Being asked to false document

[bossfrog]

Okay, I work on a psych unit. So I come into work tonight and we have a new "read and sign" instructing us to always put "yes" when our assessment form asks if the patient is interested in smoking cessation, smoking counseling, FDA approved smoking drugs and outpatient smoking cessation programs. The fact of the matter is that 80% of the time the patient is NOT interested in those things. The "read and sign" tells us to think of it as documenting that we are offering those things, but that is not the verbiage on the form. I am inclined to refuse to document this way and if they want to raise Cain about it, then I think I'll tell them that I will consult the Board of Nursing for advice on the matter.

I have already sent my unit manager an email outlining my concerns. What should I do if they tell me to do it anyway?

[jadelpn, LPN, EMT-B]

In the comment section "Patient educated regarding smoking cessation, agreed to (patch, smoking cessation....etc) while inpatient. Will continue to monitor"

Because unless your patient can go outside to smoke, I am assuming that they have a patch on. Which essentially means that they have agreed to participate--at least while in house.

[MaxAttack, BSN, RN]

I've never heard of someone losing their license over smoking cessation documentation.

Don't sweat the small stuff. You're stirring up trouble over semantics.

[klone, MSN, RN]

Can't they change their documentation? Smoking cessation counseling is a HEDIS measure. It needs to be discussed, but our documentation has the option of selecting "Patient not interested in quitting in the next 30 days." We are still required to provide cessation counseling, but that can consist of something as simple as saying "Quitting smoking is the single most important thing you can do for your health, I want you to consider at least cutting back."

[cayenne06, MSN, CNM]

I've never heard of someone losing their license over smoking cessation documentation.

Don't sweat the small stuff. You're stirring up trouble over semantics.

Yeah... but it is not helpful to chart "yes" to all that stuff if it doesn't reflect what is actually happening. I wouldn't do it, because it is ethically questionable and not in the best interest of the patient. I get that smoking cessation is an important benchmark, but it is met just as easily with truthful charting. The EHR template needs to be changed, which is a relatively easy fix (but unfortunately not a fix that nurses can make themselves, sigh. just another example of EHR systems being built with an eye towards reimbursement and meaningful use, instead of with the actual needs of practitioners and patients as paramount).

[bossfrog]

Essentially what this is is management pressing us to fudge the data for them to help the unit meet Core Measures metrics on smoking cessation and I've decided along with a couple others not to do it. If they want to threaten discipline, we'll have a conversation about that.

[Emergent, RN]

Another example of why cookie cutter mandates are an epic fail. They pile on more of them each year, with check boxes to fill in.

All of this so that the regulators can feel like they are saving lives by giving us forms on which to document, and auditing that documentation regularly.

[CryssyD]

If the question is whether the patient is "interested," and the patient is emphatically NOT interested in this instruction, you really shouldn't be charting "yes." What is the patient sues over something later, or just requests his/her records, and sees this? If they are petty enough to bring it to someone's attention (someone like a lawyer, or the DON of your facility), you could get in some trouble, I think. Not an expert, here, but little things can matter--I wouldn't answer it "yes" if it isn't true.

[jadelpn, LPN, EMT-B]

I would read the assessment again, and how it is worded. Most ask to educate on smoking cessation. NOT that the patient was necessarily interested in partaking of same. And again, if the patients are not allowed to smoke, is a patch offered? Which I am sure that some accept, some decline? So in essence, they are accepting of smoking cessation while in house. Or is there a smoking area? Can they go outside to smoke? You need to "educate" them on smoking rules of the facility. Then would be the time to educate regarding cessation.

More than one patient (psych and otherwise) have left facilities due to the inability to smoke, and the refusal of a patch. In the matter of a hold, it can become a behavioral issue, and a inability to accept any kind of assistance due to the overwhelming smoking want.

So to CYA, I would at least talk about smoking cessation, what is available to help them, what you can do for them at present. Chart that you have done so. Bottom line is that you have no clue whether they are gonna not smoke or not, but at least they have the information. And that would, I think, satisfy the "patient education" portion of your assessment regarding smoking.