Ok......I just got a call from the night charge nurse. She audits the restraint charting somewhere around 2000hrs. She called to tell me that I didn't check the box (in EPIC) that states I notified the family regarding the restraints. Every other bleepin' box was checked except that one..........she called me to tell me that I had missed that one box. FYI.....this lady was maxed on pressors, rapid Afib, intubated and lined today and started in CRRT....wasn't like I was sitting on butt all day.
She apparently will call you up to 2 times and on the 3rd time if your restraint documentation isn't perfect........you have to come back in to fix it. I work 12 and half hr shifts. Some staff members have been called as late as 2200hrs. Can this even be legal???? I feel totally harassed. I was always under the impression that my documentation was mine....done under my license. If I failed to complete everything, than it was my license at risk and that it would also show up on my evaluation.
Can management really call you for such small infractions?
If management called me at 2200 hours because a box needed to be checked, then guess what? I will be RIGHT there--
but if you are union, look at your contract first. Because you call me in, I clock in, and if I am there for 4 minutes or 26 minutes, you pay me a minnimum of 2 hours on call back. Thank you very much.
AND if you are unable to advise family the patient is being restrained (which must be an ICU thing--never heard of it) then what, you can't restrain the patient? Or you do, and what just "say" you informed the family? If this is policy or an order? Maybe whomever signs consents for the patient at admission is also notified that the patient can be subject to restraints for safety. Otherwise, I can't see the sense of daily phonecalls to family "we need to restrain patient xxx again" so a box can be checked. Check the box on admission with the other 999 boxes regarding family education and informing of plan of care. I am surprised you don't get more "noooo don't restrain my loved one" debates....
Yes, the late hour stinks, and it is a huge pain to haul one's butt out of the bed to go check a box, however, I will do it, but you can bet the farm I will be paid for it. And with night differential and my overtime rate too.
Muno, you might want to read your "compliance resource" a little more thororoughly (like, past the first sentence). The sentence you quote above is referring specifically (only) to JCAHO standards. The full response to the question about family notification goes on to reference NIAHO and CMS regs. The final senteence?
"And, as always, check specific state requirements."
The reason she is so strict on this is because it is a Joint Commission guideline and if not followed, the hospital could be held liable. Yes, your nursing license could be effected - that is if the family takes the facility to court over the patient and restraints are brought up. I recommend making sure you click the box from now on - yes, we all forget from time to time but people who are auditing the charts are just trying to cover the facility and your license :)
Is there something stopping you from "auditing" yourself after a restraint episode? That's what I have always done -- sat down once things were quiet again, or, at least, before I left at the end of the shift, and reviewed all the paperwork myself to be sure I had completed everything appropriately. It is easy to overlook paperwork things in the heat of the moment and being focused on providing the actual care to the individual, but, as you have noted, we are professionals and responsible for our own professional practice.
And it's not about reimbursement, it is about documenting that you did provide the quality of care that you say you are providing and that the state and federal rules/regs require. As much as it bugs all of us, we all know that "if it's not documented, it wasn't done." And, yes, I realize that, on the other hand, a checkmark in a box is no definitive proof that something was done, but, short of having somebody follow every nurse and physician around, every shift, every day, it's the best system we've got.
This is the crap right here, written by people that have never done the job but claim they have, that is causing all the problems.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
mcleanl said:
Actually Altra ..............what I am understanding is that we aren't documenting for better patient care but to satisfy TJC. As a nurse......I find that very satisfying (yes, I am being sarcastic). There are two camps of people........one camp that can admit how ridiculous this all is and the other that seems to believe that has some sort of deep level of importance.
I promise you, my patient outcome will not change based on this one box. If reimbursement is the issue.....and I sense that it might be........someone should be auditing me before I leave........so I can leave and rest my weary bones at the end of my 12 and a half hour shift.
Sure, If box checking is where it is at and what it is all about........no problem. I could actually reduce the amount of energy I spend on patient care and really focus my time on the box checking.
I feel you on this part-- the documentation isn't more important than the patient care. But the reason why they are auditing the documentation is because that's the way they audit the patient care. I understand you are running your butt all day, but family needs to be notified if restraints are initiated. Why? Because they may need to think about whether they want to continue with aggressive treatment, once they know what is going on. They may need to think about whether mom wanted that. They need to have the option to say no. And that's about patient rights and patient care.
Specializes in orthopedic/trauma, Informatics, diabetes.
We have recently been pushed to audit restraint charting as well. Must be a Joint Comm pet project lately.
I am not sure about making someone come back in and chart something. I live 48 mi from work. No way in hell am I coming back in to work.
I do audits for hypoglycemic treatment and documentation. We have people that do pain assessments/reassessments, CAUTI criteria. None of them require IMMEDIATE attention. That's kind of unreasonable.
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jadelpn, LPN, EMT-B
9 Articles; 4,800 Posts
If management called me at 2200 hours because a box needed to be checked, then guess what? I will be RIGHT there--
but if you are union, look at your contract first. Because you call me in, I clock in, and if I am there for 4 minutes or 26 minutes, you pay me a minnimum of 2 hours on call back. Thank you very much.
AND if you are unable to advise family the patient is being restrained (which must be an ICU thing--never heard of it) then what, you can't restrain the patient? Or you do, and what just "say" you informed the family? If this is policy or an order? Maybe whomever signs consents for the patient at admission is also notified that the patient can be subject to restraints for safety. Otherwise, I can't see the sense of daily phonecalls to family "we need to restrain patient xxx again" so a box can be checked. Check the box on admission with the other 999 boxes regarding family education and informing of plan of care. I am surprised you don't get more "noooo don't restrain my loved one" debates....
Yes, the late hour stinks, and it is a huge pain to haul one's butt out of the bed to go check a box, however, I will do it, but you can bet the farm I will be paid for it. And with night differential and my overtime rate too.