Core Measure Responsibility

Nurses General Nursing

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I work in the Quality department at a small hospital, and I am very involved in Core Measures.

Who is ultimately responsible for completion of Core Measures in your facility? We are struggling with this in our facility - The staff nurses and their managers want to say that the quality nurses are responsible, and we quality nurses want the staff nurses and managers to accept more responsiblity. Then, of course, there is the whole physician piece.

I would welcome any feedback folks will give about how they accomplish getting great Core Measure results in their facility. Also - What does your facinity do when there is a Core Measure fallout?

Thanks!

Specializes in Trauma | Surgical ICU.

Core Measures should be the responsibilities of the nurse. There I said it!

If a client is going to be admitted for CHF, the ER nurse should check if she's going to be admitted with CHF-Core Measure orders. If she's being transfered to a unit, the staff nurse receiving should be the one to check if the core measures orders are implemented. When the patient is getting discharge, the discharging nurse should check if the things are done.

Since nurses are the liaison for all departments, it is our job to remind doctors, case managers, pt, ot, st, etc. about our client's needs. We are the ones who are with the clients the longest.

When there's a fallout? It usually falls on the discharging nurses' plate. If medications for discharges are not ordered, then it should be the nurse's responsibility to call the order for the medication or ask the reason why the medication isn't prescribed.

Yes it is the floor nurses but I think that if there were more team work involved there would be less fallouts. At my hospital the quality nurse checks the charts to see what is missing, most of the time it is documentation as to why the pt is not on a particular med or an ef percent. Instead of calling the nurse to call the dr to document this if they would call the dr they could discuss each pt on 1 phone call. Just mho.

How about the PHYSICIAN take responsibility for the medication HE prescribes to his patient? There's a concept! How is it that me as a RN ends up calling a doctor at a patient's discharge and to say "Hey Dr. Soandso you for got to put your pt on a beta blocker is there some reason you did that? Why didn't you document it in the chart? Or can you come back to the floor and give the pt a script?" I can't count the times I've had a similar conversation like that. It's ridiculous. Then to get a ton of attitude from the doc like I'm bothering him irritates me to the core. Are doctors not responsible for the meds they give or don't give to the pt?

At my hospital we're threatened with write ups, meetings with the CNO, and termination if a pt leaves the hospital with a fallout on a core measure. The doctor responsible for that pt...his punishment....NOTHING! Freaking outrageous.

Specializes in Trauma | Surgical ICU.
At my hospital we're threatened with write ups, meetings with the CNO, and termination if a pt leaves the hospital with a fallout on a core measure. The doctor responsible for that pt...his punishment....NOTHING! Freaking outrageous.

There was one particular doctor on the floor who never, ever, signs his discharge meds and wants us to call him for it. We told our RN-C about it and told us to log all the occurrences. We did and there was a meeting with our RN-C, Director, Medical Director and him... needless to say, nothing happened.

Waste of time...

Just another "to do" to keep us from patient care. I'm tired of making sure everybody else gets their jobs done while my patient care potentially suffers. If there are quality nurses who follow Core Measure patients, then it should be their responsibility to make sure all standards are met.

There was one particular doctor on the floor who never, ever, signs his discharge meds and wants us to call him for it. We told our RN-C about it and told us to log all the occurrences. We did and there was a meeting with our RN-C, Director, Medical Director and him... needless to say, nothing happened.

Waste of time...

All that happened because a doc didn't reconcile discharge meds? This is routine at my hospital. I am so thankful for the docs that do it but, so many don't. It's accepted from management that they don't do it. Again, ridiculous right? Nurses are responsible for everything and are treated like dirt. I need to find another job before I despise nursing all together.

Specializes in Med Surg.

Why is it my job to make sure the doctor is doing his or her job? Aren't they professionals? Aren't they (presumably) adults capable of doing their own work? I want what's best for my patient, but some things just aren't my problem. If the facility gets dinged for something the physician did or didn't do, how am I responsible?

How about the PHYSICIAN take responsibility for the medication HE prescribes to his patient? There's a concept!

Couldn't agree more! They know they have to do it and it seems like they would get tired of us calling them about it. But no, it's our fault the doctor didn't order the correct medication. So silly. I should have gone to medical school instead of changing my major to nursing. Then I wouldn't have to be responsible for anything and just blame the nurse. Jk of course but man I should have majored in accounting or something instead of having a punching bag degree.

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Congrats OP on getting a clipboard job. Now you too can harass the bedside nurses about more things they need to fit into their day. And super congrats, since you've found our favorite thing to be harassed about! Because nothing is better than being harassed that we didn't make sure that someone else (the physician in this case) did THEIR job. Because why harass the physician directly when you can make a nurse the middleman? It would make way too much sense to DIRECTLY HARASS THE PHYSICIAN instead of harassing the bedside nurses so that we can in turn harass the physicians.

Why is EVERYONE in the hospital too scared to directly talk to physicians to make the physicians do their job? It's ordering a medication. Last I checked, bedside RNs are NOT LICENSED to order a medication. Why on earth should it be their responsibility to do something that they aren't licensed to do.

It's not getting done, HARASS THE PERSON THAT CAN DO IT. That would be the physician. Quit making nurses the middleman because it's too scary to talk to the big bad physician.

Getting off my soapbox and getting practical:

Besides, there are generally fewer physicians than nurses. Why on earth is it considered easier to get say 50 nurses to think about something than to get 10 physicians to do it? Change the behavior of 50 people or 10 people? WHY WOULD ANYONE CHOOSE 50?

Specializes in Med/surg, Quality & Risk.

I think it's your responsibility to monitor and contact the physicians, personally. As charge nurse I get this printout daily telling me about the stuff that wasn't done, and I'm supposed to call and bug them about it. Then I have to turn around and bug the nurse to make sure the order is carried out. Now ******* DVT prophy is a core measure, and so I have to get the order from the doc, then bug the nurse to apply SCD's and chart that they're applied. This rarely gets done in a 12 hour shift, and you only have 48 hrs from admission to comply. It seems like it would carry so much more weight for the quality nurses to call the docs. It also seems that you should have the power to suspend docs who consistently refuse to comply.

Careful you don't work yourself out of a job.

ETA this thing edits out the silliest fake cuss words sometimes. I expect "crap," "heck," and "darn tootin" to be asterisks after this edit.

Specializes in Hospice.

I'm with pp. I am exhausted of being told that it is my job to police everyone else on top of doing my own very time consuming job. I like our drs. they do a great job, they are smart people ...........they are capable of knowing their job and doing it. I'm tired of being told im responsible for all these things. im already responsibility for catching their d/c errors. care mgt , wound care , PT oh yeah and all of the nursing responsibilities i have always had. hourly rounding , two notes on each pt a shift, making sure axillary staff has done what was delegated to them. I can't take much more on successfully and its unrealistic to think we can. If your job is to implement core measures then DO YOUR JOB> don't delegate it to nurses where multiple people are coming in for 8 hour shifts and aren't sure what has been addressed and what hasn't. Your the best person to develop a relationship with physicians missing these measures and help correct behavior/errors at the real source. Yes i try to catch these things and follow up when i can. but the goal should be to change behavior of physicians not expect us to keep catching their misses.

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