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.
I have run into this problem many times with vitals being faked. Especially if it is on a pt. having an issue with their vitals like high or low bp, heart rate etc. Heaven forbid you should have to call a doc more than once in a shift, or take vitals more frequently than every 4 hours. I told a doc once a pt. had a RR of 17 and he laughed and said you really counted it???
It is very frustrating because if you cant trust your tech you have to do it yourself and when you are already short-staffed it gets real old. When you are hanging blood, giving bp meds, etc. you need accurate vitals!!! This is one of the main reasons I am moving into the ICU where I can do my own vitals, bs, etc. and not rely on someone else. Teamwork only happens when you can trust the other members.
I agree that you should take this up with the manager of that floor. Hopefully the manager will say something to that person and they will be less likely to do it again.
Management are much too busy making epic decisions like what color of scrubs to approve and what font to use in their latest email that no one will read to be bothered with such trifle issues as false documentation. Why.......they have a meeting at 1pm and have barely even been given time to figure out whether to get donuts for the next employee meeting or not. Can't you handle it yourself?
Sure enough someone had charted the patient's vital signs as O2 sat of 94% on 50% FIO2--ten minutes ago!
It's not unheard for a CNA on a med-surg floor to do all their vitals then chart them all afterwords, which means the difference between when vitals are taken and when they are charted could easily be more than an hour. Are you sure this wasn't the case here?
There is a reason I do my own vital signs especially once I start a shift and when I'm about to give BP meds.
One time, I had looked at a patient's chart and couldn't not find vital signs and I knew I had seen the CNA pushing the dinamap in and out of rooms. When I asked this CNA for the vitals since they were not on the chart, she made a show of looking at her paper and when she couldn't find it she proceeded to tell me that she would just make up numbers. That statement sent cold shivers down my spine! I took the pt's vital signs myself and have always been suspicious of said CNA whenever she's assigned to me. I didn't report it because I hadn't caught her red-handed but if I ever do, she will be reprimanded and reported.
that said, i'd love for cna's to get inserviced as to why vs are so important...
educating them in layman's terms, what ea vs signifies.
i do believe some omit this task, not understanding the need for accurate signs.
maybe a little more insight would motivate some to take them (vs)...and take them seriously.
leslie
I have always said CNAs need more education.
How can a CNA understand the significance of accurate vitals if they aren't told the WHY???
I'm all about teaching the WHY.
I have been CNA for over 20 years and in all that time, I have had to do plenty of teaching about the WHY and even after that, I have thrown up my hands in disgust!
The bar needs to be raised on educational standards!
I'm still working on becoming qualified to teach the CNA class. I'm passionate that we expect MORE from CNAs than just showing up and breathing.
They may not be nurses, but they have lives in their hands.
How can a CNA understand the significance of accurate vitals if they aren't told the WHY???
I'm all about teaching the WHY.
I have been CNA for over 20 years and in all that time, I have had to do plenty of teaching about the WHY and even after that, I have thrown up my hands in disgust!
The bar needs to be raised on educational standards!
I'm still working on becoming qualified to teach the CNA class. I'm passionate that we expect MORE from CNAs than just showing up and breathing.
They may not be nurses, but they have lives in their hands.
along with more education comes more pay - and nobody willing to fork out the cash.
Wow. This is disturbing. I will say that in my state the CNA program is pretty intense, and if they get hired in a hospital they usually get a lot more training. I am qualified to teach the program- took a course to get the qualifications. The local school gets them 24 advanced standing credits if they enter the Community College nursing program, so it is at a pretty high level.
That being said, I know they study a lot about anatomy and illness, they get tested on vitals and what is normal, but I am really not sure if there is an emphasis on how the vitals relate to the illness and how meds are titrated according to vitals. I will talk to my friend who teaches the program. Maybe I will show her this thread. It might give her new insight as to her teaching.
Not saying that it was the necessarily the case here, but it is possible that the CNA was late in putting vitals into the computer and then may have forgotten to change the time on the vitals to represent when the vitals were taken. It's not right, but it happens unfortunately. Better to take the vitals yourself right before you give meds anyways.
Wow. This is disturbing. I will say that in my state the CNA program is pretty intense, and if they get hired in a hospital they usually get a lot more training. I am qualified to teach the program- took a course to get the qualifications. The local school gets them 24 advanced standing credits if they enter the Community College nursing program, so it is at a pretty high level.
That being said, I know they study a lot about anatomy and illness, they get tested on vitals and what is normal, but I am really not sure if there is an emphasis on how the vitals relate to the illness and how meds are titrated according to vitals. I will talk to my friend who teaches the program. Maybe I will show her this thread. It might give her new insight as to her teaching.
In the program I went through which was offered by the local (teaching) hospital (I had to pay for it) there was no reasoning behind why the vitals are taken or why they're important, etc. I knew how important they were from life experience, education, and common sense, but most people going through the course probably didn't. I was also surprised to find that getting that certification (and in my personal case having a bachelor's degree in another field that consisted of several science courses including A&P) meant nothing when it came to pay. I started out making minimum wage as did everyone else. McDonald's LITERALLY paid (and still pays) more than CNA's make. That is CRAZY to me, but I swear on my life it's true - at least in my area. Of course, there are lots of jobs in my area as well - for CNA's and RN's. That makes a big difference because if one person doesn't like the low pay, there are 100 more people who'd jump at the chance to fill the position. One interviewer even told me when I asked if my life experience/work experience/college education was worth NOTHING (not even a quarter) that "employers can take their pick in this economy. we have more applications than we can look at."
What does that have to do with CNA's doing the "right thing"? I think it has a lot to do with it. For one thing, many of them don't understand how important VS are. For another thing, people in general (no matter what the job is) invest more of themselves into a job when they feel they are being compensated fairly. I'm not saying that it's RIGHT, but it's true. I've heard a million times,"i don't get paid enough for this" in many different fields. Before I became a nurse I would hear CNAs and even LPNs gripe about certain things and how RNs got paid so much more so they should be doing it. Even though I wasn't a RN at the time, I was a college graduate (and nursing student) so I knew what came along with the higher pay and I would speak up and say, "well, why don't you go to school and become a RN?" CNA's know that everything falls back on the RN ultimately so if there's a grudge or if they're being flat out lazy, the RN needs to take extra care to be sure they aren't being sabotaged. It's a sad reality, but until more education is required which would mean more pay it's a legitimate concern.
Edited to say: Even as someone with common sense and an education, I did know how important VS were, but I did NOT know everything. For example, I did not realize that certain medications could not be given to a patient with a certain heart rate, etc. I'm pretty sure if I didn't know that then most of the young, inexperienced students in my class didn't either. I only learned that on the job when a patient was asking for pain medication and the nurse asked me her HR. I questioned why and what the HR had to be, and that's how I learned. Had I been making HRs up before that (or after that) the results could've been fatal. I do think CNA classes should provide that info.
Of course any fraudulent charting should be reported immediately. There is most likely an issue that goes far beyond this one CNA, like a system that does not provide enough staff to meet the needs of patients, or one that allows the staff to behave in the way you describe. However, as troubling as the vitals signs charting is, the fact that a physician believes a patient who is partial DNR 1) cannot receive 100% FiO2 via NRB or even bi-pap to avoid intubation and 2) cannot rescind the DNR at anytime and get whatever treatment he/she desires is frightening. Do not only tell your charge nurse about this. Inform the physicians attending immediately. This person is treading on patients' rights and it could land the hospital in hot water and himself in jail one day.
:lol2:
Sugarcoma, RN
410 Posts
I have run into this problem many times with vitals being faked. Especially if it is on a pt. having an issue with their vitals like high or low bp, heart rate etc. Heaven forbid you should have to call a doc more than once in a shift, or take vitals more frequently than every 4 hours. I told a doc once a pt. had a RR of 17 and he laughed and said you really counted it???
It is very frustrating because if you cant trust your tech you have to do it yourself and when you are already short-staffed it gets real old. When you are hanging blood, giving bp meds, etc. you need accurate vitals!!! This is one of the main reasons I am moving into the ICU where I can do my own vitals, bs, etc. and not rely on someone else. Teamwork only happens when you can trust the other members.
I agree that you should take this up with the manager of that floor. Hopefully the manager will say something to that person and they will be less likely to do it again.