Behaviors and Failing to Chart Them

CapeCodMermaid, RN · May 26, 2012

It happens frequently....the staff get so used to the behavior they think "oh, that's just Mary". One thing that's worked for me when explaining this was "The Mall Test". If you were at the mall, and the person sitting next to you started acting like ( insert name of resident with behaviors) what would you do or think. Most of the time, the light dawns. I work in a state that still uses MMQs for Medicaid payment. We get an extra 10% for taking care of people who have behaviors, so you can be sure we spend a lot of time explaining the importance of accurate documentation.

Tired_Mommy · May 26, 2012

Interesting way to get them to perhaps see what I see. Thanks!

CT Pixie, BSN, RN · May 26, 2012

I always charted my resident's behaviors. And like you, I seemed to be one of only a few that did. Many times the charting was needed for the house psych doc to evaluate the resident also it was needed for many other important reasons. What ended up happening was 'document behavior' became part of the TAR. You'd be surprised how quick people started charting every shift once they were written up for signing off on it but not charting it.

And as CapeCodMermaid said, while it might be 'normal' for Ms. Jones to act in a certain way, it certainly isn't considered a 'normal' behavior for the majority.

IowaKaren · May 27, 2012

And no documentation = no psych eval or no intervention to help calm or possible correct the behaviors.

SitcomNurse, BSN, MSN, EdD, RN · May 27, 2012

I use the MDS language to chart behaviors, that way the social workers and MDS personnel who are completing the forms for reimbursement can easily recognize the behaviors, and GET PAID FOR IT. Read the MDS, sections C,D,E... if youa re exhibiting any of that, then ... you are missing money by not documenting it. Bring that to the table and see how it gets gobbled up, especially with all the cutbacks. The other half of that is... are you doing any justince for the resident by undermedicating depression?

buytheshoes11, MSN, RN · May 27, 2012

Yes! This happens all of the time where I work. Because the nurses are not documenting behaviors on the MAR flowsheets and in their charting, the MD and pharmacy have been decreasing the amount and number of psychotropic medications some residents are on.

Lynx25, LPN · May 27, 2012

Yes! This happens all of the time where I work. Because the nurses are not documenting behaviors on the MAR flowsheets and in their charting, the MD and pharmacy have been decreasing the amount and number of psychotropic medications some residents are on.

Then Mrs Mary Sue does a backflip out the window, and everyone is shocked...

Merlyn · May 27, 2012

I work in a LTC facility. We have quite a few residents with behaviors. We have special forms to document these behaviors but no one does so...except me. End of shift report includes "no behaviors this shift" and there certainly ARE behaviors. I'm the only one that will chart them and report to the on-coming shift. Other nurses are fully aware of the behaviors but just shrug them off. This frustrates me to no end! Anyone else dealing with this? Any advice?

It could be. In LTC everyone complained about this patient's behavior but no one charted except me. I was told that I was hateful to this patient because I was the only one that charted. The Staff called the patient's doctor and told him they wanted an order for Valium for the patient. The doc came in and explain he couldn't just write an order for Valium. He has to have a reason. The bad behavior has to be charted. The Knucklehead staff just looked at him. It was like trying to explain alternate side of the street regulations to a bunch of Cranberries.

CompleteUnknown · May 29, 2012

We only chart behaviours if there is an increase in frequency or severity of existing behaviour, if there is a new behaviour observed or noticed, during an assessment period, or during a review period such as when there's a trial of reduction in medication. Otherwise we'd have pages and pages of notes or charts on each resident each shift.

However, we can't chart 'no behaviours this shift' (as that is rarely that the case) although we could chart something like 'current interventions for challenging behaviours remain effective' with a more detailed description once a week/month or as required by facility policy.

Agree that behaviours need to be documented so that successful interventions can be developed. Our main problem seems to be people documenting behaviours but not what was tried to manage it.

It's also true that staff get used to the way residents are, and work around this (use interventions) without even realising what they are doing. That's where you get the 'oh she's always like this' and in a way it's a good thing because it means that staff are meeting the resident's needs. The behaviour does need to be documented though; I think that sometimes some staff feel that it reflects badly on the resident if they write some of this down and will only document a behaviour if they find it personally upsetting. Maybe some staff education is needed at OP's facility?

IowaKaren · May 30, 2012

Another huge problem is being able to find the time to chart on behaviors along with new medications (any medication), treatments, falls, skin issues, Dr.'s rounding, faxing Dr.'s, calling the on-call Dr. for arising issues, making appointments and finding drivers, daily huddles, helping the CNA's, helping the other nurses when they get behind due to any of the above, etc. etc. I'm sure we all have the best intentions of doing everything in a timely manner but no one is super nurse getting 12 hours worth of work done in 8 hours. Charting behaviors is so very important but sometimes finding the time (and we are all told to find the time) is like pulling a rabbit out of 'yer hat.

nurselindah, BSN, RN · May 31, 2012

CYA! That's all honey! Good for you for charting what you see!