Is this legal?? - page 4
by nurseruby 3,819 Views | 33 Comments
Because there have been so many "holes" (missing initials on MARs), our DON has established a new policy that if a nurse forgets to initial a med or treatment given, that nurse AND the nurse who worked right after her would... Read More
- 3Aug 5, '12 by tokebiWhat I see from my experience and this thread is the great divide between those in management and those on the floor. Those holes in MARs occur mostly because nurses are in a hurry, and instead of looking at why nurses are in a hurry all the time, somebody in the management comes up with the brilliant idea of making two nurses responsible for one nurse's shift! And to boot, two nurses have to waste quite some time together just to plug up the hole, and that's one less minute that could've been spent on pain assessment, a minute to prevent a fall, a minute to make a visiting family happy, a minute that could've abated the anxiety and loneliness of a wondering mind.
Seriously, do everyone here understand the sheer amount of initials we're talking about here? It's not just each medication given, that's too easy. For each psychotropic med, we initial and count the number of behaviors for which the med was ordered, each shift. For Remeron, for example, "for treatment of depression m/b sad face." Sad face. Seriously?! Never mind that it could've been ordered just to help the person to sleep. But since its labeled purpose is to treat depression, we've got to have the documented reason to receive it, and we have to count how many times the resident shows "sad face?" Not only for depression, we're also expected to count and document the number of times residents strike at staff, curse, refuse treatment, etc, for the psychotic pts. Now for BP meds, we document BP and HR before giving those meds... reasonable. But here's the thing: we have to write those frigging numbers for each med! If a resident has three different BP meds, we still have those cursed squares to write in those numbers for every single one! How does that make sense? On top of all these, charge nurses are expected to know the exact % of meals, snacks and protein shakes eaten, three times a day, document and initialed. And now, pain assessment. Oh gosh, it's important, I get that (my residents make sure I get that even without all the redundant paperwork.) I initial for each shift and document the pain rating, on top of more detailed assessment and rating whenever I give pain med. Now, we have a dedicated "pain flowsheet" on top of the regular MAR documentation, which does the exact same thing but requires more of our initials.
Rather than coming up with more and more punitive measures, think about why things happen the way they happen. Put yourselves into the shoes of the floor nurses and come up with the solutions to help us, not to make it more difficult.
- 0Aug 5, '12 by morteYES, YES, YES!
we all know that the EMAR, and computer charting in general, is made for the end user, not the persons doing the charting....wellll, the paper charting is following suit, pain flow sheet, so the surveyor doesn't have to bother themselves going thru the MAR. behavior sheets so they don't need to read nurses' notes. etc....I was thinking of my shift yesterday. 21 patients, i am sure the MAR averages better than 2 pages ea, I know some are 4, at ~ 14 meds/blocks per page, how long do you think that is going to take? on top of which, I received an admit at 1245P. Oh and did I mention, I was house sup at the same time??? cut back on duc. and the end result will improve. cut back on meds, results will improve.
Get mcd reembursement in line with reality, results will improve.
quote:Rather than coming up with more and more punitive measures, think about why things happen the way they happen. Put yourselves into the shoes of the floor nurses and come up with the solutions to help us, not to make it more difficult(quote)
- 0Aug 6, '12 by NamasteNurseQuote from CapeCodMermaidWhen I worked for the big K, we were supposed to go through the other nurses' MAR before end of shift to make sure all the meds were signed off. It lasted less than 2 weeks. And, to top it off, the DON and ADON would call all the managers to the conference room for "signing parties" where they expected us to sign someone's initials in every blank spot. I was one who wouldn't even sign off an A&D on the treatment sheet if I hadn't personally applied it, so you can imagine how eager I was to falsify medical records to make them look good.
I have never asked any nurse working for me to sign her/his initials to something they haven't done.
NOW THAT's ILLEGAL! Yes in capital letters! Facilities try all kinds of ****, that only lasts a few weeks. Who has time to re-check at the end of a shift? An d baby-sit our fellow nurses. Ha, that's never gonna last, nurses are a tough buncha cookies!
- 2Aug 6, '12 by ElladoraOur MARS are paper. We have two books with 40-45 patients in each book.
Our third shift goes through the MAR and flags missing signatures. We sign them the next day we come in. We also flag missing signatures as we catch them.
As for narcs and prns...we have a narc count sheet separate from the MAR. PRNs are documented on the back of the MAR in addition to the front (with reason, results, time, date, initials).
Sounds to me like the DON is trying to make each person accountable by using a little (lot) of peer pressure. It sounds to me like on of those brilliant (sarcasm) ideas that will last a few days then fall to the wayside.