Tuesday, October 26, 2010
As EMR's move closer to becoming sentient beings that will eventually control the world, which at the current pace of their development I would estimate to take another 643 years, I have noticed a change in how I take down details about my patients as I round each day. With a paper note I would typically write down information on the actual progress note I expected to put in the chart. Therefore the information I wrote would have to be in the final (hopefully) legible form.
So I thought I would share a few of my shorthand techniques and see what else the palliative care community had to add. Now we are not just talking about simple abbreviations here like DNAR = Do Not Attempt Resuscitate, but more complex system, although not nearly as complex as Gregg Shorthand.
So here are a few of my shorthand notes:
F25 = Fentanyl 25mcg patch q72h (The 72 is always assumed, but if the patient is on q48h, I usually put a dash modifier after the number, like this F50-)
R5, R10, R510, R1020 = Roxanol (liquid concentrated morphine) with one or two digits equaling a non-ranged dose, and R1020 = Roxanol 10-20mg. Q1h is assumedas a common dosing interval in hospice.
MS = IV/SQ morphine, never PO/SL since that is R
M = methadone (assumed oral unless written otherwise)
HM = hydromorphone (Dilaudid) IV/SQ. Chose not to use the D so not to confuse with 0
hm = hydromorphone PO/SL. Used lowercase since it is not as strong as IV/SQ per mg dose
Oxy = oxycodone
OxyLA = oxycontin These two are fairly obvious.
H = haloperidol I do not make a distinction in the abbreviation here or for lorazepam for route and usually will add route after. So H12-4 = Haloperidol 1-2mg q4h prn
L = lorazepam
SC = scopolamine patch q72h
G = glycopyrrolate (not 'R' because that would be roxanol)
A = atropine (since L = lorazepam)
B = benadryl
C = compazine
Z = Zofran
MNTX = Relistor (methylnaltrecone)
S/S = senna - s with the number of tabs am/pm indicated after S/S 2/2 = Senna-s 2 tabs Twice a day.
I have tried a couple of different systems but the one I think that works best is
HMPCA 2 / C2-60/ P1-30 = Hydromorphone PCA with 2mg/hr basal, 2mg q60min Clinician bolus PRN, with 1mg q30min Patient bolus.
Other examples MSPCA 3 / C5-60 / PØ ( If there is no clincian bolus or Patient bolus I use a line through a zero.
Scheduling vs. prn
If a drug is scheduled then I will circle the interval, so Haloperidol 2mg every 8 hours scheduled would look like H2-8 (with a circle around the eight)
Family meeting shorthand
When everyone is doing introductions, I try and write everyone's name down with out looking at the paper, so I can have reference later in the meeting if I need to address someone. I add the names in the pattern they introduce themsleves so I ahve a little map to refer back to after the meeting. I never worry about spelling peoples names and usually will just try and spell phonetically as or include a few letters. So William = Wm; Brenda = Brda, Allison = Alsn, etc. Usually that is enough for me to remember them later on when the official note is written. But it is important to know the relations so for family relations I use the following key after the persons name. Most of the following are obvious but there are a few tricks.
H = husband
W = wife
SO = significant other
SIL = sister in law or son in law. Check the name to tell the gender
DIL = daughter in law
BIL = brother in law
S = son
D = daughter
M = mother
G = grandparent
F = friend
N = neighbor
A circled name = DPOA
P = anyone on a speakerphone during the conference
I add the state two letter abbreviation for any out of town relative present
OOH = out of hospital DNR form
Do you have any that you use regularly? I will add more as I recall them day to day.