Originally Posted by graysonret
These days, with all the malpractice suits, and lawyers looking for any slip to pocket a few million, agencies are trying to cover all the possible loopholes they can...even if it sounds ridiculous. I know, I get all sorts of weird things too. How about "Identify the patient each shift" on a home health case?
It's sad but seems to be necessary. I've argued points several times, but the agencies's legal departments think otherwise. I just shake my head. Nursing used to be patient oriented. Nowadays, unfortunately, it's cover myself first, patient second.
This home has 4 special needs kids. two with trachs, 1 on vent another bipap. Both of the others and the 1 on the vent have TF. The 4th, on bipap gets st cath twice each shift, she's also the one who didn't get supper until 2200 because she is up in W/C and out to the family room with the family (spina bifida) and is on pureed diet. My first night there I thought she had eaten with the family! The Tx sheet entry that the nurse is to get her something from the kitchen, run it through the food proccessor was mixed in a mess of entries for taking the trash out, taking VS Q2H. Things that are either polilcy or just ordinary tasks and I missed it! Penmanship is a major issue too.
Then there's the everyday care, bathing, trach care, etc... you get the picture. There's so much going on in this home that it really is needed to document eveerything they do or at the very least you risk the family loosing some of their nursing hours. Besides the 4 special needs kids this foster home also averages 6 other kids at any given time. Wonderful people.
My point is not that I don't think it should be documented but that there is no reason to document it more than once.
If a TF (say keto diet (recipe included) to run via kangaroo over 10 hours vol 1000cc is on the Tx sheet and you initial that when you hang it, chart gastric content, condition of g-tube or buton, etc before starting then at least Q2H chart tolerance to that TF why would you also include an enry on the tx sheet that is...
Check tolerance to TF Q2H? You have charted it in the narrative, why initial the Tx sheet?
Same with the VS, it's on the check sheet as well as in the narrative and the primary also wants you to initial it on the tx sheet?
Double and triple charting doesn't make sense. To me, it would look like you are trying to document more than is actually being done.
My suggestion would be a Tx sheet/s, Rx sheet/s, Maintainance sheet/s, Equipment sheet/s. Then there's the nursing notes page 1 and 2 (check sheet and narrative), staffing roster which is essentially time sheets, Docs orders, hospital/dr visit sheet/s, etc etc etc.
Too many homes the deviders are not even properly used becasue some nurses just think it's easier to just chart at the end of hte shift (something I hate to see any nurse do as a matter of habit) and flip from1 pg to the next until they run out of sheets just initially every line that the previous nurse initialed for that time period.
I've seen tubing changes get missed with this habit casue the nurse the day before didn't do it (wasn't due that day).
It all just seems way to sloppy to me.
Would you like to comment?
