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?
Are you working with psych to prisoners? Balanced, sober people who are lucid don't yank out foleys... I have seen it in psych, prisoners and people with dementia of many origins. You have a rough crowd. Prisoners are usually shackled though...
Even younger, "balanced, sober" people can develop acute delirium while hospitalized and yank Foleys and anything else.
I work with several organisations delivering education and development. Falsifying documents is a serious failure of duty of care and will result in disciplinary action and further education to promote compliance with essential systems and ways of working. If this is happening regularly in this field, without checks and balances then where is the truth in what you are trying to achieve????
I don't believe a single nurse, save possibly ICU, who tells me she doesn't copy/paste at least some of the assessment info from those flowsheets. Regulatory bodies are not nurses. In a perfect world....
There are some really hateful comments on this post. Is this entire site like this? I'm new to this site. Frankly I'm shocked. Angry people, or those who are so burned out they have become just nasty...probably should reconsider working in this field. Maybe look into computers, or construction? I often wonder why someone would go into this field when they are not good with people, don't like people, and are generally hateful. Someone once told me it was for the money! That cracked me up. But, I guess if someone is in it for the money, they have never had much, and a nurses hourly drew them in. The money is terrible! Maybe that's why teachers make poverty wages...to repel people who don't have a calling to teach. I wouldn't want some angry, life hating person yanking my grandmother up in bed, or treating her like trash, any more than I would want a child loathing, mean teacher abusing my children. There is a reason we hold licensure. Nursing is a privilege. Abuse the system, or the client, and you will be caught eventually. Better yet, Karma will get you. You will be in that bed one day soon, or someone you love dearly. Better hope your nurse is nice, and cares.
Well that's true. Anyone can develop delirium. People are capable of anything, particularly if they are getting poor medical and nursing care because of the staffing and attitude conditions. I remember restraints being popular at Grady Memorial in Atlanta. That was a very sad hospital. Private hospitals, with insured clients hire more nurses, and have better ratios. County/public hospitals are understaffed, and often with nurses who don't even want to be there. It's a rough situation all over.
I worked at one hospital that monitored charting on restraints because of a Joint Commission citation for not having enough documentation, but then the charting had to meet the quality monitoring person's needs. So if charting every 2 hours, the quality people wanted to see it charted on the odd hours... literally 9,11,13,15, etc... so you would be asked to change or add charting if you say... checked the patient more frequently... or checked them early because you knew you would get busy with preparing another patient for a procedure, etc. Plus a lot of nurses copy and paste the restraint assessment without correcting it... for instance did you really evaluate them exactly the same way to see if restraints could be removed? Did you really realease them every two hours and do ROM as you have charted... or just every 4 hours as required?
That is one example... to many times the needs of the quality control people override the nurse's right to chart her work accurately. Plus no one is looking at the quality of the charting or if it reflects cares provided.
Sometimes it feels like the charting is so heavily micromanaged but the quality of care is not. That old "if you didn't chart it you didn't do it" thing... did anyone expect it to go the other way? That under pressure by monitoring of documentation by quality contorl... that people are charting more and more things they have not done?
the time variance is based on whether it is medical or behavioral restraints. behavioral should be q15 minutes everywhere. medical is if they are trying to pull out lines, tubes, etc. and only requires q2h
Well that's true. Anyone can develop delirium. People are capable of anything, particularly if they are getting poor medical and nursing care because of the staffing and attitude conditions. I remember restraints being popular at Grady Memorial in Atlanta. That was a very sad hospital. Private hospitals, with insured clients hire more nurses, and have better ratios. County/public hospitals are understaffed, and often with nurses who don't even want to be there. It's a rough situation all over.
I'm all for better nurse-patient ratios, but I agree with your theory. The highest rate of delirium occurs in ICU patients, about 70% of patients in an ICU develop delirium, yet we have one or two patients per nurse, so if your theory is correct, shouldn't ICU have the lowest rate of delirium?
There are some really hateful comments on this post. Is this entire site like this? I'm new to this site. Frankly I'm shocked. Angry people, or those who are so burned out they have become just nasty...probably should reconsider working in this field. Maybe look into computers, or construction? I often wonder why someone would go into this field when they are not good with people, don't like people, and are generally hateful. Someone once told me it was for the money! That cracked me up. But, I guess if someone is in it for the money, they have never had much, and a nurses hourly drew them in. The money is terrible! Maybe that's why teachers make poverty wages...to repel people who don't have a calling to teach. I wouldn't want some angry, life hating person yanking my grandmother up in bed, or treating her like trash, any more than I would want a child loathing, mean teacher abusing my children. There is a reason we hold licensure. Nursing is a privilege. Abuse the system, or the client, and you will be caught eventually. Better yet, Karma will get you. You will be in that bed one day soon, or someone you love dearly. Better hope your nurse is nice, and cares.
Ah, another young 'calling' nurse accusing those lesser mortals among us of being mean, nasty, burned out, and life-hating... and of having no place among the saintly few... all while wishing the brimstone of karma down upon their heads.
But in that situation I chart "patient appears asleep" in the comment section under the flow sheet. If a patient previously asked me to let them sleep instead of waking to turn, I will document this in a nurses note. "Patient sleeping calmly at this time, will not wake to turn as per patient discussion previously this shift. Patient educated on the importance of turning and repositioning in relation to skin breakdown, patient requested not to be disturbed when sleeping. Will monitor."
If it's a restrained patient we actually have a selection, "patient appears asleep". If they are awake... Then I will get assistance to release the restraints/perform care, ect... If it's an incontinent patient we are checking them every two hours anyway, which probably included turning. Care clustering, yay! I release wrist/ankles one side at a time that way if the patient is very violent they can't do too much damage.
elkpark
14,633 Posts
Even younger, "balanced, sober" people can develop acute delirium while hospitalized and yank Foleys and anything else.