why double chart?

[grneyes676]

I have been reading sample narrative notes and soap notes online the last couple days, which has made me wonder.....why would you write a narrative note including all the data that should be on your flow sheet and in your shift assessment? Don't you risk making a mistake by charting the same things in 2 different spots?? Where I work, we chart our shift assessment on the back of our flow sheets.

[Forever Sunshine, ASN, RN]

Well we write a nurses note..thats in the chart.

And then a "status update" of that resident on the 24 hour report.

[Daisy_08, BSN, RN]

One Hospital where I consolidated (full time work term-whatever you wana call it) there was always triple, most often quadruple and sometimes quintuple charting. Huge pain in the but. you would write on the for example you empty a catheter bag: chart it on the paper flow sheet, say you suspect a UTI so make a PT note at the top of the computer charting system, then you enter it in your work load, then you enter in the amount in under I&O, then you enter that the pt voided under ADL's, Charting took up A LOT of time there!

[Sarah010101]

The hospital I work at only charts variences... but i have seen nurses chart narrative Lungs clear bilat, equal a/e etc... but on the flow sheet there is a ticky for clear...

[caliotter3]

We have to double chart because the employer told us to. The narrative note must include everything that was also charted on the assessment sheet, as well as everything that was done for the patient during the shift.

[getoverit, BSN, RN, EMT-P]

Good question. I've asked that for a long time. We were all taught in school that redundant charting can set you up for an inadvertant discrepancy, but seems like some places require it. I don't understand why.

I'm very lucky, we don't double chart at all (except for some nurses who seem to need to chart things more than once!) Everything pertinent is either on my flowsheet or in a daily assessment note.

[Neuro Guy NP, DNP, PhD, APRN]

At my facility, some nurses will double chart - once on the COW (computer on wheels), and once on paper in the MD's progress notes so that the MD or NP will actually take the time to look at the progress notes! If not, the MD or NP will walk up to the nurse and ask about the patient's status, which is fine, but as one of the nurses who double charts said that she prefers the doctor read what she wrote and only ask elaborative questions instead of making her go through the whole night's events, particularly when she is very busy when patients are ringing the call bells out the wazoo.

Just my thoughts.

[psu_213, BSN, RN]

I totally agree with the OP that it is potentially dangerous to double chart. For example, lets say either you or the aide chart in the flowsheet a set of vitals on a new admission. Some nurses 'rechart' the vitals in their admission note. If there is a difference between the VS on the flowsheet and those in the NN, then all the charting at that time is questionable (I read this example in a nursing journal).

In my NN I only put things that aren't covered by my 'regular' assessment. For example, there is no need to chart "A&Ox3, BBS CTA, BS + x4" if all those things are listed as "WNL" on the neuro, respiratory, and GI sections respectively on system by system assessment form. Some things I like to say are "no visible distress" (if, indeed this is true) or "call bell explained and given to pt."

The one time I will double chart is if the previous nurse noted, for example, wheezes and now the breath sounds are clear, I will mention that in my NN. Although, if I charted WNL for resp. I should not even have to mention that in my NN.

[Up2nogood RN, RN]

Every facility has different standards. I personally think it's dumb to double chart unless it's significant enough to warrant extra monitoring or a change in pt LOC, etc. Usually I will chart in my narrative something like- assessment completed see assessment flow sheet for details. No need to write a book.

[NPinWCH]

Every legal seminar I've been to made it clear that you shouldn't double chart. If there is a flowsheet; use it. Use narratives for things that can't be flowsheeted or for procedures. If you write it out, then you don't need to flowsheet it.

Personally, I like flowsheets...lets me see the most info about a patient in the quickest amount of time and no need to translate poor handwriting or spend forever reading notes. That being said, I write some things if I need to add more detail to my exam and I always document PRN medication requests, administration and results in the narrative. Sometimes, there is a quick note about teaching being done and then a note to see the education record for details, but to completely document it twice is silly and like I said, the legal people say it's wrong...

[steelydanfan]

Every legal seminar I've been to made it clear that you shouldn't double chart. If there is a flowsheet; use it. Use narratives for things that can't be flowsheeted or for procedures. If you write it out, then you don't need to flowsheet it.

Personally, I like flowsheets...lets me see the most info about a patient in the quickest amount of time and no need to translate poor handwriting or spend forever reading notes. That being said, I write some things if I need to add more detail to my exam and I always document PRN medication requests, administration and results in the narrative. Sometimes, there is a quick note about teaching being done and then a note to see the education record for details, but to completely document it twice is silly and like I said, the legal people say it's wrong...

I loved it when we went to computer charting "(you don't ever chart again unless an event occurs)"; and yet 6 months later, the nurse educator was chastising us about not enough nurses notes being written. The REAL problem was some nurse not writing flow notes during a sentinal event; but now it has evolved into every nurse feeling like they have to write 2-3 narrative notes a day.

[nfdfiremedic, BSN, RN]

We use an electronic record that pretty much walks you through the entire assessment, known in our system as "observations." When you fill out your observations, you click the appropriate box for each item (i.e. click on "bilateral" and "clear" or "left" and "dim" for lung sounds, and so forth.) Anything that you choose to write in a narrative form above and beyond this is at your own discretion, barring an event or significant change in condition that warrants detailed explanation.