Homework
0:00:00.0 Professor Walden: Not yet, not yet. Alright, it looks like we are live. So we are going to give this a second, and let just a few folks get settled in, get popped on. Hopefully, everyone’s having a really good week. I’ve got to let you know, quite frankly, I’m just exhausted. [laughter] So, I am… There’s no secrets, there’s no… I’m not gonna fake it, that is not self-care. No, I am tired, but the show must go on. So we are going to do that. But also, really, really excited about today. So I hope you guys are all gonna settle in and get ready. Alright, and don’t worry, again, if you are catching this on the replay, and if you’re catching it a little bit later, the replay is available to you, so it’ll be available as soon as it downloads, and we will put it up there for you. But really excited, because it is Nurse Liz. Yay! [laughter] We are excited to have her. Everyone seems to know who she is, so that’s exciting. So she doesn’t need such a huge introduction, but we’re still gonna do it anyway. So let’s kind of start back up and start a little bit about what we’re gonna talk about.
0:01:25.6 PW: What I hear a lot is, I am a new NP, or I am at a new position, and I am concerned because I am taking work home, I am charting too much maybe, and they are telling me not to. Or I just don’t have a system, and I’m feeling very, very flustered about what I’m doing. So that’s pretty much what we are going to address today. So we are going to address those SOAP notes. So Nurse Liz has graciously said that she would join us and talk about this. And she is going to address how we perform, how we write a SOAP note concisely to the point, to the point where we are not taking things home, because that is not what we wanna do. We want to stop the idea that you have to take this information home and work on it off-hours, which we’re not getting paid for that and you guys know how I feel about that. We do not do things for free. So we want to address that so that you are not taking things home and writing at home on your own personal time. Because as caregivers, we need time to decompress. And so it’s really important to me that you guys do that. You guys know I talk about that a lot.
0:02:47.0 PW: Alright, so let’s get straight to the introduction. So Liz, she is from Pennsylvania. She’s an FNP nurse educator with Lecturio. Hopefully, I’m saying that correctly. Lecturio and a business owner, she has worn many hats over the last decade of her nursing, including that of a mentor’s nurse, a pediatric nurse, obviously, an FNP. She’s a mom, a wife. We have lots of things in common. A plant murderer. If you’ve not watched her stuff on her plants, it’s very hilarious. Also, I too am a plant murderer. A serial hobbyist, an aspiring digital calligrapher, but her favorite is that of an educator on topics and experiences that she’s gone through to make others feel less alone, and to make the road a little easier on other nurses. Her goal is to bring healthcare professionals education, encouragement and understanding with an open platform, and to meet them where they are at in their education and their journey. So I am so excited. Nurse Liz, I’m gonna bring her to the stage. Hello.
0:03:53.6 Nurse Liz: Hello everyone. That sounded very nice. Thank you. I was like, “Oh, okay.”
[laughter]
0:04:00.7 PW: I was super excited that you’re here. Oh, let me mention, by the way, guys, there should be a link in the group. Nurse Liz has graciously given us a document that you can follow along on how to write a SOAP note, so that it’s nice, concise and to the point. And that’s what she will be lecturing too, today, just so you are aware.
0:04:21.8 NL: And it’s basically just like a blank document as if you were in clinic and you were writing it. Sometimes I would bring that in. I give it to my students a lot. If you guys ever have students, I’ll print those off so that they have something organized, ’cause then they just walk out with chaos, and I’m like, “This will help.”
[laughter]
0:04:35.9 PW: Right, right. Absolutely. We’re gonna put that also in the chat for you guys. But I am gonna let Nurse Liz take over. Because again, as always, we wanna be super respectful of your time. Alright.
0:04:50.1 NL: All right.
0:04:53.7 PW: Maybe if you knew, right? Go for it.
[laughter]
0:05:00.0 NL: Alright, everybody. Thank you so much for letting me come and chat today. I am fairly passionate about weirdly writing notes, even though I hate it, just because I feel like everyone, as you were saying was, you would come home and you’d take them home, and you shouldn’t be charting from home, please do not be charting from home. So I think that’s the first thing. And hi everybody who’s saying hi in the chat. So I guess the first thing is just, if you are taking it home, that’s a conversation that you should have probably with your supervisor. I know, when I was in the beginning, I had a little bit longer appointment times, and then they started ramping up, and then I was seeing four 15-minute visits in an hour. And there was no time to chart, and so I just talked to the collar any position that I was with, and I was like, “I need charting time.” So I think you’ve been asking for a ridiculous amount of charting time, that’s probably not going to, at some point, it’s kind of like a give and take. They have to accommodate the fact that you have to chart, and you have to chart somewhat extensively because of the world that we… Everyone is so sue happy.
0:05:57.7 NL: But also they need to give you time. So I think if we meet in the middle, and hopefully today, I’ll be able to give you a couple of tactics to get through it. And if you have any questions, feel free to leave them in the chat. I know we’re gonna be monitoring it, and then hopefully answering some questions. So I was just gonna go top-down, kind of like starting out with your note, going through, and kind of letting you know all the tips that I do going through it in order to make it a slightly quicker process. And we’ll briefly review what is in each section, but I think everyone pretty much has a good grasp of what goes in that, what’s subjective, what’s objective, more of just, “How can we make this quicker?” So the first thing that I usually like to do, if I has seeing a patient that I have already seen before was… And you can let me know in the chat if this is something you are able to do in your charting system, was pull in from the last relevant note. So it would usually say, “Oh, hey, this person is coming in for a med check.” I could pull in their last med check and just kind of import everything. And then later, even if there’s sections like I know I’m not gonna necessarily talk about this, just delete it after.
0:07:07.6 NL: And so, that would automatically give me something to go on if I was seeing someone for a chronic visit, we’re gonna talk about their hypertension or diabetes, their high cholesterol, merge it in, and then all you have to do is from that last encounter, update a couple of lines. Has anything changed since the last time? Because this is in the first part, the HPI, so then we’re looking. And all you have to type is maybe like one new update, maybe they have high blood pressure and they’re telling you, “Oh yeah, I’ve been checking it at home. It’s actually been doing a lot better.” Delete the line you know that you wrote last time where it’s like, “Oh, this is getting worse,” and just write that things have been improving, this is the readings they’ve been getting at home. And you already have everything else there, and you can wrap up that note super fast because you’ve merged the whole thing.
0:07:52.8 NL: In terms of organizing it, so this is how I like to organize a SOAP note for my HPI. Sorry, this is how I like to order my HPI so that it’s very readable and I can copy and paste little areas easily, and things don’t get muddled. So one of the things that I’ve learned from one of my preceptors in NP school, and it looked so pretty. I was like, “This is perfect.” She numbered everything. So when you open your HPI, it would be like Number one. And it would just go down. Number one was usually the one that if it was a visit and then something acute happened, she would bump that up to number one just so it was at the top of the sheet. And all you would write under this would be the first, the heading. So it would be like, number one, hypertension, in bold or in all caps is what I did. And then underneath that, I would have a couple different… You can do dashes, you could do it in a big paragraph if you want. And I would write the status of it in the first line, “Mr. Jones presents… Mr. Jones has hyper… If I was writing, it’ll be like, “Mr. Jones is currently taking 20 milligrams of Lisinopril for once a day for elevated blood pressure.”
0:09:09.8 NL: And then in the next sentence, it would be something about the status of it, “It seems well controlled.” And then I tend to do this, because I use a lot of templates, and we’ll talk about that in a second. I will also write some of the things surrounding that, “So he has been… ” Maybe if he is an avid exerciser, I would write that. Anything that’s kind of pertinent around it, I will write there. Or if he has glaring risk factors, I’ll also write it in the HPI. And this is something where I tend to over-chart, but this has saved me so much time because, at first it takes a minute, but once you’re doing repeat visits, almost all the information you truly need is in this tiny little first paragraph. So this is what they have, this is the medications that they’re on, this is the status of it, “Is it controlled? Is it not very controlled?” And then these are the factors that we’re working towards.
0:10:02.0 NL: So say someone is trending, they’re working on controlling their blood sugar. I will put the steps that we are implementing in order to get there, so like, “They are currently seeing a dietician, and they are in our diabetes education group.” So just a little thing of like, “These are all of the interventions we’re doing.” Even though that is the plan and that technically doesn’t need to live there, because then say I am handing it off to someone else, or I am sending them over to endocrine, or I just haven’t seen them in six months and I need to get caught up in one tiny blurb, that tiny HPI is gonna have everything.
0:10:35.3 NL: Now, when I first… Now I’ll go down the list. So I’ll have, one, hypertension. Two, type 2 Diabetes. And all down, down, down, and as soon as something becomes not relevant, I’ll update it once, and I’ll say like, “Oh, this is resolved,” and then it knocks off. I will import all of the troubles, so import it all the way down. And if they are coming in and we’re not talking about that today, you just delete it. But say they are coming in for upper respiratory infection. We’re worried that, “Oh, this person might have Covid.” They also have asthma, you have it already imported so that they have asthma, it’s already in the chart, and you don’t have to go and pull it from somewhere else. Because them having asthma and Covid, we know are going to work together. So the first thing, like I said, import everything over, have it numbered. And having it numbered is nice, ’cause then you can even just copy, paste and pull it somewhere else in case you need it. I also will… I like templates. I hope you like templates. If you have not met templates, I recommend it. And one other…
0:11:38.8 NL: If you’re unsure of how to use your charting system and maybe it’s been a minute since you started, so now you feel awkward going and being like, “Hi, could you show me how to do this?” Just YouTube it. YouTube has so many videos on so many different charting systems, it’s how I learned a ton of different hacks for mine, because even the people I worked with didn’t really know them. And just spend a little bit of time watching YouTube videos on how to make templates and use them. And when you’re making templates, do not make one giant template for like, at least I don’t like to, for hypertension. I will make hypertension HPI, hypertension review of systems, hypertension physical exam, hypertension assessment and diagnosis. I’ll usually clump those together, that way you can piece it in. Because if you do… I’ve seen a lot of people do templates and it’ll be the whole thing. They merge it in, and it’s like, “Oh, today we’re diagnosing you with high blood pressure.” You merge it in, and it’s gonna mess up your other sections. So say they are also, they have diabetes and they have depression, and so you’re a review of systems and your physical exam that you’ve already merged in is very… It’s appropriate for those exams.
0:12:49.9 NL: Now, if you merge in your hypertension one, it’s gonna drop the psych one, probably. It’s probably going to drop anything you’ve done related to endo in your physical exam and your review of systems. So just make it separate, and then you can just go add in whatever sections you need after that. Or, and you can play around with it. By having totally separate templates is going to be a lifesaver when you are starting to look at things like this, that way it just doesn’t get messy. But I like to pull in a template, and I will write-out a few things that I usually ask everybody who has high blood pressure. “Have you had chest pain? Have you had this?” And again, you could only answer that in your review of systems if you would like.
0:13:29.5 NL: However, I do usually put it up in the HPI really quick, because I already have a template, so all I have to do is upload it, and I will write in the template, “The best case scenario.” So in the template where I’ll pull through, I will say, it’ll have a blank and it’ll say, “Is taking blank medication,” and then a little blank to say how many times a day or what the dose is, and then it’ll go through the things of like, “What’s their movement history like? Are they exercising? Do we have that? How is their blood pressure at home if we’re monitoring it?” And then I’ll have, “They’re denying chest pain.” They’re denying any swelling, any headaches, anxiety, anything like that. So I will always chart to, in my templates a wonderful case example. Because it’s much easier to then go back. You’re hoping that most of your patients are going to be a good example, so you’re going to do less clicks if you assume everything is good. And that’s going to lead straight into your review of systems.
0:14:27.3 NL: So again, I have templates out the wazoo for all sorts of things. I even have templates now that were hypertension good in a best case scenario. So yes, they have hypertension and I’m gonna import their review of systems as in, “You have high blood pressure, so I’m checking you. I’m doing your cardiac assessment, respiratory. I’m gonna check your… Do a vascular assessment.” All of that type of stuff. But things are in the best case scenario. And then I have one that I think I literally called it, “Hypertension bad.” And in that review of systems, it would be what people would answer if they were not doing so well with it. If it was a more end-stage and we were starting to see a lot of the symptoms with it. And I had end-stage, I had every type of system, and then bad for every single thing. So then I would have type 2 diabetes, uncontrolled. Type 2 diabetes, controlled. ‘Cause they’re probably going to, if it’s controlled, they’re not gonna have polydipsia, polyuria, polyphagia. But if it is not controlled, they probably are. They might have all these other physical findings that you’re going to see with those diagnoses.
0:15:35.8 NL: So every single time I had something, it had a good and a bad, and then all you have to do is click a few… Do a few clicks. Same thing with my acute visits. I had templates for, “Oh, you’re coming in and I think you have an upper respiratory infection, but you’re fine.” And then an upper respiratory infection where you’re not fine. And it sounds overwhelming to say, “Oh, just make all these templates.” So I thought I would let you know how I do it. So you are… I don’t know in your charting system. In my charting system, I could go into a test patient and see if your charting system has a test patient or whatever the easiest way would be, you can YouTube it. What would be the easiest way for you to get kind of like a blank document that you could chart on? So the first time… And you’re just gonna start with who walks in your door next, if you’ve never made templates before. Say someone’s walking in and they have hyperlipidemia. You are going to, on this blank template, fill out, just chart like you normally would. Even if you can import some of their old data, perfect. Chart like you normally would.
0:16:41.1 NL: Number one, hyperlipidemia under the HPI, you’re writing all the other little details about what’s the status update here. Review of systems, you’re doing your normal review of systems, your physical exam. And then you are going to save that, that you just wrote out for this person as a template. If it’s normal hyperlipidemia, perfect. You’re gonna save all of them as hyperlipidemia normal, or whatever it is. And then you can import those templates into the note. So you’re not writing in their note necessarily, you’re kind of going into a test patient and charting, because you’ve never documented this before, in this case. So you wanna use that information that you’re already gonna write as a template. And every single time you see something new, you’re going to document it and save it as a template.
0:17:25.7 NL: Now, I know some, I think if you have Epic, you’re able to just save whatever you wrote in their own note as a template. I had some really not the best charting system, so if it was in an actual patient’s file, it couldn’t be a template, it had to be in this blank document. So whatever your thing is, if you see something and you’re like, “Oh, I have never seen this before, but this seems like it could be a good template,” just merge it into a template, give it a name, and the next time you see it, it will take literally two seconds. I used to be weirdly excited when people came in with a UTI, because I knew I could chart that in less than a minute. Because I would just import all of my templates, they almost always had the same symptoms, we did the same labs. You can do labs with your templates, and then you can just upload them. So that kind of takes us through looking at your HPI, and we went on to change there with the templates, but that’s kind of like the biggest tip for saving time is utilizing templates. So let’s say you are seeing a patient, and what do you actually… What are you actually charting now that we’ve kind of laid this epic foundation? So if I’m going into a room, the things I am absolutely going to chart, the first thing is I’m going to write down if I don’t have a template already made for their chief complaint or the things we’re talking about.
0:18:48.0 NL: Say they’re coming in for a chronic thing, but they also, of a all a sudden their left knee is hurting, I am not in that moment going to make a template because… And I’m not going to try to make a lot of sense because I’m just gonna type down like, say this is the force saying they have three other chronic issues and this is number four… We’re gonna write down, “Number four, left knee pain.” And then I am just going to kind of… As they’re talking to me, I’m gonna try to look at them at the same time as I’m just kind of writing down the main things, going through all your old cards, questions like, “When did this start?” Fishing out the rest of the details and just kind of typing away, I leave that there, it looks really ugly, but all of the information is there in the HPI. Then we’re gonna move down, and I like to clarify what they’re telling me, and as I’m clarifying it, I’m typing, and I’m clicking away at the review of systems. So this is a great way to kind of speak back to them and say, “I am hearing that you have left knee pain, it is… No pain in your foot.” So you’re clicking like, no. No pain in the feet.
0:19:48.1 NL: Are you having any difficulty walking? Okay, yes. You’re having difficulty walking, you are… Have you had any physical injuries? You’re clicking all through the whole time, you’re kind of asking them these questions back, verifying, and it gives you the benefit of, they think, oh yeah, she actually heard me and she was listening. You’re gonna run into questions inevitably in your review of systems as you’re walking through it, kind of verifying symptoms, you’re gonna be like, “Oh, oh yeah, I totally forgot to ask this. Let me ask this really quick.” And it doesn’t look like you’re like, “Oh, I totally forgot.” It looks like, oh, this person’s just being very thorough and clicking through all the things, and so I will click through all of the review of systems, and the benefit, like I said, is, one: They feel really heard and validated, and two: Your review of systems is now done. If you are in a true time crunch and you don’t even have time to go through all of the review of systems that you are wanting to ask, only do the negatives, so do the things that stand out to you as weird.
0:20:46.3 NL: Left knee pain. No, there’s been no injury, it has… There’s no swelling, there’s no… It’s not worse first thing in the morning. Any questions you have, fill out things that you know you will not… That you might not remember and leave the rest blank and then see if your charting system has an answer, mine had a thing where everything else, I could again, program it to say this is a normal physical exam to me, and I could just click… I could click my few that were… I wanted the computer to definitely know, this is either abnormal or I definitely want to note that I asked this and this is how it was, and it would automatically switch everything else over to my typical physical exam that, again, I had kind of imported with a template. But in most of the cases, I would have time to just go over the review of systems with them really quick. You’re gonna get really fast at it if you haven’t already, just the more you use your… You get in kind of the workflow of what you’re asking people, and then in the physical exam, a very similar approach, I would only write down… I would chart in the moment my pertinent physical exam findings, because I don’t wanna chart a bunch in the room, I just wanna chart exactly what…
0:21:57.5 NL: Enough so that when I leave, I can wrap up in two minutes and move on to the next patient, so when you’re charging your physical exam findings, things that stand out to you, either as abnormal or you definitely want to remember. So yes, I looked at them, they don’t have edema, it’s not hot, it’s not red, and just leave literally everything else blank. Oh, you can check their pulses and document that, and then when you leave the room later, you can just go back, click that button and say, fill with all the rest of my normal physical exam findings. Treatment plan. This is where I will spend more time in the room and it’s easier because you’re actually talking to them, and this will also save you from forgetting to enter labs, from forgetting to enter meds, anything like that. While I’m talking to them, we’ve gone, we’ve figured out what treatment we want, I will tell them, “This is what I think it is.” So while I’m doing that, I’ll look down really quick, I’ll find the ICD-10 code and I will pause. A lot of the times in order to stay caught up with writing my notes, I will just say, “Hang on one moment, I am just going to finish telling the computer what we’re talking about so that I don’t forget later. I want to make sure that the computer, you and I are all on the same page.”
0:23:07.0 NL: And I have never had someone say, “I’m offended. That’s rude.” I say it all the time, I’m just like, “Just hold on, I just need to get caught up really quick on here, so all three of us are on the same page.” And literally, once you start saying that, it’s not as awkward as it sound, so I will get caught up. I will find my ICD 10 codes. Sometimes I’ve said on that too, I’m like, “I’m just trying to find what they call your diagnosis, it’s like X-42.73. So just give me a minute.” And then again, I have templates for a lot of the things I see all the time, I highly recommend having templates for your education that you provide, so I would have hypertension, new diagnosis and then hypertension stable, and that way I could import it because you don’t want to write out every time you are diagnosing someone with type 2 diabetes, all of the education you are providing with them, you don’t wanna write it out every time you prescribe Zoloft, the speech that you give about prescribing Zoloft. So I would have new diagnosis and then the med or whatever it was, and I could just pull it in and it looked beautiful, like you had documented all this patient education, and it took you 10 seconds.
0:24:14.8 NL: Again, in my treatment plans, I would number things. Number one was always… So say we’re doing hypertension again, so number one is always… I like to do the status just in one line, so again, we’re kind of pulling back up to the HPI, but this gave me two points to quickly look at and made it very, very easy to edit when anything changed. So line 1 was the update. Blood pressure, stable. Line two was the medication that they were on. 20 mg of lisinopril daily, and sometimes I would write, ‘refilled today’ if they had it refilled. Number three would be anything else that they have going on with it, they are… Again, if, more with the diabetes, if we had a patient with diabetes, I would do whatever it is. That they are continuing to see the dietician, if they had depression, recommended therapy, encouraged these different stress reduction techniques. Going down from there, you’re just listing your interventions that you did, maybe with your blood pressure, you’re reminding… You wrote, ‘discussed the benefits of a balanced diet and making sure you’re having movement in your day’. Anything like that, and then at the very last one is always when you are going to follow up, as well as any notes you want to give to your future self, so a lot of the times, say I have someone and I’m seeing them and I’m like, “Oh, your blood pressure’s trending high.”
0:25:36.9 NL: And we have a conversation, the patient and I, and I say, “Next time, if your blood pressure is still hanging out here next time, we need to have a conversation about starting blood pressure meds.” Maybe I give them a little speech about what hypertension is, why it’s important. Why we wanna control that. You’re gonna document all of that, but you’re also gonna have a template, so you pull in… Someone is saying dot codes, so dot phrases, and that’s exactly what it is. You would say, dot hypertension education. Boop, and it pulls it in. Dot, whatever you did with that, and it’ll pull it in. And again, you make those by typing it out once, for one patient, the first time you encounter that, when you decide, oh, I’m gonna start making templates, and that’s your first template, you write out the education or you go and copy it from something else that you had written before. If you were like, oh, I loved the way that I talked about that, starting Augmentin. I really feel like I documented the Augmentin really, really well. Go and make that a dot phrase, and then you never have to type it again, and it’s beautiful.
0:26:37.1 NL: So I will almost always at least chicken scratch my way through the treatment plan, because I want to; One, I have to put the medication in while I’m doing this, so while I’m talking to them and being like, “Hey, just so you know you’re gonna take this medicine, it’s probably gonna make you poop a lot. Don’t worry, we’re doing that to you. It’s fine. It should stop, if it doesn’t stop, call me.” I’m going in, finding their pharmacy, I like to send their med while they are still in the room. Otherwise, I will forget and they will never get it. And that is not what we need. I will also put their lab work in so they can leave with, if they have lab orders, they’re leaving that within their hands, they’re leaving with their X-ray. All of that is done in the room. And again, if you need to say, “Just give me a moment while I put all of this in here,” that’s fine. I like my treatment plan, honest, to be like… Honestly, to be almost done, which is possible when you’re using dot phrases and templates, that first time you’re writing it out, it’s not, it’s gonna take you a minute, but when you have templates and dot phrases, you can get that treatment plan knocked out, no problem.
0:27:36.7 NL: So now when you go to leave the room, you have a kind of a bullet point HPI that you just need to go and refine and make into sentences so that it doesn’t sound like a caveman wrote it, ’cause mine literally looks like, “Left leg hurt, no bleeding… ” Very, very… “Can walk.” Very, very… We need to embellish this, so I go back and I make the HPI pretty. If the review of systems is not already filled out, I’ll click that button, I’ll say everything else was totally fine, and then I’ll go to the physical exam, same thing. Okay, I noted that these things, I made sure that these things were okay, click the button, fill the rest of that in. Now, your physical exam is done and your treatment plan is already done, and that will probably take you two or three minutes maybe in between each patient, and you do not go into the next patient’s room until that is done. Obviously, that’s a best case scenario, but I also, I would intentionally… I will make it go a little bit late.
0:28:35.0 NL: I would never have things go more than two patients, if I had two patients that I had not closed their chart on, I was not going into the next room because I needed to catch up because again, something is going on there, and then look at it and say, “What could we tweak to make this a little bit easier?” And again, this in the very beginning will take a little bit of work, but use what you are already charting to make the templates and the dot phrases, so that you are only ever doing that work one more time, and from then on out, everything… By the time I was… I had been at my job for three years, I had a dot phrase and a template for the weirdest most… Everything. So I had some for, oh, I think your left ovary is acting up, I think you’re this. ‘Cause every single time I saw something new, I was like, I’m just gonna make a template for it, you never know, and that is how I at least got… I survived charting and it went just a lot smoother, so hopefully some of those can help you. Did any of that make sense? I feel like that was… It made sense in my brain, and then as I was saying it, I was like, that might be a little bit… We were going all over the place as I found new things to talk about. [chuckle]
0:29:51.6 PW: No, you’re fine. [chuckle] I do have… It made sense, trust me, ’cause we’re all… We all are charging, so we know exactly what you’re doing, and quite frankly, I am paper charting. Fun times.
0:30:04.7 NL: Oh. Oh. Oh.
0:30:06.0 PW: Oh, fantastic. Yeah. Free clinic, so we don’t have a lot of… We have some electronic, we work with it, but then also people revert back in a heartbeat to paper charting, so… Yay. [laughter]
0:30:19.9 NL: That’s a whole different…
0:30:20.8 PW: Yay. Right? It’s a little different, and to me, somebody said as they’re sitting here, charting. [laughter]
0:30:28.0 NL: We’re gonna fix it for you. We’re gonna fix it.
0:30:31.5 PW: I have a few questions. So where do your templates live? So you’re making them kind of, like you said, as you see things and things like that, so let’s talk about where they live.
0:30:44.4 NL: This might be dependent on your computer system, mine lived in the charting system, so I could save them either… And you can save them usually locally, which would mean it is only for you to view, but I also shared it with my whole office, so I could click a button and I would say, I’m going to share this with everyone and other people could share theirs and make them public as well, and so then you can go and take theirs, and I would a lot of the times take theirs, take someone else’s, so we had someone who… The woman I worked with was phenomenal with ortho and I am horrible at ortho, I’m like, I don’t even know which question to ask you about your elbow, so I went through and I grabbed all of her templates and I made my own ’cause you’re gonna have your own style and then you can tweak it, and that could be a really good place to start too, is most charting systems will even have a generic one. They will have a really specific genitourinary review of workup for a UTI. For all the typical things, you could even go in and pull that and then just be like, I’m gonna tweak it and then re-save it as your own, and that would give you a great, great place to launch off of.
0:31:54.9 NL: And it also gives you a really good place if you’re very new, those templates give you a great way to look at what questions you should be asking, even just the review of systems in general. If someone comes in with a UTI and you’re like, what are the questions I ask for a UTI? Go to the review of systems and go down the list. Go to genitourinary. You’re like, okay, I know urinary tract infection is the genitourinary system, go to that review of system and ask every single question on the list and then be like, okay, what are our neighbors? GI. Okay, let’s do that. And let’s do all of the gynecologic questions, because those are our neighbors to the urinary tract, go through all of those and automatically you have a more well-rounded questions that you’ve been asking them, you can fill out your HPI a little bit better, even if you have legitimately, no idea, like I do when people come in and they’re like, “My elbow.” I’m like… “Uh-huh.”
[laughter]
0:32:49.5 PW: Your elbow.
0:32:50.7 NL: Let’s talk about your elbow.
0:32:53.0 PW: Right. One of the things that I was new and I got hip to doing really quickly, I think I must have picked it up in clinicals, but when you are trying to figure out your templates and writing your notes and you’re like, I don’t know where to begin. Look at an old note.
0:33:07.8 NL: Yep. Look at an old…
0:33:09.0 PW: Go and look at an old note and be like, what did they ask? What are they writing? So my thing was always, what are they typing? Because I too would get, “You’re typing too much.” I’m that RN. So I would… And I can type really fast and I’d get it all out and they’d be like, “No, no, no, no. You’re doing too much.” Look at an old note, see how much they typed, what they typed, so you can see what they were asking. Boom, you can make your template and there you have it.
0:33:39.9 NL: And the more notes you can read, I found it got so much easier ’cause you saw a flow, you can see different examples of like, oh, I really like that person’s charting style, or this is horrific. [laughter] There, and find your in-between of what you wanna actually write.
0:33:58.1 PW: Yes, and so let’s go back to where they live. So we know we do dot phrases, we have a lot of us that love a good dot phrase, I’ve worked in Epic, so I love dot phrase. But then my question becomes, what happens when you leave the organization? Are you gonna have to start all over? What would be your suggestion? ‘Cause I have my suggestions. What would be your suggestions? This is why I’m asking, where do our templates live, because if we suddenly have to move… [laughter]
0:34:24.0 NL: Got it. Yes, so when I left, I made a Word doc, a Google Doc and I put… I didn’t do the HPIs because mine were all clickable and I was like, I don’t… I kind of wrote down, I started to write down like, oh, these are the pertinent positives and negatives, and it was taking me so long that I was just like, you know what, I typed, copy and pasted my basic template of what I would say in an HPI, I would print out… And then I printed out my education things, my template things, and kind of did it that way, ’cause mine did not let you print them. Someone said they can print those templates and take them along.
0:35:06.1 PW: Yeah, I couldn’t print mine either. So I had to do go old school and put them in a Word document and just…
0:35:13.1 NL: Yeah. Yeah. Okay. Okay, so that’s what you did too. I know, I was sitting there and I was about to mail my computer back, I was like, “Wait.” [chuckle]
0:35:21.9 PW: Exactly. No, wait!
0:35:22.7 NL: My babies.
0:35:25.0 PW: So keep that in mind, especially MPs who are newer on the scene because let’s be realistic, usually you stay at your first job for six months to a year before we realize this may not be a good fit, and you realize what you’re actually looking for, you go find that. So six months to a year, but you may have started some templates or some dot phrases, if your system doesn’t allow you to print them, every so often, make sure that you’re going in and you are either emailing them to yourself, some kind of way, putting them on a Google Doc, whatever you have to do, so that you don’t lose all of that hard work that you’re doing and you’re not having to start over, ’cause that is gonna be pretty much a headache once you do that, and you’re gonna kick yourself for not having your templates.
0:36:13.6 NL: Yeah, yeah. And something like… I just like having a document like that kind of in general, just to hold everything, this is where all of my patient education, all of the local… If someone is like, “Hey, I need a therapist.” I’m like, “Oh, let me just pull up my Google Doc,” and it had on page, whatever, it was all of my local things for this, and then I would have that anyway, when I moved on wherever, whatever resources, a page of websites that I loved, all of that type of stuff.
0:36:43.8 PW: Yeah, no that’s good. So then I have a takeaway basically, kind of what you said, and you were saying, just do the negatives, especially when you’re talking about the review of systems, I think this is so important, so I don’t want us to lose sight of it. Whether or not it’s a new job, because when it’s a new job, we have to learn new systems, and it still… It’s like we’re starting fresh all over again. So whether you’re with a new job or a new MP. Just do the negatives to save yourself some time. Because again, you’ll be sitting there forever and your patients will start running into each other and you will be there all day, all night. And that again, these are not things that we want to advocate for. We want you to have boundaries, be able to go home, chart appropriately. So to save yourself some time, do the abnormals so that everything else is like, oh, that’s fine, and you can document on those things.
0:37:46.2 NL: And then you’ll remember, yeah, everything else was normal, as long as you know what your normal is.
0:37:51.3 PW: Right. Right, right. So super important. I don’t… I think everyone… Is everyone good? Are there any more questions? What I am going to do is I’m going to put together a little bit… Kind of some of what you said, for everyone, and I’ll put that in the group for you guys so that you have that. So if you are new to making your templates along with the document that Liz has given us, so if you are new to making your templates or kind of fresh or just wanna change things up, maybe, you’ll have some some guidance so that you are able to do that.
0:38:30.6 NL: Your life will be wonderful.
[laughter]
0:38:32.3 PW: Right, right. [laughter] You’ll be feeling much, much better, because again, our goal absolutely is so that you are not taking this home. We do not want that. Okay? That is not what we want, we want… I say it all the time, I feel like those words are being overused so much these days, but self-care, we want you to go home, decompress, especially with us being in a panini, decompress, do something else other than chart or take care of somebody else. And go take a bubble bath and drink some wine or whatever it is that you need to do, so yeah. I am excited.
0:39:17.0 NL: Yeah, and review what you actually have to chart, like I was probably a year or two into it before I actually looked at what are the CMS guidelines, ’cause it kind of based them on that, of what you literally have to chart ’cause it’s not a lot. [laughter]
0:39:29.5 PW: Yes. Yeah, which is why we do the whole, you’re charting too much. I had to figure that out. That’s why the physicians are like, “Stop writing all of that.”
0:39:39.0 NL: Yeah. They’re like, “Why are you charting on five different systems?” And I’m like, “Well, because, what if hypothetically… ” And they’re like… ‘Cause I feel like in MP school, they’re like, “Okay, it could be a UTI or it could be a brain amoeba. Have you done an oral exam?”
[laughter]
0:39:53.8 NL: And you’re like, “No.” And so… But in real life, they’re like, “Oh yeah, it’s a UTI. Okay, done.” Genitourinary system. And you’re like, “Yeah.” And you’re like, “Oh, okay.”
0:40:01.9 PW: Right. They’re like, “We can run a lab. Pee in a cup. Cool. Cool.” [laughter] Here’s the drug. You’re good. Alright, so… Yeah, absolutely. So that’s exactly… That’s exactly right. So you wanna be concise, as minimal as possible. I know that goes against everything in our brain, but don’t be me, don’t type a lot, try to break it down. So I see that Bonnie has a… Bonnie is starting her first job tomorrow, so yay.
0:40:31.3 NL: Yay. That’s awesome.
0:40:32.6 PW: We’re excited for you. So yes, we will definitely get this to you, hopefully this was helpful for you. Going in there, just remember to breathe, take a deep breath, it’ll all come back to you, just put the pieces together in your head and talk about only what they’re talking about. Just start there. But yeah, so we’re gonna get that information to you guys, so if you are struggling, we’re hopefully gonna kind of relieve some of that for you, so give us a couple days and we’ll get back to you, but thank you so much, Liz.
0:41:04.1 NL: Oh, of course. [chuckle]
0:41:04.2 PW: I appreciate this so much. So hang out for a second and then I’ll be right there. Okay?
0:41:11.6 NL: Sounds good.
0:41:12.1 PW: Alright. Alright guys, so super excited. I’m glad that you guys are… You’re here, and Bonnie, we are rooting for you. Please remember, we are your MP in your pocket, so if you have any questions, make sure that you come back, stick them in the group, we can all kind of help you as you go along, point you in the right direction to websites and education and things like that, if you can’t find it immediately, but hopefully this was helpful for you guys, again, we’re gonna put together that kind of that template, and some high points of what Nurse Liz says. Please download the document that she provided for us, it will help you.
0:41:49.3 PW: You can feel free to take that into your… To see your patients right now, if that’s going to help you, so if you need to scribble first and then you are a fast hyper and go out there and type until you learn how to type and talk at the same time because that, too is a skill. Please feel free to do that, do exactly what you need to do in order to make it through the day, because we want you to make it through the day, not take anything home. That’s the whole goal. So I’m excited, so you guys, our cohort is open again, so MP Collective is open again, we’ve got lots of new joiners, so we’re gonna have some new folks come and join us, and so we’re also excited about that. Please join me tomorrow in the big group, ’cause we’re gonna go live in the big group.
0:42:34.8 PW: Nothing special, but we’re gonna go talk to the students, say hello, so that they know that we are around and we are rooting for them as well, so positive words, just to kind of touch base with them. So please feel free to join us, but we appreciate all of you for being here and can’t wait to chat some more with you, so see you over in the group. If you missed this, don’t worry, the replay will be up as soon as this downloads and probably in the next 24 hours or so, and you can find it in your portal. Alright guys, so I appreciate you. Hope that you have a great night and I hope that this was helpful. Give us a few days for the homework and you’ll have everything together, talk to you soon. Bye.