Documenting visual checks

[dachweiler]

I work on an adult acute-care psych unit. When I first started at this hospital 12 years ago, we had 2 levels of visual checks/documentation: either every 15 or 30 minutes on a flow sheet. All patients had a flow sheet for at least 3 days. Of course, suicidal/violent or secluded or restrained patients always had a flow sheet with every 15 minute checks.

Now 12 years later, EVERY SINGLE patient has a flow sheet for their entire stay. It doesn't matter what the diagnosis or patient's condition is. And now we have 10 minute checks (called "Risk Level 1"). Most of the doctors order this Risk Level 1 on all patients upon admission and just leave them on this level for days....even weeks! Alot of patients definitely do need very close supervision and ALL patients should be visually checked regularly. But I am frustrated at documenting (with a number code and my initials) every 10 or 15 minutes on 16 patients. It seems that this "Level 1" loses its power when I'm doing it on someone secluded and then also on someone who has dysthmia & just wants a "med adjustment."

How do you document your visual checks? Do you use flowsheets?

I am mainly just venting and am curious how other psych facilities do this.

(But my right hand aches from all the paperwork!!)

[PGH70]

hello dachweiler. I too work in an adult 46 bed psych inpatient unit. the only pts who get q15 minutes checks are those on Suicide PreventionII, and those on SP I get q 10 min. the SP I pts have one to one staff with them at all times, so this is rare. All the rest have a daily flow sheet. Perhaps your checks are determined by state regs. If the form could be designed where you just intial each check, and then put your signature only one time at the bottom , may be less writing.

It is impossible to do patient care for 15 or so patients plus keep up to date on the checks. I guess its just so they know who to blame if something goes wrong with that patient.

[MHN]

Hi Dachweiller, we used to have 3 levels of checks but due to recent events we now have 5 levels which range from never out of your sight(suicide watch),10/60 for seclussion, 15/60 for high dependency unit ,30/60 checks and last but not least 1hrly check.

These are all done on a check sheet for each individual client 24/7.

The check levels are initially set by the Doctors on admission they can only be decreased by the docs however we the nurses can increase the score .

The level of checks are reviewed each day by the treating team(docs)in discussion with the nurses.MHN

[pattyjo, MSN, RN]

Our 15 minute checks are fairly easy. The assigned nurse is responsible for all routine(q 15 min.) checks on his/her assigned patients and these are charted on the flow sheet one time for the 8 hour shift. If patients are in seclusion or restraints (which is happening less frequently) we have a separate flow sheet for that. Since we do have to see each patient every 15, regardless of condition, we don't use the various levels. At a hospital where I worked previously, we had a list of patients on a clip board and checked off that they were actually seen by a staff member every 15 minutes. Never knew how legal that would be, but we never got cited by any agencies, so I guess it was ok.

Patty

[sjoe]

You are right. If everyone is on the same level, then levels don't mean anything, since there's only one. Sounds like your docs are lazy and just trying to cover their butts without putting any thought into level assigning.

IMHO.