Core Measures, who is responsible?

Editorial Team / Admin · Sep 16, 2015

You may want to check out the Nurses expecting to do too much thread, as this is the issue being discussed there.

I am of the opinion that I am a patient advocate. If that means reminding a physician to order DVT prophylaxis, I'll do it. Yes, they should remember to do these things themselves, but they are fallible humans who have moments of forgetfulness just like everyone else.

Karou · Sep 16, 2015

CosmoRN started the "nurses are expected to do too much" thread.

Editorial Team / Admin · Sep 16, 2015

CosmoRN started the "nurses are expected to do too much" thread.

Guess I should check posting history a bit more often. Not quite sure why there's another thread on the same subject by the same person...

Karou · Sep 16, 2015

Everyone is accountable for core measures. The things included in core measures are included for a reason- patient safety. As nurses patient safety is our highest priority, and it is our duty to advocate and ensure that they get the best care in the hospital as well as at discharge.

I don't like having to remind a physician about a core measure issue. I also don't like when the nurse following me has to point out an order I missed or how I could have done something better. I try to be humble and realize we are all human, and the patient is the goal here. Doctors are human and make oversights as well. It's our duty and obligation to bring important matters to their attention. Core measures can be annoying but are very important financially and for the patients health overall.

I have mixed feelings on the new nurse positions that were created almost entirely to ensure that things like core measures are correct. They do save the hospital money by reviewing charts and reminding nurses to contact physicians before we have a core measure fall out... I just wish they would contact the physicians themselves rather than making us be the middle man. Then their position would feel more like a relief than instead of another eye over my shoulder being critical. Oh well.

It's not about me, or you, or the physician. It's always and forever about the patient.

As long as a nurse has documented attempts to bring a problem to the physicians attention, I don't think the nurse should be held accountable. We can't force a physician to do anything. We can tell them the problem, and if it's not being handled correctly, go up the chain of command. If a physician is truly refusing to address the concern than he needs to be spoken to by someone in higher authority. Or explain his rationale.

It's annoying, I know, but it's part of our umbrella of obligations in birder to ensure patient safety and good care.

I wish we could rely on everyone else doing their jobs right... physicians, lab, RT, PT, dietary, EVS... But we can't. Everyone is human. We as nurses are the last line of defense, the most direct care providers in contact with the patients. We will forever be stretched too thin and held responsible for everything. It's difficult, but it's nursing... Wish we were viewed as more human too sometimes though...

care.

CosmoRN77 · Sep 17, 2015

I like your response. I promise I didn't become a nurse just so that I can be an *******. I did it because I love taking care of others. I'm digging deep into myself and asking what is causing me to have inner conflict with my job. I have come to realize that it is basically coming from feeling overwhelmed with tasks And now I feel as I'm having to do other people's jobs and suffering consequences if not. Administration is not treating us as if we are doing something to help out and going above and beyond.. Thy are treating us as it's our job and we must do it or else. What a great strategy to promote team work. It is natural to start giving pushback and wanting to have a defining boundary between physicians and nurses in order to protect my job and license. Team work is awesome and I love to help. But at the same time my patients and my task completion comes first and foremost as my license is protected by me and only me.

CosmoRN77 · Sep 17, 2015

Having said that above, I'd like to seek out legal counsel for being coerced into doing a job outside of my nursing practice...

VANurse2010 · Sep 17, 2015

Core measures are everyone's responsibility. However, at my old hospital, nursing was not expected to document on things that were outside their scope of practice - i.e. we were not required to "check the box" that metoprolol was ordered with HF, for example, because ordering medications is something that we cannot do. Physicians had ultimate accountability for that. However, certain measures like patient education that definitely are a nurse's responsibility were tracked and nurse's were held accountable for that. It was a decent system.

At my current hospital, an academic medical center, the responsibility for these things lie solely with physicians - because there are plenty of interns and residents to dump it on.

dishes, BSN, RN · Sep 17, 2015

Having said that above, I'd like to seek out legal counsel for being coerced into doing a job outside of my nursing practice...[/quote
That's a good idea, maybe your malpractice insurance provider can advise you. It is better to have clear understanding of the legal implications before a sentinel event happens than to find out after.

MunoRN, RN · Sep 17, 2015

Making sure a patient is receiving appropriate care is not "outside of nursing practice", there are few things more core to nursing practice.

singwithme123 · Sep 18, 2015

Making sure that core measures are completed is not outside the scope of practice for a nurse. Writing the order yourself for VTE prophylaxis or the ACE-I for a CHF patient is another story, but I doubt you are being "coerced" into doing that. Core measures are evidence-based best practices for patient care. Yes, most of them require a physician's order. However, I have seen plenty of situations where core measures were missed, and it was the fault of the nurse. (M.D. orders SCDs, but the nurse never documents that they were applied or refused. There is an order to remove a foley on POD #2, but it isn't done. Discharge instructions are not complete or documented properly. Things like that..)

It is probably a huge hassle for some quality nurse or your nurse manager to be crawling up and down your back to make sure that things get done. I promise that there is some hospital finance person or CEO who is crawling all over them about it too, because of the impact that it has on facility reimbursement from Medicare. Most non-profit hospitals run on extremely tight margins, and they rely on getting every single penny of reimbursement that they can in order to survive. With value based purchasing, there is a financial incentive for the hospitals to make sure that their core measure scores are high. Unfortunately, historically there has not been any sort of similar financial incentive that impacts the doctors, but that is changing.

So... Take a deep breath, and ask the dang doctor for the order or the needed documentation. Even tho it doesn't feel like it sometimes, the measures really are important, and they are EVERYONE's responsibility.

mmc51264, BSN, MSN, RN · Sep 18, 2015

It seems to always come down to the nurse. (Unless you can find a resident to throw under the bus JK)

Was just talking about this the other day when something didn't get ordered that I somehow got, not blamed, but asked about. I cannot order narcotics. THAT much I do know!