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?
Where do you work?? I want to make sure I never end up there as a patient . What you are describing is illegal, immoral, and jeopardizing lives. I suggest you blow the whistle on your employer and refuse to engage in further deception in your charting. Sadly... Your employer will throw you right under the bus if something untoward happens. Your license is in jeopardy not to mention freedom. Falsifying medical records is a crime punishable with jail time. There is just so much wrong here... Run don't walk to a better job.
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.
Great thread, very relevant in today's disconnected world. Thank you RNdynamic for shining some light on this common practice.
Thanks for the kind words. No one wants to admit to themselves that they're responsible for cutting corners like this. In earnest, I believe that the people in this thread who admit to having charted lies are actually more honest, trustworthy people than the ones saying they never have. Ironic but true.
In earnest, I believe that the people in this thread who admit to having charted lies are actually more honest, trustworthy people than the ones saying they never have. Ironic but true.
That's quite a statement, considering you don't know any of us personally or have any experience with our practice. So, are you in fact saying that you consider the rest of us to be lying?
To put it another way, I believe that the open admission of having charted lies is more a sign of honesty and trustworthiness than the concealment or denial of having charted lies.
To put it another way, I believe that the open admission of having charted lies is more a sign of honesty and trustworthiness than the concealment or denial of having charted lies.
That's not really "put(ting) it another way;" you're saying that you think those of us who say that we haven't "charted lies" are lying about that. Is it really so inconceivable that there are nurses who consistently chart honestly? I haven't heard anyone here say that we never make mistakes, or we never overlook anything, or we're never too busy to get every little thing done -- we're just saying that we don't chart things we didn't do (which is, after all, falsifying medical records). Is that really so hard to believe? The people who openly admit to falsifying medical records are more honest and trustworthy?
I used to frequent this site more often but I became tired of the Holier Than Thou nursing comments and am reminded of this here. Can someone please make me understand why nursing is supposed to be some "special" profession that I would sacrifice my firstborn child to save someone else's life? It's a job! Just like any other. I can be great at my job( kind, compassionate and caring) without giving up my personal freedoms, my rights, my own health, my sanity and my dignity. Anybody here do nursing work for free? When we stop promoting a Florence Nightengale demeanor for PAID WORK, we may actually get some RESPECT.
I work NOC at a facility where I have ETOH withdrawals every shift, I am very experienced by now with the protocol and will over estimate CIWA scores to keep people managed well with their symptoms. The kiss of death is when day shift says they were "fine" all day and under medicated....
With that being said I will NOT wake an ETOH patient Q2 if they are sleeping but will if it's been 4 hours. That's protocol btw and works just fine....
I have been waiting for a thread like this for a long time. Sounds like the OP is saying that the emperor has no clothes and quite a few are shocked and insist that they always see clothes on the emperor.
Where do I start? When I worked long term care and switched to an EMAR, my nurses all of the sudden had panic attacks because the medication turned red when it was overdue. With the traditional paper MAR, placing initials in the box signified that the 0800 medication had been given between 0700 and 0900 (1 hour either way). The five years prior to the EMAR, I didn't see one nurse circle the initialed box and indicate on the back of the MAR that the medication was actually given at 0905 or 0930 and give the reason why. Every nurse "lied" by placing their initial in the box when meds were given after 0900. The EMAR only reminded them of the fact that they had been "lieing" for years. The only time they would ever consider marking the med pass as late would be if a surveyor was watching.
Now an ICU scenario: We were audited by JACHO and found deficient on Blood Transfusion V.S. Whoever interpreted our policy decided that we had only 1 minute before and after for the post 15 minute V.S. There was a few minutes longer allowance on the 1 hour post starting. This created a huge mess for nurses and auditors. The direction from the top was to implement a paper that would be issued with the Blood unit so that all the VS's could be charted on that separate paper. (The reasoning here being that nurses would approximate the time blood started at the neorificest 15 minutes and would then write the subsequent VS times in when the unit was started.) They knew that nurses would then fill in the numbers in the pre-filled time slots whenever the VSs were actually taken.
The ICU rebelled because our VS are all automatic with pressures cycle every 15 minutes on the quarter hour mark. We were failing the audits because we might start the blood at 0905 but our VS were charted at 0900 and 0915 so we didn't follow policy. Plus we also validate our monitor VS into the electronic chart. The solution here was for blood to only be started on the quarter hour marks (00, 15, 30, or 45). This made our numbers look pretty to the auditors but it wasn't very realistic. It was soon learned that we could scan in the blood in a row of EPIC that was already passed, so if the blood bank called at 0955, and I received the unit at 1001, I could back chart to 1000 instead of having to wait 14 minutes to double check and start the blood. With lots of work and oversight from management, we finally got our accuracy up high enough to pass the next survey. This doesn't even begin to talk about "blood to vein" time as being the actual time that VS should start. Luckily JACHO didn't concentrate on that whole scenario.
Also when the department of health comes out to investigate Hospital Aquired Pressure Ulcers, the facility better have documented those every 2 hour turns or else. Don't know how much leeway the surveyors give on turn times. How many turns that were every 2 1/2 hours before the hospital owns the pressure ulcer?
So, yes, I guess I would have to say that I have lied in my charting. In my practice, I have not found the EHR to be practical for real time charting. If charting was really in real time reflecting actual practice, management and surveyors would have a bit of a rude shock. Government doesn't reimburse enough to truly provide the care that is required by the regulations.
I have been waiting for a thread like this for a long time. Sounds like the OP is saying that the emperor has no clothes and quite a few are shocked and insist that they always see clothes on the emperor.
Where do I start? When I worked long term care and switched to an EMAR, my nurses all of the sudden had panic attacks because the medication turned red when it was overdue. With the traditional paper MAR, placing initials in the box signified that the 0800 medication had been given between 0700 and 0900 (1 hour either way). The five years prior to the EMAR, I didn't see one nurse circle the initialed box and indicate on the back of the MAR that the medication was actually given at 0905 or 0930 and give the reason why. Every nurse "lied" by placing their initial in the box when meds were given after 0900. The EMAR only reminded them of the fact that they had been "lieing" for years. The only time they would ever consider marking the med pass as late would be if a surveyor was watching.
Now an ICU scenario: We were audited by JACHO and found deficient on Blood Transfusion V.S. Whoever interpreted our policy decided that we had only 1 minute before and after for the post 15 minute V.S. There was a few minutes longer allowance on the 1 hour post starting. This created a huge mess for nurses and auditors. The direction from the top was to implement a paper that would be issued with the Blood unit so that all the VS's could be charted on that separate paper. (The reasoning here being that nurses would approximate the time blood started at the neorificest 15 minutes and would then write the subsequent VS times in when the unit was started.) They knew that nurses would then fill in the numbers in the pre-filled time slots whenever the VSs were actually taken.
The ICU rebelled because our VS are all automatic with pressures cycle every 15 minutes on the quarter hour mark. We were failing the audits because we might start the blood at 0905 but our VS were charted at 0900 and 0915 so we didn't follow policy. Plus we also validate our monitor VS into the electronic chart. The solution here was for blood to only be started on the quarter hour marks (00, 15, 30, or 45). This made our numbers look pretty to the auditors but it wasn't very realistic. It was soon learned that we could scan in the blood in a row of EPIC that was already passed, so if the blood bank called at 0955, and I received the unit at 1001, I could back chart to 1000 instead of having to wait 14 minutes to double check and start the blood. With lots of work and oversight from management, we finally got our accuracy up high enough to pass the next survey. This doesn't even begin to talk about "blood to vein" time as being the actual time that VS should start. Luckily JACHO didn't concentrate on that whole scenario.
Also when the department of health comes out to investigate Hospital Aquired Pressure Ulcers, the facility better have documented those every 2 hour turns or else. Don't know how much leeway the surveyors give on turn times. How many turns that were every 2 1/2 hours before the hospital owns the pressure ulcer?
So, yes, I guess I would have to say that I have lied in my charting. In my practice, I have not found the EHR to be practical for real time charting. If charting was really in real time reflecting actual practice, management and surveyors would have a bit of a rude shock. Government doesn't reimburse enough to truly provide the care that is required by the regulations.
Well said, ICU/DON. You have demonstrated the hypocrisy of the con side to the argument. In our e-charting program, we can actually alter the time to an earlier point in the shift but not a later point in time.
Karou
700 Posts
Did not read all the replies before my initial post... Wow.
Some really good information though. Especially for waking patients on CIWA protocol. Thank you for that information!