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PCR Narrative writing skills


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The main problem I see with electronic PCR's is that, although you are given the capability to narrate, a great many services and medics choose not to. Like so many medics do in every aspect of EMS, they do only the very minimum they are required to do to get by. And the electronic PCR encourages that by basically telling you you've done "enough" by filling in the blanks.

Not to mention that many electronic PCR systems don't give you a very convenient way to narrate since there is no keyboard on many of them.

There are definitely important benefits to electronic PCR's that cannot be discounted:

  • * Data storage takes much less space.

* Data retrieval takes much less time.

* Statistical analysis is greatly simplified.

* Eliminates problems deciphering bad handwriting.

* Ensures minimum baseline of essential information on each PCR.

* Makes QA a breeze.

  • There are probably others too, I'm sure. But unfortunately, as I said, it encourages laziness and poor documentation. An organisation who adopts electronic PCR's should simultaneously institute a strict policy to ensure that the completeness of documentation does not suffer from the laziness that will almost certainly ensue.

Basically, I feel that electronic PCR's are the documentary equivalent of teaching paramedics to administer drugs based on the colour of the boxes they come in. It's lazy, inadequate, and bound to create a legal problem sooner or later.

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I know this is an old post, but oh well...lol. Where I used to work, we used a product called NarrativePRO. It was a program that we used along side our ePCR. I really liked it because even though it gave me a ton of options, I could edit the options to use my own words. I prefer to write in a chronological, CHART format (which by the way NarrativePRO is designed to do), but for the you SOAP writers it also does that as well. All I had to do was follow the program and it would compile the narrative for me. Simple but way, way more thorough than hand writing.

Hope this helps:)

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