We will chart every 90 days if a resident is stable with no changes in condition. If a condition is a fall, cold s/sx, UTI..things of this nature that will pass but need to be monitored, a nurse will put the patient on 'alert charting' and designate the type of charting needed. That has really helped us cut down the unneeded shift charting on some issues like skin tears or bruises (why chart q shift on a condition of these? We also monitor these issues on the MAR, so it is documented daily anyway).
We also do random chart audits every month..actually that is what I did! We would have a random list of 12 patients per month and I would go over their last month and make sure I felt charting was sufficient. Making it random helps, but last month...the random only showed 2 people that had a change in condition, so the others were rather borring..LOL! But I did find some slack in charting on weights or I/O or even bowel monitoring..and since a patient is charged for this...I caught it and got things back on track!
If a person is on hospice it is q-shift for communication reasons to hospice nurses. If they came back from the hospital, depending on condition it is policy to chart q shift for 3 days..but we nurses can extend it if we wish. Falls are 3 days too, same guidelines about lengthening it (ie pain issues or increased confusion post fall...).
The nicest thing we started doing is if things are very important to chart, caregivers must sign the MAR stating that they charted, or simply that they checked on that particular issue (ie skin issues). They have to fill out a shift summary and a 24 hour communication report as well...so if I don't sometimes see it in the chart..it will be in there, and I have them do a late entry if needed in the chart. That has been sooooo helpful and cut down unneeded charting quite a bit (or charting the same things in three or five different areas!).
IT has been helpful that the nurses have say over charting, and we have some guidelines for when we go "shoot...ummmmm I don't know" LOL! It really caters to need of individuals specific to their changes or conditions as they progress, and has improved over the year we have tried this! We have also gotten kudos for documentation of skin issues via the MAR (we also have weekly checks by LN on larger than 2cm tears or over 3 cm bruises till resolved on a separate sheet of paper in the MAR, and charting...so it is very followed through, especially since medicare kept on declining to pay for dressing supplies!).