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?
About self extubations: it's been shown in the literature that unrestrained patients do not have significantly higher rates of self extubations than restrained patients who use all sorts of creative maneuvers to get the tube out. They will shake their heads. Use their tounges. Sit up and bring their head down to their hands. Or bite the tube clean through. There is no substitute for eyes on the patient. Of course this isn't always achievable, but ICU nurses spend a lot of time in patients rooms, assessing everything about the patient, including restraints. Yes, turning and positioning does happen Q2 hours on my unit. So does releasing restraints and monitoring them per protocol. So these tasks are completed, not always at the exact time such as 8,10,12.
If one has enough time to watch other nurses and see how their tasks match up with their charting, then one has time to do their own work and not have to falsify charting.
About self extubations: it's been shown in the literature that unrestrained patients do not have significantly higher rates of self extubations than restrained patients who use all sorts of creative maneuvers to get the tube out. ...
This seems to be a myth, a common myth, but still a myth. Every study I've seen to supposedly support the claim that restraints don't prevent self-extubations doesn't actually support the claim. The ones I've seen are retrospective, which means they are looking at whether or not nurses were accurate in guessing which patients might self extubate, and what they show is generally that we need to restrain more patients if we want to prevent self extubations, not that we need to restrain less.
Lets see your looking at a retrospective review of 100 intubated ICU patients. Of those 100, 80 were restrained and 10 of those self-extubated. Of the 20 not deemed to need restraints, only one self-extubated. This seems to be typical of the study results that people incorrectly believe show restraining patients is more likely to cause self-extubation. Those 20 not deemed to not need restraints typically include brain dead patients, persistently vegetative patients, paralyzed patients (either through medication or injury) etc.
The only way to know if unrestrained patients have a higher rate of self-extubation is conduct a randomized controlled trial, which none exists, likely because it's quite obvious that the unrestrained group will have higher rates of self-extubation with everything else being equal.
I had some nurse aides give me some crazy blood pressures one time. I thought they were just jotting numbers down. The next night I gave each of them a deceased patient. Lo and behold room 407A had a bp as well as 208B . I fired them on the spot. Don't chart what you don't do!
I work in a major university medical center in the Northeast, with magnet status. That goes to show you how prevalent this sort of thing really is.
In most modern EMR systems, it is difficult to "chart lies". In most facilties, there are teams of IT people whose job is to look at computer footprints. If you are sitting at terminal one at the nurse's station to on a laptop at beside.
Most do not have a function for a copy and paste. There are more often than not the inability to "change times". Or is there is that ability, it readily shows when you changed said time.
If people go in and change documentation, it shows a complete footprint of that as well.
How do I know this? Being with a fellow coworker as their union delegate when laid out in front of us was a complete timeline of what was and was not being done--captured in black and white. Some backed up with video camera footage. This facility even went so far as to copy personal email checked with the company computer.....and YES, if you are using company WIFI on your personal phone, that can be captured as well.
Awesome possum, big brother is alive and well in health care. And mind you, the goal is not IF you did or did not do something. It is regarding reimbursement, and by falsly charting and getting caught you are affecting their bottom line.
"I don't believe a single nurse, save possibly the ICU, who doesn't admit to "copy paste". Trust me, it's done in the ICU. It's not considered illegal if the nurse accurately documents changes from the previous assessment by changing what they wrote prior. It does, however, increase the chance of error.
Specializes in Nurse Leader specializing in Labor & Delivery.
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.
But wait, aren't you the OP who said that the nurses routinely chart lies? So how is that better than what you are saying is so horrible by skipping a CIWA or doing it while they're sleeping?
Specializes in Nurse Leader specializing in Labor & Delivery.
I think we all work with one of those. Ours wakes up sleeping patients to give them the bedtime Ambien.
Sent from my iPad using allnurses
It's quite common for post-surgical patients to wake up in horrible pain because they had been sleeping and weren't given their pain medication. When I worked L&D, I would still wake post C/S patients when pain meds were due and encourage them to take them.
My mistake, I should have clarified. To decrease self extubations, in restrained or unrestrained patients, there also must be other interventions put in place by the team, such as sedation vacations and respiratory driven protocols. With the use of these, our unit has achieved a 40% reduction in self extubations. I do maintain the view that restraining a patient is not going to prevent self extubations in patients who really want that tube out.
Specializes in Certified Med/Surg tele, and other stuff.
"I don't believe a single nurse, save possibly the ICU, who doesn't admit to "copy paste". Trust me, it's done in the ICU. It's not considered illegal if the nurse accurately documents changes from the previous assessment by changing what they wrote prior. It does, however, increase the chance of error.
We don't have a copy paste feature, so it isn't possible. I wouldn't use it anyway because it is too dangerous, IMO.
Specializes in Certified Med/Surg tele, and other stuff.
It's quite common for post-surgical patients to wake up in horrible pain because they had been sleeping and weren't given their pain medication. When I worked L&D, I would still wake post C/S patients when pain meds were due and encourage them to take them.
We routinely wake our surgical patients up for pain meds as well. They actually sleep better when they aren't in pain.
I'd say the only thing I frequently chart inaccurately is timing. I don't usually write down exact times of when I assessed a patient, or when I changed a dressing or started an IV, so I'll approximate when I finally get around to charting what I did.
Vanilla101
28 Posts
About self extubations: it's been shown in the literature that unrestrained patients do not have significantly higher rates of self extubations than restrained patients who use all sorts of creative maneuvers to get the tube out. They will shake their heads. Use their tounges. Sit up and bring their head down to their hands. Or bite the tube clean through. There is no substitute for eyes on the patient. Of course this isn't always achievable, but ICU nurses spend a lot of time in patients rooms, assessing everything about the patient, including restraints. Yes, turning and positioning does happen Q2 hours on my unit. So does releasing restraints and monitoring them per protocol. So these tasks are completed, not always at the exact time such as 8,10,12.
If one has enough time to watch other nurses and see how their tasks match up with their charting, then one has time to do their own work and not have to falsify charting.