Disaster charting: how’s your hospital changing charting in response to the COVID-19 pandemic and how do you feel about it?

[RosalindaRN]

I know that many hospitals, including the hospital I am employed by, have moved into “disaster” or “crisis” charting. For my hospital this means charting Q12h on each patient and charting changes in condition (I.e. the patient went into respiratory distress and went from RA to 15 L NRB). Previously we had charted Q4H and charted changes in conditions as well. Additionally we are no longer charting on patient education or ADLs which is something we had previously been expected to chart on at least once a shift. What kind of changes are you all seeing to charting at the hospitals you work? Are you concerned at all that the changes in charting could be putting your license in jeopardy? In nursing school I know we were all taught “if it isn’t charted, it didn’t happen” so I wonder if we really are protected in the event a patient or patient family member decides to pursue legal action. Thoughts?

[JBMmom, MSN, NP]

We have a disaster navigator in our epic EMR. Fortunately, our 12 bed unit has not really been over-run, we've ended up tripled at most and most of us hate the disaster charting because it's not the flow that we're familiar with. I think there are also some allowable changes to frequency per our organization, but most of us have not found it necessary to do so. I had a 1:1 assignment recently and the only thing I had to adjust was not scanning all of blood products given in the massive transfusion protocol because some of the products were given in IR and at CT scan. A verbal second check was done with another nurse. I think there are also some additional coverages for things like your license and hospital liability under pandemic/disaster conditions. Good luck!

[LovingLife123]

I love disaster charting!!  I chart a full assessment once a day and then note any changes.  Vitals are still hourly.  I and Os are q4 now.  No plans of care or education.  I have taken full advantage of it which has  freed me up to actually care for my patients properly.  
 

I don’t get those who don’t take advantage of it.  It gives you more free time to do all the things you need with your patients.  Several of my coworkers have stated, I don’t trust it.  I don’t even know what that means.  It’s been approved to chart that way.  My patient’s skin has never been better because I actually have the time to fully assess and treat things before they turn into pressure ulcers.  

Im able to be proactive instead of reactive with disaster charting!!

[TheMoonisMyLantern, ADN, LPN, RN]

I work in LTC, at my employer out documentation has actually increased. All residents regardless of covid status get q4hour vital signs which may not sound bad, but when your floor has 60 residents it takes time. On the covid unit which holds 30 residents and has stayed full the past several weeks all the residents must have a cardiopulmonary assessment completed by an RN qshift in a narrative note along with their overall status. As you can imagine it takes quite a bit of time to assess thirty residents and chart it. The notes are in addition to all the usual charting we do, and then of course charting for medications, wound care treatments, IV meds/fluids, etc. Some nights I'm the only nurse on the floor, but they've tried really hard to have two per shift. Even then it's pretty rough.

I think the reason our charting has increased is that LTC's have been having so many deaths and outbreaks that the facilities are bracing for scrutiny once the pandemic is over with.

[JBMmom, MSN, NP]

2 hours ago, TheMoonisMyLantern said:

I work in LTC, at my employer out documentation has actually increased.

That sounds like the worst possible change to make in LTC. I guess that I can understand the reasoning, as you stated, but the increased workload in an environment already known for running short on staffing sounds horrible. I'm so sorry you have to deal with that, on top of taking care of residents that can't see family or friends. So much attention has been paid to the doctors and nurses that work in hospitals, I think the true heroes of this pandemic have been all staff members in LTC! I hope that things return to something closer to normal for you soon!