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?
It seems to me that some alcohol withdrawal patients end up in the ICU with tubes in every orifice and complications such as VAP CLABSI UTI which possibly could have been avoided and prevented if they have been medicated properly right from the start.
Pts end up that way in the ICU because of nurses not keeping up on regular CIWA assessments and medicating adequately, deferring the assessment until the patient wakes up. What you said you do is precisely why these patients are undermedicated; you are recording artificially low CIWA scores or none at all.
You say you aren't a fan of CIWA because patients aren't medicated well, but evidence has shown that CIWA is effective at preventing progression to severe withdrawal -- when you actually assess your patients.
There are studies that correlate restraints with worse outcomes, but I'm not aware of any that show restraints cause worse outcomes, those are two very different things.
I'm not aware of any studies that show the outcomes of patients needing restraints are due to the restraints themselves vs the underlying reason they are needing restraints.
I have read of incidents where restraints provided a means for certain patients to harm themselves, and I recall reading that in one patient's case restraints were directly related to their death. Restraints can can be harmful psychologically for patients. Even if a causative relationship is not demonstrated between the use of restraints and these events, and the patient's underlying medical problems could be demonstrated to be the primary cause, the fact that patients were able to harm themselves/be harmed through the use of restraints is significant. Our job as nurses is to keep patients free from psychological/physical harm. A current medical-surgical text book cites instances of patients being harmed through use of restraints, and strongly cautions against the use of restraints, stressing the the need for very frequent checks for safety, circulation, skin break down, position change, need for toileting, etc. Of course, there are situations where their use is necessary, but the watchword is use with great caution.
Yeah, of course they are in ICU. However, some facilities are discontinuing sitters and restraining pt's on regular floors. I find that very sad that grandpa has to be restrained instead of redirected by a sitter.
To answer your question, I do not lie, and I never will. Have you ever sat in a deposition?
Yes, that post was from a phone using autocorrect. Intubated.
I have read of incidents where restraints provided a means for certain patients to harm themselves, and I recall reading that in one patient's case restraints were directly related to their death. Restraints can can be harmful psychologically for patients. Even if a causative relationship is not demonstrated between the use of restraints and these events, and the patient's underlying medical problems could be demonstrated to be the primary cause, the fact that patients were able to harm themselves through the use of restraints is significant. Our job as nurses is to keep patients free from psychological/physical harm. A current medical-surgical text book cites instances of patients being harmed through use of restraints, and strongly cautions against the use of restraints, stressing the the need for very frequent checks for safety, circulation, skin break down, position change, need for toileting, etc. Of course, there are situations where their use is necessary, but the watchword is use with great caution.
I'm quite sure you will find more situations where patients injured themselves ( or staff ) because they were unrestrained or under-restrained, than you will find situations where patients were hurt directly as a result of being restrained. Restraints are generally used when patients exhibit self harming behavior (pulling at lines, tubes, climbing OOB, self mutilation, violence toward others). The risk of injury from being underrestrained is much greater than the risk of injury from being restrained.
I'm quite sure you will find more situations where patients injured themselves ( or staff ) because they were unrestrained or under-restrained, than you will find situations where patients were hurt directly as a result of being restrained. Restraints are generally used when patients exhibit self harming behavior (pulling at lines, tubes, climbing OOB, self mutilation, violence toward others). The risk of injury from being underrestrained is much greater than the risk of injury from being restrained.
If you read my post, you will see that I said that "Of course there are situations when their use is necessary, but the watchword is use with great caution."
How about those who chart "pleasant and cooperative" when describing a she-devil who bites, kicks and scratches. I chart what I see. I must be looking after Damian, because they aren't "pleasant and cooperative" when I get them.
I chart the behaviours, verbal abuse, etc. and very few on my unit do this.
Specializes in Certified Med/Surg tele, and other stuff.
How about those who chart "pleasant and cooperative" when describing a she-devil who bites, kicks and scratches. I chart what I see. I must be looking after Damian, because they aren't "pleasant and cooperative" when I get them.
I chart the behaviours, verbal abuse, etc. and very few on my unit do this.
I do the same, however, I always give an example of behavior or verbal abuse (in quotes) so if my charting goes to a jury, I won't get charged with neglect because my charting looks like I may be avoiding care because of the patients behavior. A jury may assume that I'm possibly exaggerating the patients behavior, but the quote can prove otherwise. Always give examples if you can.
Wow. Sounds like you work at a terrible facility. Restraints should almost never be used, and if someone is put in restraints, they undoubtedly SHOULD have extremities (one at a time) freed w/ active OR passive ROM q 1-2 hrs. Shame if you are not doing this!!!!
Lol....restraints should almost never be used? You must not work in a inner city hospital. I put on restraints first and get an order after so I don't lose a foley, IV or dobbhoff. I've seen nurses that are passive on getting restraints and the patient almost always gets hurt. Ever sene a pulled foley before? It's not pretty.
Don't worry, I chart what those sweet old girls say. Pt. told writer to "go fffff her self" and kicked writer in shin while continuing to should "female dog, female dog, go fudge yourself".
I would never document a turn that wasn't done. That being said, they require documentation every 2 hours. Not 2 hours 1 minute, not 2 hours 30 seconds, it HAS to be every 2 hours or sooner. I will enter even intervals 2000, 2200, 0000 etc. even though I know I didn't go in exactly at that time to do it. I feel that the important thing is the care you perform, but you shouldn't be charting basic nursing care if you haven't done it. It isn't acceptable to chart turns Q2 if it was only done twice in a shift, just as you shouldn't chart oral care Q hour in the ICU unless you actually did it 12 times in a 12 hour shift.
As for the passive range of motion, it has been so long since I've had a patient in restraints I can't remember the charting. I know that I don't take the restraints off unless there is a need because usually the patient has more opportunity to harm themselves and/or staff.
RNdynamic
528 Posts
Pts end up that way in the ICU because of nurses not keeping up on regular CIWA assessments and medicating adequately, deferring the assessment until the patient wakes up. What you said you do is precisely why these patients are undermedicated; you are recording artificially low CIWA scores or none at all.
You say you aren't a fan of CIWA because patients aren't medicated well, but evidence has shown that CIWA is effective at preventing progression to severe withdrawal -- when you actually assess your patients.