyDeleteKeep in touch when you have time, would still like to know how your journey is going. When are you applying, and are you already finished with school?