state is threatening to go after license over precharting

Nurses Safety

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This is not me I am talking about. They could get me on same charges if they searched enough charts but lucky I have not done it in a while. I know two nurses who were found to have charted things before they did them and state inspectors called it fraud and are threatening to bring them up before the board. The facility has gone to bat for them and stated such extreme measures are not necessary. All they say that is necessary is a education program. The facility is right because half the nurses I know would lose their license(including me) for precharting on one occasion or another. For instance, say it is 1pm and the patient is on a q2 hr treatment. I know it is very hard to get back to chart something at 3pm so I will sign off on the thing I know I will do at 3pm. I don't think I have ever signed off on anything in advance that I did not do. In the future I will take the risk that it never gets signed off rather than sign it off ahead of time. Apparently, presigning is a much more serious crime.

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We went over the whole "don't chart it before you do it" in school during the first few weeks, but my question is how did the state find out that it was "precharted" ? If the nurses did the duty at the time they signed on the chart and it was done and charted what's the BIG deal... it's just something I don't get.

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In my experience stuff like this is reported in retaliation by a vindictive person or a disgruntled employee trying to get someone in trouble. It has also been discovered in cases like a woman who was found dead at 530 am and nurses had charted 6 am stuff on her.

While I recognize charting ahead is not a good thing, who has time to check and chart q h on routine stuff....i could spend all day backtracking q 1 h to do documentation. We get counseled if we're OT charting...gotta give a little sometimes, although I'm sure the BON's don't see it that way.

I don't believe the potential for harm justifies revocation either but then I'm not a BON investigator...gotta hope they use some common sense when they investigate this stuff.

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I'm just a student, So I can't give an opinion one way or the other, but I do have an example from clinicals where precharting could have caused a serious problem. I had a patient that was a quadreplegic. He was scheduled for a 10am pain reliever. The nurse initialed the MAR before she gave it, then noticed they were out of that drug. Then she got busy and forgat to order it. While the pt. could not feel pain, his body still reacted to it. His BP and pulse increased and he started sweating. At 1200 his BP was 140/90 where his 0800 had been about 110/70. I reminded her 3 times about the med as well as told my instructor. When I left at 1330 she still had not ordered the med, but according to the MAR, it had already been given. My instuctor told me to inform the pt about his increase in BP, and to remind the nurse to give him the med. I'm not sure what happened, that was my last clinical at that facility.

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we had a nurse prechart that she had evaluated a patient. He died before the last entry was timed, which was a definite clue that she was precharting. The family grabbed that one big time, because the assumption was if she lied about charting she lied about caring for him and she could have prevented his death in some way. Don't make a habit of precharting.

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I will never prechart... because I know it's wrong (thanks to my great instructors) I now realize how precharting could be a very bad thing. I sure would hate to have to up in front of the BON

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Specializes in NICU, PICU, PCVICU and peds oncology.

Most of the nurses in my unit will prechart every shift. We do a lot of redundant charting, including writing in the nurses' notes "Report given to oncoming nurse. Orders reviewed." Then the oncoming nurse charts the identical information... "Report received. Orders reviewed." Change of shift in our unit is a very hectic time since we change on the hour. Often the time on the notation is quite wrong, because we never, ever have our report completed within our scheduled and paid time. There have been rumors that we're going to computerized charting... but like everything else in our world, no one can say when. That should make things even more interesting.

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The dummies did it the day the inspectors were in the building. To me it says they really did not realize it was wrong because no one does something that is not on the up and up when the state is looking over their shoulder. If you chart something as done at 3pm and the patient is discharged at 2pm they sort of got you don't they.

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Specializes in LTC,Hospice/palliative care,acute care.
The dummies did it the day the inspectors were in the building. To me it says they really did not realize it was wrong because no one does something that is not on the up and up when the state is looking over their shoulder. If you chart something as done at 3pm and the patient is discharged at 2pm they sort of got you don't they.
sheesh-the current crop of surveyors in this area are sooo out of touch with the reality of nursing in long term care.To take something like that as far as the BON sounds typical.They dinged us hard this year on some of the most bizarre stuff........The whole surveying process is really a crock of shyte-they walk into the pretty private LTC's in this area and turn a blind eye to the crap that they walk into our county home and search for....Back on topic-one way to make sure this can't happen again is to adjust those med and tx admin times.We know approximatly when the surveyors are due and we won't sign off things like the 2 pm nourishments any earlier when we think they are in the area....Your co-workers just had a brain fart and I hope the facility backs them......keep us posted....
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Specializes in Telemetry, ICU, Resource Pool, Dialysis.

I heard about a nurse in my facility who was fired for pre-charting. She went much farther than anyone here, though. Apparently she was known to read magazines for the most of her shift, and never seemed to chart except at the very beginning. Some of the other nurses looked in her charts while she was on break and saw that she had completed ALL the charting for the shift, including assessments, nurses notes and meds by the time she went to lunch. There have been times I have pre-charted things like dressing changes, then went to do it and found a problem that I had to add to my notes. Or charted a med that the patient ended up refusing. For instance if they said they would like pain pills at their 2400 assessment and them refused them. I think these little things are alot different than charting a whole assessment or NN ahead of time, though. That makes the record completely inaccurate. JMO

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sheesh-the current crop of surveyors in this area are sooo out of touch with the reality of nursing.....keep us posted....

They are tearing us apart. We have so many defiencies that my NM was in tears. Only good thing about it is that all of a sudden we have full staffing all of the time. Full staffing is the only possible was to clean things up. Apparently they will be back and back again.

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Specializes in Going to Peds!.

We have computer charting that will NOT allow you to chart "in the future". Our facility still has the paper chart, but we are phasing it out. The docs are supposed to enter their own orders now. (Yeah right!!)

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