Documention in the Emergency Dept.

jayne109, RN · Feb 12, 2008

YuP!! we are going through the SAME thing and it is driving me up a wall! There are laminated cards everywhere that say Revenue lost for different stuff not charted-like $1087 for not charting an actual (not TKO, KVO, WO)rate on NS. Not charting stop times for antibiotics-and having to do it on multiple pieces of paper. Sorry, soap box for me!

bill4745, RN · Feb 13, 2008

We have a computerized charting system, and we have to chart in detail every little thing we do. We check off boxes and the chart says "

"Placed on cardiac monitor, alarms on , sinus rhythm, pt identified by hospital bracelet and stating bday".

MAISY, RN-ER, BSN, RN · Feb 13, 2008

Even though we have computer charting, our chart has a "superbill" all items are listed and have to be checked off....all it needs is an order by the doctor to be billed correctly.

Maisy

LeesieBug · Feb 14, 2008

THIS IS DRIVING ME BLOODY CRAZY!!!!!!!!!!!:bugeyes: :uhoh3:

OP, thanks for posting this to give me a chance to express that heartfelt thought!

Our big one now is the IV rates/solutions/stop times....to the point of having to state that "fluids continued at time of transfer", on a pt that is being flown our for a trauma, or other critical situation....

Exactly WHEN do you ever d/c an iv on a dang trauma patient or an AMI prior to transfer..if I didn't chart that we suddenly decided to d/c the IV (oh wait, I guess he doesn't really NEED the nitro or integrilin..it's all just fluff), then by God it is still running as they head out the door....

I just want to pull my hair out. If this was the only item of minutia that has to be charted in multiple, ridiculous ways I would be okay...but it is one of a million tiny details that have to be in the chart, just so, to satisfy billing requirements.

TinyNurse, RN · Feb 15, 2008

The way it was explained to me is that each year medicare changes what exactly it will pay/reimburse for. This year it just happens to be start and stop times on IV infusions. It's weird because as a travel nurse I see the push for the changes at each facility I visit.

One facility I worked at had computer documentation and wouldn't allow you to close the chart unless you charted a stop time on an infusion (or noted that it continued to infuse at admission or transfer).

I agree, the more time charting means less time with the patient. makes me mad.

TraumaNurseRN · Feb 15, 2008

We had a staff meeting this morning and were told (again apparently...I was away for awhile) that the insurance companies will not pay for care unless we document (basically for them) the same information (ie., IV starts, fluids, rates, actually most of the interventions, etc.) in multiple places on multiple forms. Does this happen in "your" emergency dept/hospital also?
Does this even make sense in emergency depts with over crowding, nursing shortages, the acuity of many of our patients, etc?
The way I see this...and I'm venting now...this leaves the nurse taking care of the chart and not the patient. We charted many years ago to document/communicate the cares, then for the lawyers to prove that we "did" what we said we did....now the insurance companies/medicare are telling us how to chart, thus how to spend our time and direct our cares!!!!
Or is this just "my" hospital? Please share with me.
Thank you.
UP Nurse

yes....we do it as well...but ya know, I see the point, we spike a bag and don't chart it....it doesn't get charged....So in the end, the ones with insurance pays and the others don't...somone's gotta pay....:nuke:

raynefall · Feb 15, 2008

We are doing this at my hospital also. They sent us an email saying that the stop time needs to be clicked off in a reasonable amount of time. Let's see, in the midst of all the emergencies, I suppose I'm supposed to stand there and watch each med drip all the way down to the last drop in order to click it off right after it's completed, ridiculous..... charting the fluids/med was given should be enough, imo.

S.T.A.C.E.Y, LPN · Feb 19, 2008

This is one thing I'm glad that we don't have where I work. Here in Ontario its a government run health-care system, so we don't have to worry about billing insurance companies. I dont have to keep track of the minute details for everything. I've talked with some friends working in the states and the differences in our charting is HUGE. I may not have the help of a tech to take care of all my little tasks, but I don't spend my day behind the desk or computer charting each and every minute detail of what was done.

loricatus · Feb 20, 2008

We are doing this at my hospital also. They sent us an email saying that the stop time needs to be clicked off in a reasonable amount of time. Let's see, in the midst of all the emergencies, I suppose I'm supposed to stand there and watch each med drip all the way down to the last drop in order to click it off right after it's completed, ridiculous..... charting the fluids/med was given should be enough, imo.

This got me thinking about what happens when a code comes in: Do they not pay for IVP and IVF if the the resuscitation effort isn't successful, using the rationale that the patient was already expired? What about IVF that continues after the expiration time is called? Really gotta start wondering how far this stupidity is going to go-pretty soon they are going to have us start calculating the actual drops so that billing can accurate . :smackingf

:idea:What we really need are scribes-a nursing student that follows us around and does our charting for us, just like some doctors have (with premed students as their scribes).

Altra, BSN, RN · Feb 21, 2008

This got me thinking about what happens when a code comes in: Do they not pay for IVP and IVF if the the resuscitation effort isn't successful, using the rationale that the patient was already expired? What about IVF that continues after the expiration time is called? Really gotta start wondering how far this stupidity is going to go-pretty soon they are going to have us start calculating the actual drops so that billing can accurate . :smackingf
What we really need are scribes-a nursing student that follows us around and does our charting for us, just like some doctors have (with premed students as their scribes).

Brilliant! :up:

But ... why would IVF continue to infuse after expiration time? In my experience, MD calls it, all IV tubing gets clamped until coroner's office is called.

UP Nurse · Feb 21, 2008

I appreciate all the comments to my post. Thank you everyone.

I really think it is another way for insurance companies to avoid paying for services for their customers. The more details they require of us, the more chances we will miss documenting something that common sense (where did that go?) says we did...like stop IVs when the code is called.

Smaller hospitals do not have interns, residents, etc., to "write" for attendings. We do have a "recorder" for codes, usually an LPN...then it is reviewed by the RN in charge of the patient at the time of the code. But when it is a critical patient, who isn't coding, we are on our own and there could be a lot of IVs, IV drugs (start and stop times...where they flushed and with what...again start and stop times....dispite what policy says you will do).

It is very frustrating...nursing a piece of paper rather than the patient, just so we are paid to care for the patient...in a time of nursing shortages and increased patient volume. Ugh!!!!!

UP Nurse