Today, as part of my rapid response rounding, I spent an hour at the bedside of a patient who was having respiratory issues secondary to TB and exacerbated by CHF. The whole time I was there, the patient's O2 sat never exceeded 89% despite his being on Hi Flo NC at 100% FIO2 and 30L/min. I had a lovely argument via telephone with the brand new intern who claimed that putting patient on NRB would violate the patient's wife's wishes that he be a partial code and basically disallowed everything except for pressors in the event of a code. (The patient and his wife had no idea that they had apparently signed away their rights to an O2 mask!).
In any case, the doc at one point said, "I just checked his chart, and he looks like he's doing okay.". HUH??? I walked to the nearest computer cart and opened the patient's chart. Sure enough someone had charted the patient's vital signs as O2 sat of 94% on 50% FIO2--ten minutes ago! Up and down the halls I roamed searching for the person who had charted these vitals. The hour I spent in that room, not one other person had come in to take vitals or assess the patient. Apparently it was the CNA. CNAs are responsible for getting vitals on the patients on our med-surg floors. Unfortunately this is not the first time I have found the charted vitals to be completely divorced from reality. Every med-surg patient has a respiratory rate of 18 or 20 for some reason, and nobody's O2 sat is ever below 90 unless the patient is busy for some other reason (diarrhea for instance) and the floor nurses want her/him transferred to a higher level of care. I have noticed that assessments and vitals are especially fictional if the patient, like this one, is on isolation precautions.
I could not find the CNA, but the RN for the patient assured me that the charting must have been a mistake. She thought that the CNA must have charted another patient's vital signs in this patient's chart. I decided not to make a stink about it so as to maintain good relations with the staff on that med-surg floor, but the more I think about it the more I feel that the CNA made up those vital signs just so he wouldn't have to enter the room; the values were much too similar to what the vitals had been 4 hours previously.
What do you think? What would you do? Find the CNA and question him (he pretty much disappeared after that!)? Fill out an incident report. Contact the manager for that floor? I did put a note in the chart stating that I had been at bedside during the time the vitals signs were alleged to have been taken and charted the actual O2 sats and FIO2 on top of the erroneous values.
Exactly. I'd rather know what I'm dealing with. Same applies to the BP machines. Often, they either take forever to get a reading, or it's incorrect. Last night for example, I ended up taking a manual BP because the machine was wonky. Same with respirations. You have to count them, not guestimate. Vital signs provide a picture about your patient. Also, I would rather avoid CPR or finding a dead patient.
i have to say that during my time of being the vital sign taker aka CNA, respirations usually did fall between 16-20 and that was on med/surg. sometimes i'd get a 14 thrown into the mix and then of course anything over 20 was usually obvious and could actually be heard. there were a few times when i got something abnormally high and before charting it i would go to the nurse and say, "i'm counting 34 so would you please come check?" or the opposite of, "i just can't count this patient's respirations so would you mind seeing what you get?" because let's face it - patients with very low RR can be hard to assess if you're trying to be discreet. another reason i would ask for someone to come and double check is bc i didn't want to chart something if the nurse was able to remedy it first which they often wanted to do. either way, i didn't ever make something up! but i DID see that happen before w another CNA. i actually came home and told my husband about it bc i was griping about how she made me do all the work not to "see if i could handle it" but bc she was lazy, and i mentioned how dangerous it was to skip vitals. even as a "newbie" i had seen how quickly a patient's VS could change and reporting that change to the nurse was usually the first step/indicator of problems that were arising.
that being said, i made mistakes myself, and that's exactly what they were - mistakes. i remember one time in particular a nurse was charting (paper charts) and had been sitting outside of the patient's room whose vital signs i was taking and left the chart she was working on at that patient's alcove. i ASSUMED that was the patient's chart and therefore charted the right vitals in the wrong chart. we caught the mistake later and there was no suspicion bc it was clear what had happened. ideally, i would have double checked the front of the chart and matched up the name/room, and ideally the nurse wouldn't have left a patient's chart in a different patient's alcove, but we're humans who make mistakes. there was another time where i had written a patient's VS on a piece of paper bc their chart wasn't there and i planned to put them in later. the doctor showed up, asked if i had the VS, so i reached in my pocket and handed him the paper. later, when the nurse was checking the chart and wanted to know the VS - the doctor was gone and so was the paper.
i think before you assume the worst you have to give the benefit of the doubt. i would've been very upset if i were accused of falsifying records intentionally bc i would never do that. however, if it's something that you notice happening AFTER they're confronted or if there's no valid reason, it needs to be taken further. if he/she uses an electronic BP machine, how about stopping them after they've supposedly taken 3-4 patient's VS and ask to see the history on the machine. see if the history on the machine matches up with what has been charted. that would be a pretty simple way to find out and you would have proof that would be hard to deny when confronted.
Wow. That is falsification of records. Do you have a Risk manager in the facility? At the least, I would contact the Nurse Manager and report this.
Unacceptable and dangerous.
This.
The person most likely to help you AND keep you safe if you wish to remain anonymous is the Risk Manager. Find out who they are, make a call, send an email and state in both that you don't wish for your name to be brought up. I used to sit on the Risk Management Committee and each time we had a meeting, we'd walk in at the meeting time and the "issues for discussion" would be already on the board. We had no idea if they came to be a "top priority issue" because of complaints (like the one you would have turned in), because there were actual events or if it was something he witnessed during rounds.
"How did this get brought up?", "Why this issue not that one?", "Who thinks this is an issue?" and other fishing questions were asked every meeting. I never once saw him answer any of them, usually gave the patent "Doesn't matter, its what is on the plate right now." Risk Managers are very fluent in not giving away their sources.
I remember when I was a CNA and transposed the respiration and HR...when the doctor came in he mentioned something to the nurse manager. Mortified I quickly changed it and from then on always double checked! It was interesting to note that I had done this all night and not one nurse had noticed.....maybe aides feel they can "get away" with being lazy when no one checks on them?
I would give the aide the benefit of the doubt, We all make mistakes. Letting the patients nurse know of the situation should be sufficient especially if she attested to it being an accident. If it happens again with the same aide then something must be up and additional action should be taken.
Charting fake vital signs is definately an issue. I am a nursing student in a RN program currently. Prior to the start of my program, I worked on an extremely busy DOU floor for two years. RN's as well as CNA's are ALWAYS understaffed at this hospital and especially on this floor. It is pretty sad for the patients. It was my first job as a CNA. During my orientation I was oriented by a CNA who had worked on the floor a few years already. One shift we got really busy and the CNA pulled me aside to tell me that when it gets really busy like this, "I do what I have to. I look at the last vital signs I took, and I make up something similar." :/ What the heck?!!! I was new and did not know what to think of what she had told me. If this was my family member I would have flipped! I couldn't believe what I was hearing. This CNA was jeopardizing these patients lives! When I become an RN I will definately have to follow up on the CNAs I work with because I kow what goes on. Sad. There is a reason why there is an anonymous ethics hotline. It is there to be used.
i've had this happen before vitals looking off and went right to the cna and asked tell me how you count resp and how you take a blood pressure and count a pulse turns out they were not taught properly so i taught them and went with them to do the vitals and re-check against what i got i did reinforce the critical importance they thanked me profusely and actually was never afraid to ask if they had a question
before you criticize someone, you should walk a mile in their shoes. that way, when you criticize them, you're a mile away and you have their shoes.
I am always willing to give others the benefit of the doubt. In your situation, I think management should had been made aware of the situation. They would had talked with the CNA and if was a honest mistake, then he would be more careful and hopefully learn from it; but if he made it up, then management would have a recorded episode, on file.
Report it to the manager of the ward and do an incident report. this is terrifying. can you call the registration board?
I caught a RN of 11 years doing this a few months ago. It was the last in a line of incidents, I fired her and reported her to the board of nursing. sadly on investigation she didn't know how to take a manual BP. How did she get by for 11 years?
Do people make up vitals? Absolutely. Would I take one set of vitals that could have just been charted on the wrong person or numbers transposed as evidence of someone falsifying the numbers? Absolutely not. Mistakes happen. I've transposed numbers. Caught a respiratory therapist that charted a pulse ox of 68% that then charted weaning the O2, hehe. He hit the 6 instead of the 9 key above it. I've charted on the wrong patient, in the wrong time column, hit the wrong keys, mixed up pulse and respirations... If someone jumped to the conclusion that I was falsifying documentation, I'd be really offended.
As for being able to eyeball respirations.... I can do it. I still count, but if I make a guess before counting, 99% of the time I'm within 1 either way of the correct number that I count.
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joanna73, BSN, RN
4,767 Posts
Exactly. I'd rather know what I'm dealing with. Same applies to the BP machines. Often, they either take forever to get a reading, or it's incorrect. Last night for example, I ended up taking a manual BP because the machine was wonky. Same with respirations. You have to count them, not guestimate. Vital signs provide a picture about your patient. Also, I would rather avoid CPR or finding a dead patient.