When the electronic record goes down, care does not stop. Nurses fall back to the paper medication administration record and downtime forms, and residents keep receiving their medications and treatments. The real challenge often comes afterward. When PointClickCare is restored, what was written on paper has to be carried into the system accurately, and gaps or duplicates left unchecked can become safety and survey problems.
A clear reconciliation process turns a stressful cleanup into a manageable one.
Reconciliation is easier when downtime was handled well from the start.
Keep current printed MARs and downtime forms available and know where they are stored.
Make sure each paper entry has the resident's name, medication, time, initials and, for anything unusual, a note.
Record the exact start time of downtime, so you know which period needs reconciling.
Assign one person per shift to collect and secure the paper records.
If your facility has a written downtime procedure, follow it. The steps below are general good practice, not a replacement for your policies or your pharmacy and clinical leadership's direction.
Do not start entering data until IT or your vendor confirms the system is stable. Then define the reconciliation window, meaning the period from when the system went down to when it came back and nurses began documenting electronically again. Everything in that window needs review.
Collect all paper MARs, treatment records and notes from the downtime. Sort them by resident or unit. Keep originals together and do not discard anything. The paper is part of the legal record and should be retained according to your policy.
Before entering anything, look at what the system shows for each resident during the window. A scheduled medication with no documentation may be genuinely missed, or it may simply be given on paper. Comparing the two prevents double entry.
Have nurses who administered the care enter it whenever possible, since they know the circumstances. Where a different person must enter, they should note that the entry was transcribed from paper and by whom. Follow your policy on late-entry labeling and timestamps, so the record shows both when care was given and when it was entered.
Then add a second set of eyes. A common approach is a nurse or supervisor reviewing the paper against the screen for each resident.
Look for:
Missed doses, where neither the paper nor the system shows administration.
Duplicate doses, where something was given on paper and again after restoration.
Orders that changed during downtime, such as new, held or discontinued medications.
Escalate anything that may involve a medication error to the DON and follow your error reporting process, including notifying the physician and family as your policies require.
Once everything is entered and checked, have the supervisor sign off. Store the paper with a cover note stating the downtime dates, who reconciled it and when. Keep it for the period your retention policy and state requirements specify.
Hold a short debrief within a few days, while memories are fresh. How long was the system down? Was the paper ready? Were any doses missed? Update your downtime plan with what you learned, and practice it occasionally. Check that printed forms were stocked, that the unit knew where to find them and that the restoration message reached every shift. Staff who have rehearsed the process handle the real thing far better.
Downtime is partly an IT problem and partly a clinical one. UnityCare IT can help reduce how often it happens through reliable networks and internet failover, communicate clearly about restoration, and help you test and update your downtime procedures so your clinical team is not improvising when the system returns.
Keeping PointClickCare and other EHR systems fast, connected and available.
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