Circular Logic in Nursing

[BrandonLPN, LPN]

So, as a night shift LPN at my facility, one of our duties is to perform 24 chart checks for new orders. This being a large 500+ bed facility, one nurse might find himself responsible for upwards of 80 chart checks depending on staffing. So it can be fairly time consuming.

And, as is standard in LTC, each unit has a 24hr communication board on which days/evenings notes which residents had new orders written that day. Simple enough. And, this being LTC, it's not at all uncommon for only a dozen or so residents to actually have new orders on any given day on a given unit.

But what dives me nuts is that most of the night nurses I work with think that checking each chart is unnecessary cause "you only need to check the ones who're on the 24 board".

It goes like this:

Other nurse: "Sweet! I only got six charts to check tonight!"

Me: "You realize you have to check every chart, right?"

Other nurse: "That's stupid, there's only six residents on my 24hr board."

Me: "Yes, but you don't know there weren't other orders"

Other nurse: "Yes, I do" *waves 24hr board like I'm an idiot*

Me: "Yeeees....but what if an order got missed?"

Other nurse: *blank stare*

Me: "If the day nurse missed an order, wouldn't it stand to reason that order wouldn't

be on the board?"

Other nurse: *blank stare* "But there's only six orders on the board!" *once again waves the 24hr board as though I'm an idiot*

Me: *seizes board from them and proceeds to beat them to death with it*

Or something like that.....

[Alex Egan, LPN, EMT-B]

Yea...chart checks mean every chart. The 24 hour sheet is a tool but not foolproof. Back when I did LTC we would check all 60 charts every night.

[iluvivt, BSN, RN]

Could you explain to them that the whole purpose of the chart checks is to look for any missing orders and to verify the ones you already know about for accuracy. I think that if they are this dense you need to give them some likely scenarios. While you were at lunch the doctor came in an changed the coumadin order and forgot to flag the chart or whatever your system is and place it back in the rack. When you do your 60 charts check you find the missed order....yeah....give them examples. I have never worked in LTC but I get it!

[TheCommuter, BSN, RN]

I'm so glad my facility transitioned to electronic charts for all patients. Nowadays, a chart check consists of a double-click on the patient's name to look for new orders.

I worked in LTC for six years. My least favorite task was the 24-hour chart check.

[Farawyn]

Never worked in LTC, but in the hospital we had to check the chart when it was flagged and every 8 hours, timing and signing each chart while on paper and clicking it when we switched to EMR. I often found orders not flagged. Most of us checked the charts, or it was our ass.

Now I have a picture of a buxom British man/woman beating other nurses to death with a white board and an evil grin, though, so thanks for that. :/

[Libby1987]

"..and this is to ensure all of the orders made it to your board." ?

backed up with beating them for good measure.