Honestly, what does documentation get you?

[Sassy5d]

Yesterday was very trying. Not because anything super serious was going on, but because I had 4 patients, all at once, that needed a bunch of stuff, all at once.

I had 3 seriously ill pts, the docs were taking their sweet time requesting admits. I get a new 1, c/o chest pain.

She was brought back, vss, EKG nsr. Md said it was ok to monitor until room opens up. She proceeds to go outside and smoke, and smoke, and smoke. Nobody charted.

Long story short, there was more work put into this pt I swear than my sickies. It became quite clear to me, that this was a genuine, I'll c/o chest pain so I get IV pain medications. Don't get me wrong, as frustrating as it is, you gotta prove it's not an MI. I get that. But the things coming out of her mouth, the demands, everything... And I'm attempting to chart it all up.. Every coworker walks by, sees the name and says 'oh ya, she's here every other day'

I can't believe that this is the 1st time she's behaved like this. There's no documentation. She's flat out complaining because dr so n so isn't on and they always give dilaudid. I challenge the doc who orders the morphine and they tell me that they have to treat it like an MI.

Not even 10 mins after I give her her iv med, she says take the iv out, I'm going home. She complained when I diluted her morphine, then flat out tells me as I'm giving it that she was gonna wanna leave right after.

So I ask. What does documentation get you?

[NurseOnAMotorcycle, ASN, RN]

It gets you legal "cover your @$$" when she stumbles into traffic, tries to get cash by suing, and the lawyers want to know what happened.

Document, document, document!!

[emtb2rn, BSN, RN, EMT-B]

Unfortunately this is the pt you really need to document on. They say it, i document it in quotes.

[Sassy5d]

So it's purely documenting to cya?

I quoted everything she said, including her telling me during d/c that she's going to f/u with dr so n so (ER) doc.

I was trying to document the story of her drug seeking behaviors, her behaviors in general. How she was basically a demanding b until I gave her medication. How frequently she rang and demanded pain meds before she was seen by md.

It just took so much time away from my sick patients. So I was frustrated. Taking away from my documentation of those pts. And nobody has been documenting this.

[zmansc, ASN, RN]

No, it's not purely to CYA, it also gives a record to the next doc and nurse (if you read it) as to this pt's history.

I have docs that watch the documentation to see if their orders have been completed.

It provides a place for the next nurse (if this pt is around for shift change) to confirm what they think was done/not done after receiving your report. If your teammates help each other out like mine do, then it also provides a place for you/them to let each other know what has been/has not been done.

Besides, if there wasn't documentation, where would you record your assessments?

[Altra, BSN, RN]

I'm not sure exactly what you're asking, OP. As I was up close & personal with substance abusers pretty much non-stop yesterday for 12 hours, I can certainly relate to that frustration.

But the most meticulously detailed description of drug-seeking behavior yesterday, in no way means that a patient is not having an MI today. With some additional time/experience, I'm betting you'll see some of your *most special* frequent flyers present with some really bad stuff. If anything, substance abuse increases cardiovascular risk -- it really is a ticking time bomb.

[Sassy5d]

I'm not sure exactly what you're asking, OP. As I was up close & personal with substance abusers pretty much non-stop yesterday for 12 hours, I can certainly relate to that frustration.

But the most meticulously detailed description of drug-seeking behavior yesterday, in no way means that a patient is not having an MI today. With some additional time/experience, I'm betting you'll see some of your *most special* frequent flyers present with some really bad stuff. If anything, substance abuse increases cardiovascular risk -- it really is a ticking time bomb.

I know she will walk in 1 day, or drove in with an actual cardiac event. I guess I was just venting on her behaviors. There are plenty of cp pts that come in that are not ordered iv morphine though.

No one is documenting her behaviors. Obviously normal stuff is documented.. Labs, vs, ect. But in all the frequency of visits, nobody is documenting what she is saying or doing. What good is all my documenting when i feel like I'm wasting my time. You want to come in, get iv narcotics and then demand AMA paperwork and the doc just says oh your stuff is back let me get her d/c'd. Meanwhile, I'm dealing with refractory hypoglycemia that you're dragging your feet on the admission.

I guess I'm just irritated at the blatant drug seeking. And she keeps doing it because it works and apparently, we're rewarding the behavior.

[Anna Flaxis, BSN, RN]

You are not going to single handedly "fix" this person. Even if she came in and the doc didn't order any IV pain meds, she'd just come back another time and get a doc who does. If you research learning theory, you'll find that intermittent reward strengthens behavior.

You can't turn her away at triage, and you can't dismiss her complaints simply because of her behavioral history.

You can document on her behaviors all you want, but if all of that meticulous documentation is taking you away from other sicker patients who need your attention, then you are not prioritizing well, and it's on you if harm comes to another one of your patients because you were caught up in this one's drama.

Having said that, do you have a social worker available? You might get social work involved next time you encounter this person. It might be possible to establish a plan of care that becomes part of her EMR, so that there will be more consistency from clinician to clinician.

[SionainnRN]

I know at my hospital we can see their past visits but not the documentation that goes with it. If it's slow I can pull up their dc note from the doc but not the nursing notes. So your coworkers may be documenting but you just can't see it. Plus we get so many drug seekers and frequent fliers I only chart behavioral things when they are really out of control. I'm not charting that they're on their call light all the time and being obnoxious.

[Sassy5d]

We can see it all, and it's not being documented. But each time she comes, she cusses and rings and comes out in the hall and carries on till she gets what she wants then she wants dc papers and to leave.

It's water under the bridge. Thanks for everyone's input

[floridaRN38]

I had a pt yesterday. Same thing sayin the Percocet ordered makes him itch (but he takes it at home daily). So I got dilaudid order for him. He was shouting profanity at the staff. I documented everything he said. I document in quotes even the F word and how he wished all of the staff should get ******* cancer and know what it feels like ".

But my question is. Can you get in trouble for documenting the profanity words that come out of their mouth???

[forgop]

We all have these patients-

They don't pay a dime for their "insurance", they call 911 for the "free ride", and they claim they're having (insert random symptom of the day) with 10/10 pain. They claim they're on home oxygen to warrant the "free ride" home in an ambulance because they didn't bring their home O2 tank, despite the fact the patient refused to wear the oxygen in the room. The service is never fast enough, the pain meds are never strong enough, and the harder you bust your butt, the more they'll make you work, and the words "please" or "thank you" aren't even in their vocabulary.

I do NOTHING out of the way for them, I take my sweet time, and the more you inconvenience them than you go out of your way for them, the less likely they'll come back.