CNA training: Some questionable behavior

puggymae · Jul 27, 2007

This is NOT acceptable. I once worked with someone who charted for the entire shift before she ever saw the patients! One evening she charted for 0600 "asleep. Noneventful shift. No noted change in condition." The only problem was at around 0100 the patient coded and died. The coroner was called in. The BON was notified. This incident eventually ended in court.

The people you work with will be sorry if the State makes a surprise visit and notes the charting!

Jamie2887 · Jul 27, 2007

Ok, so as I posted before I am taking CNA classes for the NS. Today was my 2nd day of clinicals, and I observed some practices that other "real" CNA do, and I am not sure they are doing the right thing. Just a couple examples: In charts they are charting for July 27, 28, 29, while it's only the 26th. They charted that resident K. had 50% food intake and 300 ml. fluid during the day shift on the 29th!!!!!! 2 days FROM now. They also charted that resident V. had 1 BM, was anxious and restless, and they changed him 2X (briefs) and walked him outside for 10 minutes. Again, this was under July 29th. When asked, they told me that it's called "mirror charting" when they chart ahead based on the "usual behavior and numbers" for this particular resident. So, if I usually have 1 bm, and eat 50% of my lunch, they will chart that for the whole week on Monday!!!! They also did the same thing with vitals: pulse, BP, etc.
Am I just jumping to the wrong conclusions, or should I talk to the nurse?
Thanks! :uhoh21:

I would ask someone about this! It dosn't sound right, I start NS in aug, but i'v worked in an emergency clinic for a year, and we NEVER assume anything, even if a patient has been to our clinic 3 days in a row, we have to re-check ALL vital signs, it either sounds like they were trained the wrong way, or maybe just lazy, but I wouldnt risk you getting in trouble.

trainer2070 · Jul 27, 2007

I'm not agreeing with it at all, but with the CNA's that I've worked with that is very common. I've only seen a couple that actually go around an record the actual meal %., VS, fluid intake, bm or times changed. They usually go by what the previous day was for the same category. They get away with it because no one calls them on it.

santhony44, MSN, RN, NP · Jul 27, 2007

Even if this is considered acceptable practice in that facility, it's not good practice. As Puggymae says, it can cause real problems if the expected events don't happen or something else happens, and that's always a possibility. A resident can code, become ill and be admitted to the hospital, so on and so forth.

I would say that it's basically falsifying a legal document and I would agree that state could do a lot with this.

xNursePinkx2b · Jul 27, 2007

It's not right at all, unfortunately, it is common. They'll have a lot of explaining to do if state comes in and checks charts, or if a patient dies and someone checks their chart. Just don't do what these people are doing, it can get you into a lot of trouble.

leslie :-D · Jul 27, 2007

and to think a part of my assessments are based on what the techs chart...

but even more frightening, it's not only techs/assts who do this. :stone

leslie

Dolce, RN · Jul 27, 2007

Wow, and I thought pre-charting 10 minutes ahead on PACU flowsheet charting was bad... Pre-charting 3 days in advance!?!?! Unbelievable! The patient record is for FACTS only, not "usual patient behavior." This is so upsetting because it calls into question the entire work of the CNAs at that facility. If they are so unethical about their charting, how is their patient care? I bet it sucks!

RNsRWe, ASN, RN · Jul 27, 2007

Holy Mackerel, I can't believe I'm seeing posts saying this is common! COMMON?? At my hospital, there'd be a freak-out of biblical proportions if this were discovered to be occuring.

Our techs only chart on the I&O sheets what they dump out of foleys and urinals, and toilet hats. And that's assuming they bother. They can't seem to bother charting whatever they actually gave the patient in terms of intake, so forget about charting too much, LOL!

I sometimes see nurses doing nighttime charting early in the evening, or evening charting in the morning, and all I can think about is "what do you plan to say or write to cover your butt when you LEAVE and the patient doesn't match up to the charting later??" Much like the post on this thread that mentions a patient having a "noneventful night" at 0100 and that patient is dead before breakfast. Good planning there.

I think it's stupid to chart anything ahead of time, so obviously a three-day advance is asking for a lovely lawsuit when that patient dies on day two of the Psychic Charting and the family figures out that no one has been paying a danged bit of attention to their Dearly Departed.

And like Leslie, I DO base some of my assessments on the vital signs that I see charted by the techs, and the outputs. If I caught one of them charting on the next HOUR ahead, I'd have their butts in a sling, I can promise you that!

RNsRWe, ASN, RN · Jul 27, 2007

When asked, they told me that it's called "mirror charting" when they chart ahead based on the "usual behavior and numbers" for this particular resident. So, if I usually have 1 bm, and eat 50% of my lunch, they will chart that for the whole week on Monday!!!! They also did the same thing with vitals: pulse, BP, etc.
Am I just jumping to the wrong conclusions, or should I talk to the nurse?
Thanks! :uhoh21:

Oh, and by the way, the phrase "mirror charting" is a creative way of saying "lying through my teeth and falsifying a legal document, for which I can be held liable".

It's not careless charting, it's deliberate deception. It's fraud.

MoopleRN · Jul 27, 2007

At my former facility, a NH, it was common on 1st and 2nd shifts for the aides... until State found out. Nurses are responsible for the aides/their charting and while they can't keep looking over their shoulder as they chart, a frequent looksee, IMO, is in order. At my current facility, a hospital, charting is way more accurate.

I don't think the original poster is jumping to the wrong conclusion (what wrong conclusion IS there if they're obviously falsely documenting) and yes, s/he should talk to the nurse. In private.

bethin · Jul 27, 2007

Huge no no! What if they chart that a resident ate 50% of supper two days from now but in two days they are deceased and buried? That chart is going to be reviewed. There's too many what if's that could happen. How can you guess what a resident's output will be in 2 days? That is very important, especially if the resident has CHF, renal failure, etc.

My advice: don't do what these aides are doing. Someone will notice and you'll be in a heap of trouble. Do what you know is right. Even if they give you a hard time don't do it. It may be nice to be friends with your coworkers but it's not necessary. It's more important to take care of the resident and be truthful.

When I worked LTC I was too busy to chart as it happened let alone do two days worth of charting. I stayed over just to catch up on charting baths, meals, activities, etc.