Core measures to my core.

[CrystalCMSRN]

I have accepted the fact that core measures are here to stay, and that they are best practice for our patients. Besides if 5 of my relatives were admitted to the hospital... and lets say one didn't get aspirin and the other didn't get VTE prophylaxsis then developed complications as a result... I would be highly upset. I would like to know what your hospitals are doing to help with compliance. We currently:

Place a core measure checklist on the chart which is to be addressed each shift and prior to discharge. We are suppose to check to make sure vaccines have been given or at least refusal documented, VTE assessment complete with intervention, and then the common AMI,CHF,PN,STROKE core measures. We also have core measure quality nurses that audit charts to help us fill in the gaps or note errors for example a patient may have previously refused a vacc on an admission months ago... the documentation stays in the system so when the nurse checks THIS admission it may appear as if the vaccine has been addressed (i love when they catch those!)

If there is a fallout then the data abstract is sent to the manager and the manager attends a montly core-measure meeting to address the issue and the staff nures are talked to.

Core measure data is communicated via e-mail to all employees.

Ive taken an interest in core measures as a staff and charge nurse... NOT as a quality coordinator. It is the expectation that core measures are ultimately the staff nurses responsibility so I'm looking for help as to how to help us OWN it. It's funny, there are hospitals with 0 fallouts... they are tiny 25 bed hospitals.... well, my unit only has 25beds so I know we can do it too. SUGGESTIONS?

[Marisette, BSN, RN]

As a charge nurse on my med/surf nit, I get to check the core measures. Fun stuff! Not...

If something's left off, I have to leave a note for the MD/NP.

What's really fun is the ER admits. If the MD doesn't order the right antibiotics for a pneumonia patient or a morning echo, I have to go to the ED and get the order corrected.

Like I said, fun, fun.

They might as well give you a prescription pad so it could be done right on first try!

[MessyMomma]

They might as well give you a prescription pad so it could be done right on first try!

I know! It sucks to have to hunt down the doc and explain that he ordered the wrong antibiotic. Most are open to changing it, but some, of course, are firm in their orders.

Maybe I could ask for a bonus foe each error I catch! Hah!

[wooh, BSN, RN]

If RNs are doing the MDs' job, will the MDs be doing the RNs job? Sure, I'll order the right antibiotic just as soon as the MD comes around to hang the antibiotic.

We've got a big push going on at my facility about not exceeding our scope of practice. At the same time, we're given the responsibility for stuff like this. Can't have it both ways. Either we're supposed to do the MDs' jobs or we're not.

[MessyMomma]

If RNs are doing the MDs' job, will the MDs be doing the RNs job? Sure, I'll order the right antibiotic just as soon as the MD comes around to hang the antibiotic.

We've got a big push going on at my facility about not exceeding our scope of practice. At the same time, we're given the responsibility for stuff like this. Can't have it both ways. Either we're supposed to do the MDs' jobs or we're not.

Oh no, I hope what I said wasn't taken the wrong way. I am not exceeding my scope of practice.

We have preprinted orders for pneumonia or SCIP. The MD/NP/PA simply checks which orders s/he wants. There are guidelines as to the correct "things" to pick to be correct.

For example, a CAP needs only IV Levaquin and PO Zithromax while HAP needs Zosyn and Vanc (these are just examples, can't remember specific antibiotics!). The doc checks the Levaquin and we get the patient to the floor. I'm just pulling our Core Measure checklist and filling it in. I see that he forgot/neglected to order the Zithromax. I go to ER and talk with him. Usually, he fixes it, thanks me, and we're good.

Or a ScIP has no VTE, I call the doc and get it ordered.

In both cases, I just helped/ensured/whatever, that we didn't "faill" our Cores. I hope that doesn't seem like I'm practicing outside my scope.

[wooh, BSN, RN]

You're not. But you're still doing the MD's job. Actually, you are now SUPERVISING the MD. It's the MD's job to pick and order the antibiotic. It's the MD's job to order things. NOT OURS. So why is ordering things now our responsibility? Last I heard, with the exception of Doogie Howser, the MDs are all grown-ups. THEY need to be responsible for doing their job. And held accountable by someone that can actually hold them accountable. MD doesn't do their job? Hospital should find a new one. That's what they do when the RNs don't do their job. They don't go and tell the CNAs to make sure the RNs do their jobs and threaten the CNAs' jobs when the RNs don't.

[MessyMomma]

You're not. But you're still doing the MD's job. Actually you are now SUPERVISING the MD. It's the MD's job to pick and order the antibiotic. It's the MD's job to order things. NOT OURS. So why is ordering things now our responsibility? Last I heard, with the exception of Doogie Howser, the MDs are all grown-ups. THEY need to be responsible for doing their job. And held accountable by someone that can actually hold them accountable. MD doesn't do their job? Hospital should find a new one. That's what they do when the RNs don't do their job. They don't go and tell the CNAs to make sure the RNs do their jobs and threaten the CNAs' jobs when the RNs don't.[/quote']

I can see where you're coming from and I respect your opinion (You are one of my favorite posters, BTW). But...Our hospital encourages collaborative efforts to ensure Core measures are met.

I don't "supervise" the docs or "tell" them what to order; but if they make a mistake or omission that's gonna cause a failure of a measure, I help to fix it. I don't tell them that they have to correct it; I just point out an error.

I personally would feel crappy if I knew of an error/omission/mistake and I didn't try to get it fixed.

[anotherone, BSN, RN]

You're not. But you're still doing the MD's job. Actually, you are now SUPERVISING the MD. It's the MD's job to pick and order the antibiotic. It's the MD's job to order things. NOT OURS. So why is ordering things now our responsibility? Last I heard, with the exception of Doogie Howser, the MDs are all grown-ups. THEY need to be responsible for doing their job. And held accountable by someone that can actually hold them accountable. MD doesn't do their job? Hospital should find a new one. That's what they do when the RNs don't do their job. They don't go and tell the CNAs to make sure the RNs do their jobs and threaten the CNAs' jobs when the RNs don't.

Exactly. I am sick of this. just like med recs should be and imo are physician responsibility. . everything gets dumped on nursing to catch. ok that attending ordered "wrong"abx coverage but the stupid nurse should have caught it...... them here comes the parade of "wooh if you really cared about your pts you would do it" @@ .we are always being told "residents need attending supervision for this or that" or why wasn't this questioned. Frankly the residents should know what they need to be supervised for. I refuse to take any responsibility for it.

[anotherone, BSN, RN]

If I notice something missing I page to question it. But I resent the fact that it is now nursing reaponsibility to pull up a list and make sure the MD ordered the right meds based on said list.

[Marisette, BSN, RN]

I can see where you're coming from and I respect your opinion (You are one of my favorite posters, BTW). But...Our hospital encourages collaborative efforts to ensure Core measures are met.

I don't "supervise" the docs or "tell" them what to order; but if they make a mistake or omission that's gonna cause a failure of a measure, I help to fix it. I don't tell them that they have to correct it; I just point out an error.

I personally would feel crappy if I knew of an error/omission/mistake and I didn't try to get it fixed.

I don't think your exceeding your scope of practice either. Just kidding about the prescription pad. Most prescriptions are electric anyway. It's just that it's a difficult predicament nurses encounter in the health care setting. When the MD forgets, or wrongly orders the wrong antibiotic, he shrugs it off to the RN who is responsible for making sure the core measures are followed. He will get an "oops, ha, ha, try again" from management. The RN will get a write up, counseled or fired for failing to make sure the core measures are followed. The MD should be held accountable to performing his job.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

If I notice something missing I page to question it. But I resent the fact that it is now nursing reaponsibility to pull up a list and make sure the MD ordered the right meds based on said list.

EXACTLY!!!! As soon as they reverse the gravitational flow (as in :poop: flows UP-hill), then I will happily embrace the responsibility of the errors of higher-ups. But as long as nurses continues to try to "own" it, there is no motivation for those 'doctors-in-learning' to be held accountable to the MINIMUM magnitude that nurses are.

I wonder if there's an alldoctors.com website where residents or doctors are trying to OWN making sure those and all other medications are being administered on time.

[wooh, BSN, RN]

I wonder if there's an alldoctors.com website where residents or doctors are trying to OWN making sure those and all other medications are being administered on time.

Well we have a website here, and not a single CNA seems to be trying to "own" making sure the nurses give meds on time. And that would be the equivalent here.