Last night an hour before shift change, my baby came back from surgery and was on a vent. Vent keep on beeping off, CXR was done, NNP looked at X-ray, X-ray showed that the ETT was in to far, so it needed to be pulled back just a bit, so our RTs in NICU pulled back just a bit and vent continue to go off. RTs examine vent and tubing and decided that the baby needed a 3.0 instead of a 2.5...so they notify NNP, but NNP was nowhere to be found, page NNP...RTs decide that it would be in the baby's best interest to go ahead to change the ETT..myself and another RN was at bedside. Anyway, ETT change, baby was fine, no harm to baby whatso ever...NNP came back when RTs were securing the new ETT, look at ETT and agree that it was the baby's best interest to change the tubing and everything went smoothly from there. 15 minute before shift change, one of the RTs comes up to me and stated that an incident report needed to be filled out because it was an "unplanned extubation"...so I did that...then went back to my charting and charted what happen. At the I wrote, "...incident reported filled" in the nurse's note. My question is, was I wrong to put "incident report filled" on the note???
amen. we can argue over the presidental race crocs ~vs~ nursemates, which shift works the hardest, etc., etc.,:argue:[/size']
..but not over documented and researched standard nursing practice. i'd really be leery of working with a nurse whose practice was determined soley by "this is what feels right to me personally..":no:
and i leery of one who could pretend to presume the entirety of another's practice based solely on a clearly stated never-even-performed and therefore hypothetical act.
and amen is right, we sure do know who can argue:chuckle
ya'all can pile on all you want. i find it fascinating! i made some fact based statements along w/a healthy dose of skepticism and what a bone some of our puppies choose to repeatedly go after. i don't scare easily....
for those w/the ability to comprehend:
1) i've never filed an incident report.
2) stated if i didn't feel the practice for doing so was 'kosher' so to speak and had representative evidence that such procedure in my own facility was indeed corrupt and w/out ability to comply w/chain of custody for lack of better terms
3)then, i would choose to chart it.
i find it doubly humorous that many of the same nurses who advocate so strongly for having our own malpractice insurance, despite authoritative assurance from employment facilities that 'you don't need it, we've got your back' and have then either read here or even experienced the horror of that situation coming to pass without said back up and instead said 'set-up', could then not possibly think that in some situations it might be better to deviate from an otherwise accepted practice.
the really funny part, just this morning in our apn forum a mid level practicitoner discussing a completely different issue that necessitated his filing of numerous incident reportd then found this come to pass(and i'm pretty sure he'll forgive me the license):
unfortunately for the hospital before things escalated they had a surprise inspection by jcaho (now the joint commission). i was asked to explain the background behind the stack of incident reports. things got even more tense when i pulled out my copies and noted that some were missing. net result was some new management was put in place which was much more sensitive to the needs of the patients.
wh-wh-what???? the shock overwhelms....
keep on keepin' on and one day should the need for my own report ever come to pass, i will most fondly think of my fellow posters who so passionately care for me, little miss mab, so very very much:heartbeat
and i leery of one who could pretend to presume the entirety of another's practice based solely on a clearly stated never-even-performed and therefore hypothetical act.
:heartbeat
....and since you have not performed this act, i would be interested in how you have avoided noting any "incidents", ever. once a month per nurse was about average on my previous floor, since these were used for process improvement, not "punishment".
i don't presume to know the entirety of your practice, nor does the matter hold much concern, since i neither give or receive report from you . you are, of course, free to practice and chart however you desire. however, choosing to fly by the seat of one's pants in opposition to established practice guidelines doesn't hold up well in court. hey, its your life..
Our incident reports are filed electronically, which gives all parties who contribute the opportunity to amend (ie "missing DD found on bench at shift change") and view, rather than vanishing into thin air. I quite often go back over incident reports I've generated to see what action was taken further up the chain, and it reinforces for me that the aim is to look at system errors rather than assign blame.
I generate incident reports for a variety of events that would not otherwise be documented - like when a lift didn't open flush with the ground and I tripped face first: I wasn't injured, but a LOL could well have been. Last week I was kicked in the face by a demented patient: I wasn't injured, and it wasn't something that affected the patient, but I generated an incident report because it's assaults like this that led to us having a security response code and patient attendants to sit with disruptive patients.
On a number of occasions incident reports to do with drug errors have a note from the unit manager to the effect that the nurse involved was councelled about drug administration and procedure etc. I wonder if, in the event the patient's case went to court, even on an unrelated issue, and a notation was made in the history that an incident report had been completed, that nurses' file could be accessed to look for similar councelling events, to establish a pattern. Or if the incident report was categorised as being a drug error, type X, if the legal team could ask to see all similar reports, looking for ward- or hospital-wide trends.
I'm not a lawyer and I don't know, but I was always under the impression that it was for these reasons, rather than because incident reports contain more 'truth' than nursing notes, that documenting the generation of incident reports in patient notes was against hospital policy.
I find it doubly humorous that many of the same nurses who advocate so strongly for having our own malpractice insurance, despite authoritative assurance from employment facilities that 'you don't need it, we've got your back' and have then either read here or even experienced the horror of that situation coming to pass without said back up and instead said 'set-up', could then not POSSIBLY think that in some situations it might be better to deviate from an otherwise accepted practice.
I fail to understand how you perceive an incident report "covers your back" or would otherwise be desirable to have as 'back up' in court.
An incident report is an internal quality improvement document. The intention is to prevent future occurances - it's not a document that protects you after an incident occurs - that's what your charting is for.
If you respond to this post, please answer this question: what would you write in an incident report that you wouldn't write in your charting?
Like BlueRidgeHomeRN, I also don't understand how a nurse can practice for "enough years to know better" and never have submitted an incident report - perhaps you're not "covering you back" as well as you think you are.
One note: If you keep you own copy THEN it is subject to "discovery" by the opposing side. That's also why it isn't wise to keep your "brain" after your involvement with the patient is over. One copy is to be made for the benefit of YOUR side.
...could then not POSSIBLY think that in some situations it might be better to deviate from an otherwise accepted practice.
You've never read Patricia Benner's "From Novice to Expert."
Of course I deviate from 'otherwise accepted practice,' but not in ways for which there is very clear evidence that would increase my liability and the probability that I would get sued.
That's also why it isn't wise to keep your "brain" after your involvement with the patient is over.
Really? I had a professor in nursing school (pediatrics) who said she kept all her jot sheets for 18 years (since parents can sue until the child is 18, generally speaking) because if she was ever sued, she wanted to have something of her own to jog her memory of the child. Because of this, and because I greatly respected her and trusted her, I have been storing my own jot sheets.
If this is actually not a good habit, I'll go destroy them. I never thought about it from that perspective, as in having to provide a copy to the other side.
If this is actually not a good habit, I'll go destroy them. I never thought about it from that perspective, as in having to provide a copy to the other side.
Again, it has to do with discovery. If you are called in to testify, you may be asked if you kept any notes from your patient care. If you answer yes, those notes become discoverable and you may be required to enter them as evidence. If you say no under oath, you have committed perjury.
What ever you think you will need in court, what ever you need to jog your memory should go in your documentation.
guys! thanks so much for all your input! I talked with my medical director and manager this morning and told them what had happen exactly, showed them my charting and that stated that they will take care of it. We had all misunderstood one another everything is being resolved right now as I speak. Thank you everyone!
and i fail to understand how you could possibly be reading so selectively, to be generous, as to have not quite yet comprehended the salient point behind my obviously unique stance here.
as much as i'd wish you really were just simply ignorant or slow, and not instead just engaging in some pointless melodramatic display of what one could only call a pathology of sorts, i do know this is simply a game and though it appears some have dramatically more free time than others, i'll continue to respond as time and (lord knows not only my) patience will allow.
the poster above, talaxandra, gave an excellent description of a system in place that appears to fulfill all of the safeguards that i would hope to be in place when utilizing the "ir" procedure. as in my first, and laughingly imagined before entering into this toxic reality some seem to thrive on, and would-be only post, in this environment i would indeed follow accepted practice and have no qualms or need not to.
stretch the boundaries of your imagination if need be and imagine for a moment that not every hcf has such a transparent system in place. imagine even, to answer tag-team #1's question as to how one might actually have worked and never have filed an ir, that to do so one might have been at one such hcf that may not promote/encourage or, in fact, even provide such a system at all.
of course not for long....
to answer tag-team#2's questions:
i fail to understand how you perceive an incident report "covers your back" or would otherwise be desirable to have as 'back up' in court.
i should just respond, repeatedly asked and answered, but wth. the simple proof that such a previous ir exists, particularly multiples of such regarding same, would not allow a hcf to deny any such knowledge of whatever the issue at hand is and therefore proceed as if this 'whatever' had only occurred as the failure of one individual or a team or whoever at hand.
you're not this slow... i even quoted a provider who has witnessed filed incident reports disappearing. you wanna take the fall for the tenth exact process error because the hospital has no record of anything similar before which would lay the preponderance of liability on the institution and not whatever scapegoat du jour exists?
an incident report is an internal quality improvement document. the intention is to prevent future occurances - it's not a document that protects you after an incident occurs - that's what your charting is for.
color=black]right, i think that concept is clear. are you clear that lots of procedures are in place in theory that don't actually work in reality? oh yeah, you are nurses.....as blatantly referenced, my charting is fine, i'm not overly concerned w/my protection. what i don't want to do is protect an egregiously at fault facility. why would you?
if you respond to this post, please answer this question: what would you write in an incident report that you wouldn't write in your charting?
nothing. geez, enough w/the asked and answered bs. except i would hope if anyone else who knows of the existence of this horrid practice might do same in event of egregious error/death as then proof of prior knowledge cannot 'disappear' as, unprompted even, someone on this site today day cited a credible example of.
like blueridgehomern, i also don't understand how a nurse can practice for "enough years to know better" and never have submitted an incident report - perhaps you're not "covering you back" as well as you think you are.
no, the question states, years of practice? well, in my case, months would have sufficed for me to say 'enough to know better'. as it took me only that long to realize that unfortunately in certain nursing cultures a toxic and maladjusted attitude is not only accepted and encouraged but that those who don't whimper and tolerate and perpetuate same so easily become the next target.
whatever guys, it's your game....because no way anyone is this dense.
i'm off to the lake....but i'm by at least every other day or so. if per usual, this round will continue long enough until even the players themselves can't stand each other.
ooouuuu. The lake sounds so good. We are waiting for the possible tornado outbreak. Praying it passes.
Personally, I don't even use the term "incident report" in nurses notes.
It seems that nurses use this term differently.
It is used to report anything out of the ordinary- family/patient/visitor emotional of physical incidents, equipment incidents, patient medical situations out of the ordinary, management contact situations, non-response to pages...
Some see it as a form of punishment- something that most facilities are trying to change.
Miss Mab
414 Posts
and i leery of one who could pretend to presume the entirety of another's practice based solely on a clearly stated never-even-performed and therefore hypothetical act.
and amen is right, we sure do know who can argue:chuckle
ya'all can pile on all you want. i find it fascinating! i made some fact based statements along w/a healthy dose of skepticism and what a bone some of our puppies choose to repeatedly go after. i don't scare easily....
for those w/the ability to comprehend:
1) i've never filed an incident report.
2) stated if i didn't feel the practice for doing so was 'kosher' so to speak and had representative evidence that such procedure in my own facility was indeed corrupt and w/out ability to comply w/chain of custody for lack of better terms
3)then, i would choose to chart it.
i find it doubly humorous that many of the same nurses who advocate so strongly for having our own malpractice insurance, despite authoritative assurance from employment facilities that 'you don't need it, we've got your back' and have then either read here or even experienced the horror of that situation coming to pass without said back up and instead said 'set-up', could then not possibly think that in some situations it might be better to deviate from an otherwise accepted practice.
the really funny part, just this morning in our apn forum a mid level practicitoner discussing a completely different issue that necessitated his filing of numerous incident reportd then found this come to pass(and i'm pretty sure he'll forgive me the license):
-------------------------------------------------------------
posted by coreo
unfortunately for the hospital before things escalated they had a surprise inspection by jcaho (now the joint commission). i was asked to explain the background behind the stack of incident reports. things got even more tense when i pulled out my copies and noted that some were missing. net result was some new management was put in place which was much more sensitive to the needs of the patients.
wh-wh-what???? the shock overwhelms....
keep on keepin' on and one day should the need for my own report ever come to pass, i will most fondly think of my fellow posters who so passionately care for me, little miss mab, so very very much:heartbeat