Do you chart lies?

[RNdynamic]

Does anyone else find themselves taciturnly encouraged by their organization to chart lies, or to put it another way, to enter fictitious information into flowsheets? Of course the organization would never want you to come out and say you are doing this, nor would they or you want to think of your little data entries in the flowsheets as not being truthful. We always seem to find ways to rationalize what we are doing.

For example, my facility requires patients in restraints to have q2hour visual checks and in the column for that visual check, you are supposed to inspect skin under the restraint, offer fluids or food, check for incontinence, and perform passive range of motion. You're supposed to check off that you did all this, every 2 hours. Now, I know damn well that neither myself nor my peers actually perform passive range of motion exercises on our restrained patients every 2 hours. Most of these patients you want to avoid disturbing at all costs or they'll start screaming their heads off or try to climb OOB. But we all check off that we did passive ROM. Some people might rationalize this by saying "well, when we change his gown we are performing passive ROM on his arms," or some other equivalent stretch of the imagination.

Another example is charting "patient was turned q2h" when they were turned maybe twice in the shift. Another big one is entering in a CIWA assessment for a sleeping patient. I'm sure there are lot of excellent nurses out there who wake their patients to perform CIWA (which is what you are supposed to do) but most I know will not wake up an alcohol withdrawing patient in the rare moments they can be found sleeping unless absolutely necessary. Yet, they all put in the CIWA assessments on time. I could go on and on, with people charting that saline locks are patent without flushing them, non existent pain reassessments, and so forth.

Do you encounter this often? And being as honest as possible, have you or do you do it? Do you feel that you have much of a choice?

[elkpark]

I've never charted stuff that I didn't actually do, and I've never worked anywhere that encouraged me, "taciturnly" or otherwise, to do so. On the contrary, what I've seen is nurses getting into serious trouble for falsifying records to indicate that they provided care that they didn't actually do. In a worst case scenario, that is something that can cost you your license, and your employer certainly will not defend you if it gets reported and investigated.

[RNdynamic]

Honestly, I have never seen a nurse get caught for falsifying records in either of the hospitals in which I've worked, but I've seen nurses chart lies all of the time. How would they get caught? In most cases it is impossible to prove something wasn't performed just for the reason that no one saw them do it, unless it is something blatant like faking a dressing change and someone finds the old one still on the patient or documenting you gave a med but you didn't and the old IV bag from yesterday is still hanging. Those sort of things generally are not the type of lies that people chart. Usually it is the smaller stuff, and I see it almost every day. Mostly stuff that is in flowsheets in little boxes that you check off.

In my old hospital, we were so short on the med/surg floor and often have no aides and some of the young charge nurses just "wrote in" their 2am vitals because they were sick of doing extra work and thought that the vitals were pointless.

[toomuchbaloney]

I don't narrate things I didn't do.

I don't check off boxes for tasks I did not complete.

There is more than one way to get into trouble with unethical employers and refusing to fill in all of the boxes neatly so that it looks like everything was done on time and with a smile, when they weren't is one of them.

When you determine not to falsify your records to make your employer happy you must be prepared to be reprimanded with an expectation that you will complete ALL of the tasks. Choose your battles carefully.

Good luck.

[icuRNmaggie, BSN, RN]

ICU nurses are supposed to document a full assessment every 4 hours. Now am I really going to check peripheral pulses, mental and emotional status on a sleeping stable patient at midnight, no. I chart rhythm, VS, asleep appears comfortable and assessment deferred so as to not disrupt pt's sleep. I will do a focused assessment on this person again when he awakens. ICU patients should have a brief hourly note.

I chart truthfully and in the moment as much as possible.

I will do the CIWA ( VS skin tremors) on a sleeping pt and release restraints whenever I have help and document accordingly. I only check the ROM box if I did ROM.

No one has ever reprimanded me for the way that I chart.

[RNdynamic]

To do a CIWA assessment, a patient has to be woken up, and you are supposed to wake them up to do it. This is part of the protocol. You can't assess hallucinations, delusions, headache, or even tremors when a person is sleeping. Even withdrawing patients sleep, and documenting the absence of a tremor in a sleeping patient is not accurate charting. In my opinion, you would be charting lies.

[icuRNmaggie, BSN, RN]

I leave those areas blank so I am not charting lies. I back it up with my hourly note. There is a lot you can eyeball in a sleeping or sedated person.

What matters is that they are safe, the symptoms are under control and free of seizures. You know you can feel tremors in a sedated person without waking them up.

[RNdynamic]

If you are leaving parts of the CIWA assessment blank, then how are you calculating CIWA scores? The point of CIWA is to calculate a score at regular times using a standardized tool. Based on the score, you medicate the patient to stay ahead of severe withdrawal symptoms and prevent them from going into worsening withdrawal and a t/f to the ICU.

If you are calculating CIWA scores on sleeping patients and leaving parts of it blank, you are not following the protocol and you aren't coming up with CIWA scores. You can't assess orientation, anxiety, hallucinations, delusions, etc on a sleeping patient. Even tremors are masked by sleeping. The CIWA assessment is designed to be used on a patient after they are woken up.. so I don't know what you are doing... but it doesn't sound good.

[caliotter3]

I've seen it all the time. Every time a nurse falsified her time sheet to be paid for work not performed, I have not been the only person aware of the act. Clients encourage it, some demand it, employers usually brush off the report and do nothing. I've been called in, sat down, and told what to do because someone was in the building inspecting or something, and lucky for me, what I was asked to chart was factual. I already knew what kind of employer this was. Down the road I ended up leaving because I witnessed something and reported it. I made a third report outside of the employer because I knew I had to; to defend myself if the employer turned the tables on me, and because I am a mandated reporter. Nobody likes to pay the price for doing what they are legally required to do. Always easier to chart the truth than to be wondering what will be the consequences if one gets caught on the other side of the coin.

[icuRNmaggie, BSN, RN]

It doesn't sound good to awaken a sedated DTs patient either. It sounds dangerous and unnecessary.

We will have to agree to disagree.

[RNdynamic]

It doesn't sound good to awaken a sedated DTs patient either. It sounds dangerous and unnecessary.

We will have to agree to disagree.

If someone is having DTs, they aren't going to be on CIWA. They are going to be in the ICU on MINDS. DTs are lethal and involve seizures and cardiac instability.

Tons of people undergo DTs because they were undermedicated on the CIWA protocol, often due to nurses deferring assessments because they don't want to wake up patients or giving artificially low scores to sleeping patients. That is what is dangerous.

[icuRNmaggie, BSN, RN]

The CIWA is a guideline for potential alcohol withdrawal and not a substitute for clinical judgement.