Falsifying documentation

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Hi,

A patient of mine whom has multiple foot wounds whom I see for wound dressings made a complaint to me that one of the previous nurses had attended 2 out of the 3 wounds on his foot only. The nurse was bandaging up his foot and when the patient realised that she had missed the other wound, pointed it out to her. She continued to bandage up the foot and did not attempt to dress the remaining wound. The nurse then documented that she had attended all of the dressings and left.

When I went in for the next visit, the patient advised me of this, I took the bandaging off and there was indeed no dressing on the wound in question.

Is this considered falsification of documentation and what would the consequences be?

Thanks

Each wound has its own form. She completed all 3 of the forms. She also documented in the computer that she did all 3. The issue here is not that she may have had a lapse in concentration and forgot to do something (we all have those days), the issue is that the patient told her that she had missed the wound, did nothing and continued to document that she did them.

The patients wound significantly deteriorated after the event. The patient is a diabetic and has PVD. I had been spending a lot of time on his wounds prior and was seeing improvements. If his wounds were not looked after and deteriorated then he may need to have an amputation which would mean he would be a bilateral amputation (already had one leg amputated before) and result in him placed in a nursing home.

After providing the above information, would you still have the same opinion?

I might get flamed here but on the surface, I would not have immediately considered this a [u']serious-type/sentinal[/u] mistake. It's certainly not good and could have important ramifications, but it's not like a full Heparin bag run in over 30 minutes or 50 units of Lispro given to a non-diabetic. Not dressing a wound is not the mountain top of horrific nursing actions. Now I would have spoken with the nurse; Why? Because I would want the same courtesy. Does her documentation clearly state that she dressed three wounds or does it just state that she dressed THE foot wounds? Perhaps she was distracted and not focused, which I agree is not a good or proper thing, but we all have made mistakes. Is it possible that it was accidental? You are not privy to all of her employment information that your supervisors are. So yes I would have spoken to the nurse AND I would have informed my supervisors of the patient complaint and my later assessment of the dressings/wounds (which I would document with a fine toothed comb) but that is where I would have dropped it.

And did you hear her yourself state that she didn't want her previous issue hidden from the boss? Or is it just gossip you heard from the other nurse involved?

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

We can't tell you what we would do as a manager, no matter how badly you seem to want to hear, "Your manager needs to fire her!"

We aren't there, we don't know the nurse, we don't know you, we don't know the patient.

If you're not the manager, it's really not even your business at this point.

Take care of the patient, and go on with your day.

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Specializes in Med/Surg, Ortho, ASC.
We can't tell you what we would do as a manager, no matter how badly you seem to want to hear, "Your manager needs to fire her!"

We aren't there, we don't know the nurse, we don't know you, we don't know the patient.

If you're not the manager, it's really not even your business at this point.

Take care of the patient, and go on with your day.

Seriously disagree. If negligence or falsification is brought to my attention, and my observation correlates the issue, it is totally my business. The idea that the Manager of multiple home health nurses somehow magically knows what's going on (or not) in any particular patient's home is crazy. Regardless, as the OP, I'm going to CMA, not bury my head in the sand.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Seriously disagree. If negligence or falsification is brought to my attention, and my observation correlates the issue, it is totally my business. The idea that the Manager of multiple home health nurses somehow magically knows what's going on (or not) in any particular patient's home is crazy. Regardless, as the OP, I'm going to CMA, not bury my head in the sand.

My comment is regarding the OP's multiple attempts to get us to say what kind of discipline needs to happen to the other nurse. If the OP isn't management, it's none of OP's business what kind of disciplinary action takes place.

The incident has been reported up the chain, the patient was cared for, the patient will continue to be cared for, and this is no longer the OP's business as a nurse.

Any other attempts to find out what did happen or conjecture about what should have happened to the other employee are just busybodyness, IMO.

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The OP wasn't there and doesn't know what actually happened. At this point it's hearsay because the OP did not witness the other nurse deliver care. Did the patient potentially take off the bandage and remove the dressing? Also, did they do this and forget (for ex. because of Dx of dementia, etc). Also, I have seen (some) patients do strange things for strange reasons (ex. attention/boredom, vindictiveness, prejudice, to assert a sense of power/authority, etc)... Sadly, patients aren't always trustworthy, well-intentioned, or honest. In this regard, I have listened to patients accuse Nurses of not delivering aspects of care/treatment (ex. meds, dressings/wound care, bathing), after I myself witnessed the nurse deliver the exact care/treatment they're accusing the nurse of not performing. This can be incredibly frustrating to nurses who provide exemplary care only to be repeatedly slapped in the face with such blatant disrespect, let alone without even a modicum of gratitude. I certainly hope the Nurse did not do what the patient is implying. The OP should get both sides of the story, the patient's account and the nurse's account, to help form a rounder picture before the OP approaches their supervisor, or anyone with their concerns. This is a sticky situation, and more complex than the topical way the OP is approaching it. Where is the OPs analytical skills? Examine every potential, perspective, and angle!

I'd advise the OP to be very careful. what if this patient does have ulterior motives? One day, the OP could find themselves on the receiving end of finger pointing should the patient decide to intentionally and falsely accuse the OP of something for whatever reason they decide.

A new (male) nurse that I was training and orienting to our unit was once accused of sexual abuse by a female patient. She said he grabbed her breast while taking her BP, despite the fact that I stood there hovering over him, assessing his technique and supervising the entire thing. I never left his side for the entire shift and could attest that he did not molest her in any way shape or form. A thorough investigation was still done and it was dismissed because it was discovered that the patient made the accusation because she was angry that she couldn't have her way. She admitted that she was never abused by this nurse but was upset because this nurse refused dispense hydromorphone outside of the MDs Rx orders on the MAR. Instead, this nurse exhausted all other measures and then contacted the doctor to do their own pain assessment to determine the next course of action if her current dose of hydromorphone was inadequate. She didn't convey S&S of pain, and when the nurse informed her we'd consult with her MD she objected: "what'd you have to go and do that for? It's might rights! Just give me another few ******* pills". This is also a patient who suffers from chronic constipation/fecal impaction... she's a pill herself to take care of.

I've seen it happen so many times. It only becomes apparent when Nurses become aware of odd behavious and start charting it then the patterns become apparent, and we can add a flag their chart. Only then do others understand the insidious nature of certain patient behaviours, or take it seriously.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Seriously disagree. If negligence or falsification is brought to my attention, and my observation correlates the issue, it is totally my business. The idea that the Manager of multiple home health nurses somehow magically knows what's going on (or not) in any particular patient's home is crazy. Regardless, as the OP, I'm going to CMA, not bury my head in the sand.

We also have the responsibility to advocate for the patient. Based on what the OP has stated: I would certainly give the patient a complaint form; document completely what I observed when assessing the wound and complete an incident report if my observation grossly differed from the previous documentation.

This is not a coworker relationship issue; it's a patient care issue with major ramifications.

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We also have the responsibility to advocate for the patient. Based on what the OP has stated: I would certainly give the patient a complaint form; document completely what I observed when assessing the wound and complete an incident report if my observation grossly differed from the previous documentation.

This is not a coworker relationship issue; it's a patient care issue with major ramifications.

Absolutely, give the patient a complaint form if that's how the facility handles allegations. Patients file complaints for all sorts of things all the time, and the majority of complaints are trivial (ex. hospital linen quality, nurses not smiling enough, how much they hate hospital food, etc...). Nursing is now treated like a hospitality service. Anyways, the OP seems to have a personal investment in this that borders on unprofessional. It's the not the OPs role/authority or responsibility to discipline this nurse or have access to the disciplinary process she/he will be subjected to. That's for the "higher ups" to decide. You have to wonder why the OP is so interested in this one particular nurse? We're they formerly in a relationship? Something feels off and very inappropriate in the way the OP is personally, emotionally invested in this. The claim could be real or it could be ********, but it's not for the OP to decide.

Any claim of abuse or negligence should be and (at least where I work) is always investigated, but the OP is trying to be involved in a way that is inappropriate. This case is one of the reasons why I will never work as a visiting/home-care nurse... that, and the safety concerns. Entering someone's home is an uncontrolled and potentially dangerous situation. I feel safer in a hospital where I have back-up: security guards, other nurses or HCP's to witness my work or assist with troublesome patients, and other forms of practice supports. I had an in-patient last year who had ulcers all over his legs and MAR orders for his wound care/dressings. He would accuse all of as of not changing his dressings, so we developed a buddy system: another nurse would supervise to act as a witness while the assigned nurse performed wound care and dressing changes, and then the assigned nurse would chart accordingly.

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Specializes in SICU, trauma, neuro.
She said that she did do all 3 dressings. Management did not even bother to contact the patient as the regule manager was away at the time. I was told to tell the patient next time I saw them that the nurse would not visit again, and the nurse was told not to visit them again and that was how my workplace dealt with the incident.

I'm confused...how would you know what management did? You are not privy to that information.

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786wsuyxh

Since the patient brought it to your attention I would write an incident report and give it to management as well as providing the appropriate care and documenting truthfully.

I think she should get the patient and family who witnessed it to call the boss. It really isn't a peer's job to counsel or investigate a peer. That is what Management gets paid for. I might make a note in the chart stating the patient's concern and state that I dialed Manager Smith's phone number and handed the phone to the patient and advised the patient to report same to said Manager. Patient reports Manager Smith said and did_____________.

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786wsuyxh

It really isn't a peer's job to counsel or investigate a peer.

You are absolutely right!

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Hi CaffeinePOQ4HPRN,

First and foremost I would like to say that no, there was no 'relationship with this nurse'. The reason which I am so 'emotionally invested' in this is because I am truly concerned about the patients safety. I have personally seen the consequences of her actions before with a previous incident, there was no open disclosure to the patient by management and he was not told why the skin on his entire bottom extending up to his back had broken, he was under the impression he was allergic to tegaderm which the nurse involved in the incident told him! I had to continually remind management and monitor to ensure that he was told the truth and not made to believe he was allergic fo something he was not.

Now there is a second incident in which I have discussed in my original post. We have a duty of care to our patients and I am truly one to believe that we are their advocates as in my workplace, I have seen that management would rather ignore the issue and sweep things under the carpet than actually deal with them instead of participating in open disclosure which they profess to practice.

The competency standards where I work also state that we have a duty of care and recognise the ability to prevent harm, I do take my role seriously and due to the nature of community health, where we are often the only one seeing that specific patient for long periods of time with no other review by colleagues, things happen which are absolutely unbelievable with consequences to the patient.

Also, unfortunately, the place I work has had a high turnover of staff from the top to the bottom. Junior staff acting in senior roles resulting in inadequate follow up of incidents, hence the reason why I am always asking for the outcome of incidents which I report. It is also why I am asking for the opinions of those in management positions on this forum to see how other institutions deal with these issues to improve their service and prevent further issues from happening.

I dont want any more patients to be harmed, and I see the patients as someone who could by my mother, my father, a family member. If we dont advocate for them then who will? (especially in the environment I work in).

I dont want my inaction to result in harm to the patient especially when I know about the inadequacies of my organisation.

Absolutely, give the patient a complaint form if that's how the facility handles allegations. Patients file complaints for all sorts of things all the time, and the majority of complaints are trivial (ex. hospital linen quality, nurses not smiling enough, how much they hate hospital food, etc...). Nursing is now treated like a hospitality service. Anyways, the OP seems to have a personal investment in this that borders on unprofessional. It's the not the OPs role/authority or responsibility to discipline this nurse or have access to the disciplinary process she/he will be subjected to. That's for the "higher ups" to decide. You have to wonder why the OP is so interested in this one particular nurse? We're they formerly in a relationship? Something feels off and very inappropriate in the way the OP is personally, emotionally invested in this. The claim could be real or it could be ********, but it's not for the OP to decide.

Any claim of abuse or negligence should be and (at least where I work) is always investigated, but the OP is trying to be involved in a way that is inappropriate. This case is one of the reasons why I will never work as a visiting/home-care nurse... that, and the safety concerns. Entering someone's home is an uncontrolled and potentially dangerous situation. I feel safer in a hospital where I have back-up: security guards, other nurses or HCP's to witness my work or assist with troublesome patients, and other forms of practice supports. I had an in-patient last year who had ulcers all over his legs and MAR orders for his wound care/dressings. He would accuse all of as of not changing his dressings, so we developed a buddy system: another nurse would supervise to act as a witness while the assigned nurse performed wound care and dressing changes, and then the assigned nurse would chart accordingly.

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786wsuyxh

I think she should get the patient and family who witnessed it to call the boss. It really isn't a peer's job to counsel or investigate a peer. That is what Management gets paid for. I might make a note in the chart stating the patient's concern and state that I dialed Manager Smith's phone number and handed the phone to the patient and advised the patient to report same to said Manager. Patient reports Manager Smith said and did_____________.

Counseling and investigating a peer was not mentioned in my quoted post. My post concerned an incident report, appropriate for the occasion.

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