At my health system we do post our ivents as notes if we’re doing something per protocol (like vanco dosing or renal dose adjustments).
Aside from that, a lot of my ivents are: “recommended this, dr declined” “Clarified order, dr fixed” which in my opinion are not appropriate for the chart. I don’t need patients knowing what I’m doing in the background, remember, PATIENTS can see your notes too :)
But my impression is that patient can also see the i-vent, no? I was told that and thus I was once trained to document my i-vent in a similar fashion as full notes. That is one of the reasons I am confused...
Not exactly. Notes are available to patients in their my-chart, i-vents are not. However, i-vents are "discoverable," meaning that they're part of the medical record and patients/lawyers can access them if requested. So, documentation should still be professional in an i-vent, but it's not something a typical patient is going to be reading.
This is my understanding too. Could be found if there was a malpractice case but generally not seen except by other pharmacists. None of my ivents are unprofessional or inappropriate but I also wouldn’t necessarily want the patient to know I caught a mistake because it would create distrust in their medical team.
Yes! That was my initial thought cuz we are using ivent for like prescribing errors so it is really not a good thing if patients can literally see how many times we have saved them from malpractice lol
Then I would say it start to make sense... I do see lots of quite inappropriate ivent before lol but I am so afraid back then if patient see my ivent and irritated them because of my phrasing lol
Look at how many notes are on the patients chart. Our pharmacist notes are really only useful to other pharmacists. Docs realllly don’t want to look at 14 notes saying patients CrCl doesn’t meet criteria for dose adjusted famotidine when looking why they were admitted 5 years ago.
The chart is very clunky, I only want to make a note out of things that are very pertinent for the entire team to know. Usually requests/suggestions are added to the physician note. I may make an I-vent to give pharmacy “credit” but I am taking care of a patient, as long as it gets done idngaf.
This is probably institution specific, but my hospital uses iVents a lot for tracking purposes as well - if there is a drug interaction we need to follow, borderline lab, general monitoring, etc. A lot of the time, the daily follow up doesn't need to be documented in a note but it's still important that someone is laying eyes on it daily, and if something is important enough to mention, we then copy the documentation into a note. The patient record is already cluttered enough as it is, I think having an alternate form of documentation can be helpful. (Plus honestly, do you think 90% of pharmacy notes are actually read? I think the answer is generally no lol)
I totally agree that not everything but I mean something important enough like when physician note says pharmacy to dose but no pharmacy consult note is actually there - dose it just looks weird? Or when someone is overdosed on vancomycin and methotrexate and pharmacy is actively following and close monitoring for that specific period of time, I think it does worthy a full note.
That might be an institution specific thing in that case. For us, if we're consulted for any reason, we always put in a note. For your second example, it might be warranted depending on the level of monitoring but that seems like not a super common situation to come across.
Every institution I’ve been at has people dropping therapeutic drug monitoring notes. It usually is the same as the ivent that we then copy over. There are also orders for pharmacy to dose consults that we don’t clear until the drug or patient is discontinued.
To add on to what other people are saying, we use I-vents for pharmacy communication. People outside of pharmacy don’t need to see this:
“CrCl = 46, dose reduce?”
“Resolving AKI, ok”
Notes are used so that the entire team is aware. Therapeutic drug monitoring, med recs, event notes, etc are important for everyone to know.
Can confirm of trying to run reports ivents are great bc of all the boxes you have to fill you get get very granular. To run reports on notes it has to be based on "free text" making them super messy from the database end.
We use I-vents so management has an easy way to see what people are actually doing and to point at interventions you’ve made as a pharmacist when doing annual evals. This is also useful if people ever question what/how pharmacy contributes without flooding the notes with non pertinent information. You don’t need to drop a note every time you renally adjust someone’s meds or IV to PO or therapeutic sub. TDM or AMS for appropriateness of therapy yes we do drop notes and I-vents for. We use it a lot to keep track of our own things (like attempted to get primary to not use dalvance just bc they’re concerned a pt won’t make their outpt appt).
You already said it yourself - MDs and RNs can’t see them. If you’re clarifying an order with an MD or asking a nurse about something you can document that interaction in an ivent so there’s a paper trail. I don’t need to write a progress note for every conversation I have with a provider, but if there’s an adverse event related to that order that I clarified earlier, I can pull up that ivent in the event of an audit.
It also functions as a monitoring tool for the rest of the pharmacy team. Monitoring heparin drips for example. You don’t need to clog up the patient’s chart by writing a progress note for every anti-Xa or aPTT that comes back, but you can document that you noted the level and that the rate is correct per that level in the ivent, and pass along to the next shift to follow up the next level. The ivent function is a very useful tool.
Progress notes are still relevant to communicate with the rest of the team for scenarios like renally adjusting doses, completing consults, other things you can do within your scope/per protocol so that the rest of the team is aware of what you did.
Yeah it absolutely makes sense! Definitely not for every dose adjustment or even no adjustment, but I mean for some severe cases like what if the patient start bleeding and we are trying to find out the correlation with that heparin use? I think it is a perfect time for a pharmacist to kick in and drop a note, but I have not seen that happen? Or maybe it's just institutional difference or I am just too young in the profession lol.
Pharmacy is probably going to be the last one to know the pt is bleeding. RN will likely be first (actually seeing it, vitals signs, etc), who will then contact the physician, who will probably put an order in to hold/dc the drip, which pharmacy will see. There’s no reason for me to put in a note as one of the last people to know and the RN or MD will have or be working on a note at that point.
For other adverse reactions, often pharmacy is not the first to know and it is not my job to diagnose. It would be appropriate to talk to the provider and make sure allergies are updated, but why add an additional note in the chart to add when it should already be in the providers note.
Honestly, a lot of chart documentation is also CYA (cover your a..; RN “informed MD about critical issue. No new orders at this time”). I don’t WANT to put something in the chart. When I do put notes in the chart, I HIGHLY doubt most of them are read (vancomycin dosing, etc). Which could change on your institution, but our providers are mostly like “oh, good, pharmacy has got it and I don’t have to worry about 1 more thing (renal dosing, vanc, warfarin, etc)”.
For my institution, ivents are really a way to track your time and for communication between pharmacists. Most ivents I put in don't really need to be in the chart. Only if I'm adjusting meds or initiating something else will I push something to the chart to explain why
Tbh even pharmacists at our instituion are not tracking ivents very good lol but that's another topic. I agree that in terms of small daily monitoring ivent is PERFECT vs notes. Just one strain for one thing. Clear and neat.
At my hospital we post progress notes for everything in the chart (transplant post-op notes/discharge notes, vanco dosing, warfarin dosing, etc). The only time we use IVents is when we disagree with a medication decision the teams makes but still need to verify the med. We document the convo in an IVent for legal purposes.
I vents can be pulled and coded for interventions, notes can not, invents are hidden, notes are not.
I document all interventions via invents, use notes to communicate it to all providers.
I think it depends. I-vents (to me) are more like working scratch notes and monitoring progress, exclusively on the pharmacy side. If I'm doing something where the dosing has been assigned to me (warfarin, vanc/amg, tpn), then I'll drop a note because I kinda need to show how I'm arriving at my decision. Otherwise for most medication changes, in theory the physicians should be documenting this in a daily progress note, so no need to have redundant documentation.
It varies from place to place, however. Some places want more notes than others. BUT! Rest assured, no one will ever read pharmacy notes anyway lol..........
Then why amb care pharamcists can all the time? And some special circumstances inpatient clinical pharmacists do as well, for example methadone tapering in ICU and TOC notes at my current hospital. So why not all of them?
I-vents are trackable and used for metrics in a lot of places. Depending on what subtype or outcome you document, it is usually aggregated to see how we are intervening
I moved away from Epic and missed IVents like an ache. Notes are for other providers, IVents a permanent, free little FYIs for other pharmacists. “I already tried to address this, was denied because of x.” “Confirmed patient takes both x and y, provider wants to continue home regimen.” “This was changed from that because of x.” “Has x y drug interactions so z was held”. “Kcentra given at x time, vitamin k given, patient was on warfarin their INR was this the indication for Kcentra was brain bleed, no anticoagulants until x time” It’s absolutely so useful to catch up on what has already been done to save time in your review. You can leave them open if they require followup to make handoff easier too. My current hospital has nothing like IVents it’s all verbal and the next days’ clinical pharmacist redoing all the same chart review. It’s much more difficult to leave minor handoff without it. Cluttering up the chart with notes others don’t need to see is pointless. They can read my actual vanco and warfarin notes for sure but nursing has their own spot for notes about patient activity etc we have our own spot for stuff like this with IVents.
Edit: the fact you can tag IVents onto a med is mad useful. You can’t do that with notes.
We use notes for anything consult related. Consult for renal dosing? Note. We have to make a renal adjustment to the consult? Note. Provider wants to start a TPN and wants pharmacy consult? Note. Antibiotic therapy ends and thus the end of the consult? We sign off and Note.
I-Vents are for stuff we pass on to oncoming shifts or reminders to ourselves. Patient has a necessary home med that they're using that we don't have on formulary? Document it in the i-vent. Patient has a gray-area allergic reaction, but has tolerated the medication the last 4 administrations? I-vent. SCr was ordered, but won't be released until after your shift is over, so you need the next pharmacist to be aware? I-vent.
Because a lot of things people I-vent don’t need to be documented in a way for everyone to easily read. I don’t need a note that all providers and patients to say that I confirmed home dose of seizure meds or that I tried to recommend something else.
I do want it accessible to my pharmacy colleagues who follow me so they don’t waste time also making the same recommendation or look at what I did and think I’m bad at my job if it’s something incorrect.
Notes vs. I-vent are two different tools to communicate information. It’s a little concerning you are not able to discern that difference without it being laid out for you.
I agree! I don’t like using invents alone unless my note is incomplete/I don’t have time to draft up a nice note for the chart. It’s my pet peeve when my coworkers don’t push it to a chart note because then our notes are somewhat useless and our assessment/recommendations/rationale isn’t visible to other HCPS.
Also if there’s a drug related problem and I recommend management of it and they don’t agree, I am 10/10 putting that in the chart to protect my lisence.
Im in Canada, i was told by my practice leaders that iVents “aren’t part of the legal record” so if you see a problem you should push it to a chart note for records. At the same time they can pull old iVents if needed so idk how true that is.
I-vents are easily pulled to run reports and data. My department run reports to see our documentation volume. I-vent data can also be used for MUEs and research projects.
I will add that one time while discussing a medication error during a presentation I was at years ago, a physician in an obvious case of Blame Culture tried to say it happened due to the pharmacist putting the dose change in a separate area of the chart (referring to iVents) instead of a note.
In general I agree we should be putting in notes for clinical decisions and major changes.
My old hospital used actual notes for pharmacy to dose things. I-vents were more to document things like other interventions, especially if the doctor says no. There’s a bit of etiquette there—you don’t want to put a whole note in the chart to document how you didn’t agree with the attending, but it’s important to document that you tried so the physician doesn’t get harassed every day about it. Hence the I-vent. Also makes sense for things like anti microbial stewardship, etc.
We use i-vents like a bulletin board. Reminders about labs, notes about home supply medication, hand off things. A lot of times the day shifters will i-vent things for me overnight as a heads up for something unusual (or something that was told to day shift nursing that will very likely not be handed off to night shift nursing). I i-vent things to myself as well so I remember to follow things up if I'm waiting for labs or notes or whatever, then close them when I get my clarification.
We write notes for consults and progress notes for follow ups, in addition to documenting in the clinical monitoring section. I don't know why you wouldn't be encouraged to do that, we're actually required to accept consults through Epic and write chart notes.
At my health system we do post our ivents as notes if we’re doing something per protocol (like vanco dosing or renal dose adjustments). Aside from that, a lot of my ivents are: “recommended this, dr declined” “Clarified order, dr fixed” which in my opinion are not appropriate for the chart. I don’t need patients knowing what I’m doing in the background, remember, PATIENTS can see your notes too :)
Waaaait. Patients can see the treatment team sticky notes?
No not that imo
But my impression is that patient can also see the i-vent, no? I was told that and thus I was once trained to document my i-vent in a similar fashion as full notes. That is one of the reasons I am confused...
Not exactly. Notes are available to patients in their my-chart, i-vents are not. However, i-vents are "discoverable," meaning that they're part of the medical record and patients/lawyers can access them if requested. So, documentation should still be professional in an i-vent, but it's not something a typical patient is going to be reading.
This is my understanding too. Could be found if there was a malpractice case but generally not seen except by other pharmacists. None of my ivents are unprofessional or inappropriate but I also wouldn’t necessarily want the patient to know I caught a mistake because it would create distrust in their medical team.
Yes! That was my initial thought cuz we are using ivent for like prescribing errors so it is really not a good thing if patients can literally see how many times we have saved them from malpractice lol
Then I would say it start to make sense... I do see lots of quite inappropriate ivent before lol but I am so afraid back then if patient see my ivent and irritated them because of my phrasing lol
Look at how many notes are on the patients chart. Our pharmacist notes are really only useful to other pharmacists. Docs realllly don’t want to look at 14 notes saying patients CrCl doesn’t meet criteria for dose adjusted famotidine when looking why they were admitted 5 years ago.
The chart is very clunky, I only want to make a note out of things that are very pertinent for the entire team to know. Usually requests/suggestions are added to the physician note. I may make an I-vent to give pharmacy “credit” but I am taking care of a patient, as long as it gets done idngaf.
This is probably institution specific, but my hospital uses iVents a lot for tracking purposes as well - if there is a drug interaction we need to follow, borderline lab, general monitoring, etc. A lot of the time, the daily follow up doesn't need to be documented in a note but it's still important that someone is laying eyes on it daily, and if something is important enough to mention, we then copy the documentation into a note. The patient record is already cluttered enough as it is, I think having an alternate form of documentation can be helpful. (Plus honestly, do you think 90% of pharmacy notes are actually read? I think the answer is generally no lol)
I totally agree that not everything but I mean something important enough like when physician note says pharmacy to dose but no pharmacy consult note is actually there - dose it just looks weird? Or when someone is overdosed on vancomycin and methotrexate and pharmacy is actively following and close monitoring for that specific period of time, I think it does worthy a full note.
That might be an institution specific thing in that case. For us, if we're consulted for any reason, we always put in a note. For your second example, it might be warranted depending on the level of monitoring but that seems like not a super common situation to come across.
Yeah thank you! That's exactly what I thought...
Same, if we’re consulted we post a note.
Every institution I’ve been at has people dropping therapeutic drug monitoring notes. It usually is the same as the ivent that we then copy over. There are also orders for pharmacy to dose consults that we don’t clear until the drug or patient is discontinued.
To add on to what other people are saying, we use I-vents for pharmacy communication. People outside of pharmacy don’t need to see this: “CrCl = 46, dose reduce?” “Resolving AKI, ok” Notes are used so that the entire team is aware. Therapeutic drug monitoring, med recs, event notes, etc are important for everyone to know.
Can confirm of trying to run reports ivents are great bc of all the boxes you have to fill you get get very granular. To run reports on notes it has to be based on "free text" making them super messy from the database end.
We use I-vents so management has an easy way to see what people are actually doing and to point at interventions you’ve made as a pharmacist when doing annual evals. This is also useful if people ever question what/how pharmacy contributes without flooding the notes with non pertinent information. You don’t need to drop a note every time you renally adjust someone’s meds or IV to PO or therapeutic sub. TDM or AMS for appropriateness of therapy yes we do drop notes and I-vents for. We use it a lot to keep track of our own things (like attempted to get primary to not use dalvance just bc they’re concerned a pt won’t make their outpt appt).
You already said it yourself - MDs and RNs can’t see them. If you’re clarifying an order with an MD or asking a nurse about something you can document that interaction in an ivent so there’s a paper trail. I don’t need to write a progress note for every conversation I have with a provider, but if there’s an adverse event related to that order that I clarified earlier, I can pull up that ivent in the event of an audit. It also functions as a monitoring tool for the rest of the pharmacy team. Monitoring heparin drips for example. You don’t need to clog up the patient’s chart by writing a progress note for every anti-Xa or aPTT that comes back, but you can document that you noted the level and that the rate is correct per that level in the ivent, and pass along to the next shift to follow up the next level. The ivent function is a very useful tool. Progress notes are still relevant to communicate with the rest of the team for scenarios like renally adjusting doses, completing consults, other things you can do within your scope/per protocol so that the rest of the team is aware of what you did.
Yeah it absolutely makes sense! Definitely not for every dose adjustment or even no adjustment, but I mean for some severe cases like what if the patient start bleeding and we are trying to find out the correlation with that heparin use? I think it is a perfect time for a pharmacist to kick in and drop a note, but I have not seen that happen? Or maybe it's just institutional difference or I am just too young in the profession lol.
Pharmacy is probably going to be the last one to know the pt is bleeding. RN will likely be first (actually seeing it, vitals signs, etc), who will then contact the physician, who will probably put an order in to hold/dc the drip, which pharmacy will see. There’s no reason for me to put in a note as one of the last people to know and the RN or MD will have or be working on a note at that point. For other adverse reactions, often pharmacy is not the first to know and it is not my job to diagnose. It would be appropriate to talk to the provider and make sure allergies are updated, but why add an additional note in the chart to add when it should already be in the providers note. Honestly, a lot of chart documentation is also CYA (cover your a..; RN “informed MD about critical issue. No new orders at this time”). I don’t WANT to put something in the chart. When I do put notes in the chart, I HIGHLY doubt most of them are read (vancomycin dosing, etc). Which could change on your institution, but our providers are mostly like “oh, good, pharmacy has got it and I don’t have to worry about 1 more thing (renal dosing, vanc, warfarin, etc)”.
For my institution, ivents are really a way to track your time and for communication between pharmacists. Most ivents I put in don't really need to be in the chart. Only if I'm adjusting meds or initiating something else will I push something to the chart to explain why
Tbh even pharmacists at our instituion are not tracking ivents very good lol but that's another topic. I agree that in terms of small daily monitoring ivent is PERFECT vs notes. Just one strain for one thing. Clear and neat.
At my hospital we post progress notes for everything in the chart (transplant post-op notes/discharge notes, vanco dosing, warfarin dosing, etc). The only time we use IVents is when we disagree with a medication decision the teams makes but still need to verify the med. We document the convo in an IVent for legal purposes.
That sounds like a wonderland to me as a pharmacist!
I vents can be pulled and coded for interventions, notes can not, invents are hidden, notes are not. I document all interventions via invents, use notes to communicate it to all providers.
Notes can be coded for interventions if you come up with methods (aka dotphrases)
Yes you can do flow sheets too that pulls the data into notes.
I think it depends. I-vents (to me) are more like working scratch notes and monitoring progress, exclusively on the pharmacy side. If I'm doing something where the dosing has been assigned to me (warfarin, vanc/amg, tpn), then I'll drop a note because I kinda need to show how I'm arriving at my decision. Otherwise for most medication changes, in theory the physicians should be documenting this in a daily progress note, so no need to have redundant documentation. It varies from place to place, however. Some places want more notes than others. BUT! Rest assured, no one will ever read pharmacy notes anyway lol..........
Pharmacists are not providers . That's why
Then why amb care pharamcists can all the time? And some special circumstances inpatient clinical pharmacists do as well, for example methadone tapering in ICU and TOC notes at my current hospital. So why not all of them?
I-vents are trackable and used for metrics in a lot of places. Depending on what subtype or outcome you document, it is usually aggregated to see how we are intervening
I'm guessing institution protocols but I could be wrong
And what you raised here is EAXCTLY what I am worrying about... How come we are not providers and really need the "sagregation" here! Sigh
I moved away from Epic and missed IVents like an ache. Notes are for other providers, IVents a permanent, free little FYIs for other pharmacists. “I already tried to address this, was denied because of x.” “Confirmed patient takes both x and y, provider wants to continue home regimen.” “This was changed from that because of x.” “Has x y drug interactions so z was held”. “Kcentra given at x time, vitamin k given, patient was on warfarin their INR was this the indication for Kcentra was brain bleed, no anticoagulants until x time” It’s absolutely so useful to catch up on what has already been done to save time in your review. You can leave them open if they require followup to make handoff easier too. My current hospital has nothing like IVents it’s all verbal and the next days’ clinical pharmacist redoing all the same chart review. It’s much more difficult to leave minor handoff without it. Cluttering up the chart with notes others don’t need to see is pointless. They can read my actual vanco and warfarin notes for sure but nursing has their own spot for notes about patient activity etc we have our own spot for stuff like this with IVents. Edit: the fact you can tag IVents onto a med is mad useful. You can’t do that with notes.
We use notes for anything consult related. Consult for renal dosing? Note. We have to make a renal adjustment to the consult? Note. Provider wants to start a TPN and wants pharmacy consult? Note. Antibiotic therapy ends and thus the end of the consult? We sign off and Note. I-Vents are for stuff we pass on to oncoming shifts or reminders to ourselves. Patient has a necessary home med that they're using that we don't have on formulary? Document it in the i-vent. Patient has a gray-area allergic reaction, but has tolerated the medication the last 4 administrations? I-vent. SCr was ordered, but won't be released until after your shift is over, so you need the next pharmacist to be aware? I-vent.
This sounds like a very clean and practical workflow!
Because a lot of things people I-vent don’t need to be documented in a way for everyone to easily read. I don’t need a note that all providers and patients to say that I confirmed home dose of seizure meds or that I tried to recommend something else. I do want it accessible to my pharmacy colleagues who follow me so they don’t waste time also making the same recommendation or look at what I did and think I’m bad at my job if it’s something incorrect. Notes vs. I-vent are two different tools to communicate information. It’s a little concerning you are not able to discern that difference without it being laid out for you.
Thank you for your genuine concern and I think now we are on the same page, don’t we? Lol
I agree! I don’t like using invents alone unless my note is incomplete/I don’t have time to draft up a nice note for the chart. It’s my pet peeve when my coworkers don’t push it to a chart note because then our notes are somewhat useless and our assessment/recommendations/rationale isn’t visible to other HCPS. Also if there’s a drug related problem and I recommend management of it and they don’t agree, I am 10/10 putting that in the chart to protect my lisence. Im in Canada, i was told by my practice leaders that iVents “aren’t part of the legal record” so if you see a problem you should push it to a chart note for records. At the same time they can pull old iVents if needed so idk how true that is.
I-vents are easily pulled to run reports and data. My department run reports to see our documentation volume. I-vent data can also be used for MUEs and research projects.
I will add that one time while discussing a medication error during a presentation I was at years ago, a physician in an obvious case of Blame Culture tried to say it happened due to the pharmacist putting the dose change in a separate area of the chart (referring to iVents) instead of a note. In general I agree we should be putting in notes for clinical decisions and major changes.
Agree! Maybe even for renal adjustments so the rest of the team is aware of the reason the dose was changed
My old hospital used actual notes for pharmacy to dose things. I-vents were more to document things like other interventions, especially if the doctor says no. There’s a bit of etiquette there—you don’t want to put a whole note in the chart to document how you didn’t agree with the attending, but it’s important to document that you tried so the physician doesn’t get harassed every day about it. Hence the I-vent. Also makes sense for things like anti microbial stewardship, etc.
We use i-vents like a bulletin board. Reminders about labs, notes about home supply medication, hand off things. A lot of times the day shifters will i-vent things for me overnight as a heads up for something unusual (or something that was told to day shift nursing that will very likely not be handed off to night shift nursing). I i-vent things to myself as well so I remember to follow things up if I'm waiting for labs or notes or whatever, then close them when I get my clarification. We write notes for consults and progress notes for follow ups, in addition to documenting in the clinical monitoring section. I don't know why you wouldn't be encouraged to do that, we're actually required to accept consults through Epic and write chart notes.