I have a quick story and then a question to ask my fellow nurses... I am a wound care nurse in a LTAC hospital and have been with the same company for the past five years. Our company has hospitals all over the country. A little more than a year ago my very good friend and charge nurse with this company was promoted to CNO at one of our hospitals about two hours away. Long story short: my husband received a very nice job offer in the same city she was transferred to and, eventually, we moved and I accepted a position in the same hospital. She is now my CNO - my boss.
It is our corporate policy to take photos of any alteration of skin integrity within eight hours of admission. If the wound nurse is not available, the charge nurse is responsible and then the wound nurse reassesses the patient on their next day back. This happens quite often on night shift and weekends. We admitted three new admits the other night and the night charge nurse took photos, however, those photos were lost on the camera. The following day, I retook the photos and did my documentation as the policy states. The loss of the original photos was reported to the CNO. Two days later, while doing a routine chart audit, it was noticed again that the chart was not corporate compliant due to those missing photos. The CNO and Nurse Manager told the quality coordinator to tell me to turn off the time/date stamp on the camera, retake the photos, and then back date the documentation of the photos to the night the photos SHOULD have been taken. I refused.
Am I crazy, or is this blatant falsification of documentation? Nothing about this idea sounds good or right. Forget the fact that my "friend" has suggested this, but the legal ramifications could be BIG!!
I am asking for your thoughts, opinions and/or ideas. Should I be looking at this from a different perspective? Am I making a mountain out of a mole hill?
Your post certainly caught my interest. I have a quick question (okay make that a few). Is it normal practice to take pictures of all wounds? Is this done on all patients? Do they have a say in the matter?
As to you situation, I would advise you to never compromise your integrity. As mentioned by others, take the pictures again if you must, but don't mess with the date/stamp feature.
Is it normal practice to take pictures of all wounds? Is this done on all patients? Do they have a say in the matter?
The acute rehab unit I worked on did this also, it's a bit of a CYA move so that if anything gets worse or anything is accused of getting worse, there is proof of what the wound looked like upon admission.
The patients are required to sign a consent waiver when they're admitted which has a blub about photos on it. No one ever had an issue with it, there are no identifiers on the picture.
It's also really helpful to get a good look at the wound before going into the room, I think.
Specializes in Psych, Addictions, SOL (Student of Life).
NO matter what -DO NOT PARTICIPATE IN THE FALSIFICATION OR PT RECORDS! I don't care how good a job it is or if it's your friend asking just don't do it. I was caught in a very similar situation in which I was asked to "Wave your magic wand and make it all go away" with a wound that appeared on a patient on a Monday following a vacation that I took. I refused and told the DON that she could document whatever she wanted under her log on. About 6 months later I was laid off under a reduction of force even though we were understaffed. It turned out for the best since the last two years under new management they were asking nurses to do all kinds of shady things with their charting. Ultimately it will be your license on the line so don't do it. It did take me 3 months to get another job but it is all for the best.
It's pure falsification don't do it. The nurse who took the photos on admission can add a note that she was unable to locate the photos she originally took at such and such a time and that there was no change in the wound appearance from her earlier assessment, but no, don't alter the time stamp. Plus, that fact that she is asking you to do it and not doing it herself leads me to believe that she knows its wrong and the possible repercussions. I also think that your "friend" would probably throw you under the bus if it became a serious issue.
Caliotter3, your words ring true. I have had the same thoughts, however, not nearly as eloquently described as what you have done here. The words I used to my husband were more like, "damned if I do, damned if I don't" in referring to reporting the request for falsification. I made my decision not to comply with her request and I intend to stand firm regardless of any retaliation effort. Perhaps it is time for me to move on and make a change. I won't make an emotional decision in haste, however, it is something that I will likely contemplate over the next few days. This incident would not be the sole reason for my departure, merely the straw that broke the camel's back. Wish me luck!!
OP, You did the right thing. You do realize that your friendship is over, right? The minute she asked you to risk your conscience, income, and maybe risk criminal prosecution it was over.
OP, You did the right thing. You do realize that your friendship is over, right? The minute she asked you to risk your conscience, income, and maybe risk criminal prosecution it was over.
Could your IT people find the original pictures?
Remember that word "CRIMINAL". It means that you can and you will get put on the Naughty List and never be able to work in a federally funded facility again. Medicare fraud is frowned upon. Oh, and you would be prosecuted for attempting to defraud an insurance provider if the local DA, or heaven forbid Federal Prosecutor were to get wind of it.
They can take my job and I will cuss.
They can take my license and I will cry.
But if they take my freedom, then I will hope to die.
Your friend needs to be reported to your corporate compliance officer and to CMS immediately.
She likely has committed numerous fraudulent acts if she asked you to commit one.
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
No, you are not making a mountain out of a molehill. Your guts are correct on this one. Don't do it. VERY bad idea! If you have any nagging doubts, just picture yourself on the witness stand being grilled about back-dated photos. If you lie for your CNO out of loyalty, you may be disappointed to find she doesn't have similar loyalty for you and throws you under the bus.
Specializes in Mental Health, Gerontology, Palliative.
Dont do it.
What I would tend to do is document something along the lines of 'due to a technical difficulties, photos taken on admission lost. Photos of wound retaken on X day"
Dany102, it is our company's policy to take photos of "any alteration of skin integrity" on every patient upon admission. That means anything from rashes to wounds and anything in between. CMS requires that we report any pressure ulcer present on admission. The crazy thing is that company policy states this documentation must be done within 8 hours of admission; CMS gives us 3 days!! We've shot ourselves in the foot on this one. And no, I do not have a say in the matter. In fact, photos must be taken again on discharge (pressure ulcers) and if they are not present on the chart, CMS can and will reduce reimbursement by 2%.
Thank you lowetidern (and Glycerine82 as well) for answering my questions. I guess the whole thing seems... Strange to me. I'm not from the United States so maybe I just don't understand the legal landscape, or perhaps I'm not familiar with the culture. I had no idea this was done routinely (in the States). And this brings about some concerns to me.
What if a patient's wound(s) is/are in the groin area or buttock? What if the patient is a minor (underage)? Wouldn't that technically constitute child Mediaography? Since this seems to be standard practice, I'm assuming there are exemption clauses that covers medical situation but still... This feels inappropriate to me. It is not something I have heard, or come across yet, here. I could see where wounds would be recorded in judicial or legal situations. But even then anyone can refuse (unless a court order is issued). There are also cases when an unusual/rare condition/injury may be recorded for the advancement of medical knowledge but, again, with the patient's consent. Yes, there is that waver/consent form patients signs on admission but that seems too vague at times.
My other concern is with the number of people having access to these pictures (think of the worst case scenario). I'm assuming they are linked with the EMR/EHR charting system. So I wonder how many people have access to them. Only the personnel assigned to care for a specific patient (Nurses? CNAs? LPNs? Doctors? Interns? Residents? Techs?) or everyone on the floor/department? I am not trying to cast or implying doubt on the integrity or professionalism of any one but at the same time, knowing this has very little to do with promoting healing or the well being of patients, I wonder if it's really necessary. I can see a few ethical problems with this.
Anyway, I really did not mean to sidetrack or divert the tread and, if it is unwelcome, I apologize for doing so.
I am a SANE nurse as well. We can, and do for the most part, take pictures of adolescent genitals if necessary to provide evidence. The camera we use is kept in a very secure place with limited and tracked use. Its only used for SANE cases.
Thank you lowetidern (and Glycerine82 as well) for answering my questions. I guess the whole thing seems... Strange to me. I'm not from the United States so maybe I just don't understand the legal landscape, or perhaps I'm not familiar with the culture. I had no idea this was done routinely (in the States). And this brings about some concerns to me.
What if a patient's wound(s) is/are in the groin area or buttock? What if the patient is a minor (underage)? Wouldn't that technically constitute child Mediaography? Since this seems to be standard practice, I'm assuming there are exemption clauses that covers medical situation but still... This feels inappropriate to me. It is not something I have heard, or come across yet, here. I could see where wounds would be recorded in judicial or legal situations. But even then anyone can refuse (unless a court order is issued). There are also cases when an unusual/rare condition/injury may be recorded for the advancement of medical knowledge but, again, with the patient's consent. Yes, there is that waver/consent form patients signs on admission but that seems too vague at times.
My other concern is with the number of people having access to these pictures (think of the worst case scenario). I'm assuming they are linked with the EMR/EHR charting system. So I wonder how many people have access to them. Only the personnel assigned to care for a specific patient (Nurses? CNAs? LPNs? Doctors? Interns? Residents? Techs?) or everyone on the floor/department? I am not trying to cast or implying doubt on the integrity or professionalism of any one but at the same time, knowing this has very little to do with promoting healing or the well being of patients, I wonder if it's really necessary. I can see a few ethical problems with this.
Anyway, I really did not mean to sidetrack or divert the tread and, if it is unwelcome, I apologize for doing so.
Dany102
142 Posts
Hello lowetidern,
Your post certainly caught my interest. I have a quick question (okay make that a few). Is it normal practice to take pictures of all wounds? Is this done on all patients? Do they have a say in the matter?
As to you situation, I would advise you to never compromise your integrity. As mentioned by others, take the pictures again if you must, but don't mess with the date/stamp feature.
Thanks