Hospice charting (Neg- Charting) ?

AtlantaRN, RN · Feb 24, 2009

Negative charting... I always chart what I see. In hospice you NEVER say the patient is improving (but you can say "patient states i'm having a good day.") In the hospital setting, negative charting meant that in your narrative, you would only document a deviation from normal.

I would think as a new grad, especially a new grad to hospice-you will go through an extensive orientation. ((i've been a nurse for 12 years, and have been with this hospice company for 6 months and am just finding out that there is a 3 day class in Alabama for nursing orientation)).

Don't worry, you will be paired with a seasoned nurse that has seen "everything."

It's a great field. Good wishes to you!

linda

jenrnmcg · Feb 26, 2009

Hello...From my experience it is stating the obvious but something we do not usually chart...ie: pt transfers to BSC with use of this RN hand, piviots per self; no s/s dyspnea or pain noted; performs own pericare; able to transfer self back to bed with out assist; no s/s pain, dizziness, sob noted; I hope this helps

Whispera, MSN, RN · Feb 26, 2009

I thought negative charting was charting the things that aren't within normal limits. That way you don't chart what's A-OK, only what needs help....

Melinurse · Feb 27, 2009

I'm confused sort of, our hospice tells us to " paint a negative picture ". I chart what I see that's it. Can someone further elaborate on this? I am a new grad and new to hospice too.

rnboysmom · Mar 2, 2009

Never have liked the term "negative charting". I prefer the term "charting toward decline". As a new grad in hospice, this may acctually be easier for you than if you were in some type of previous position that "charted by execption" or charte improvement. Each visit, simply look at your patient assessement and note what the patinet is 1. no longer able to do or is now having difficulty with 2. how their disease process is affecting their or their loved one's life and 3. what you are educating them about. Even if it does not show on your physical assessment, you can sum it up by writing a simple short narraitve that starts with the following phrase..."This patient continues to meet hospice criteria a.e.b......" or "This patient continues to show evidence of decline a.e.b......"

Mamanurse62 · Mar 3, 2009

rnboysmom is correct regarding charting toward decline. This is most important to document for the patient to maintain medicare/medicaid eligibility. If the patient doesn't show decline on paper (the chart) they may have to be discharged. If you document even the smallest change, or loss of independence, it may mean the difference if the patient staying on service or discharged. Patients are recertified after the initial 90 days, a second 90 day period and every 60 days after. Hope this helps.

siouxsieyq, BSN, LPN, RN · Mar 5, 2009

Our PCM reminds us to chart to the Hospice or billable Dx. If a patient is on service for COPD or Lung Ca, make sure to include doccumentation showing any decline (increasing SOB, more frequent use of O2 or PRN neb Tx to manage Sx., etc) in that area. Of course it is important to chart overall decline and declines in other body systems as well. We had a patient on service for ovarian CA, but was asymptomatic of the disease by the time 3rd or 4th cert period rolled around. She met criteria for coverage under dementia guidelines, however, so her hospice diagnosis was changed to dementia. Don't know if that helps or not, as I too am still a Hospice newbie... Just somethin I've learned in my short time their

AtlantaRN, RN · Mar 20, 2009

I'm confused sort of, our hospice tells us to " paint a negative picture ". I chart what I see that's it. Can someone further elaborate on this? I am a new grad and new to hospice too.

my hospice is the same way...they tell the nurses to NEVER document that they are improving in any way, but you can say "patient states having a good day, ate 100% breakfast...."

linda

nursebitback · Mar 22, 2009

I would say that a nurse has to be very cautious with taking charting advice from non-nurse types, but the truth is, a nurse has to be very cautious in taking charting advice from ANYONE other than her own internal internal voice.

Let me take the blinders off for you less than informed ones. Negative charting doesn't mean charting exactly what you see. That is called charting the truth. What it means is that they want you to focus on the abnormalities and ignore the normalities. When the abnormalities are documented along with the normalities, a balancing effect occurs. If a patients pulse is 140, his respirations are 38, that seems pretty bad. But if you include the fact he just had the biggest bowel movement of his life and you walked up on him before he had a chance to pull his pants up, well, that sort of puts the readers mind at ease.

The truth shall set you free. Which unfortunately sometimes means being fired from a home health or hospice job.

pammyf · Mar 29, 2009

Sounds like a linguistic issue. Patients are supposed to be declining; however minimal the decline might be in some cases.The "iffy" patients are the ones that careful attn be paid to negative charting if appropriate. If you focus on the positive then the chart auditors may see red flags and think the patient is not appropriate for hospice.

So lets say the wounds you are healing because of your great teaching and great nsg care. and the lungs are clearing for some reason and on and on. On one hand you want to shout and extol the virtues of your great nursing interventions. you can and should report the positive effects. If the patients dx is one in which the course of disease process will take them down then have fun with some positives. when you have the non cancer dx folks failture the thrive or old age disabled folks use your common sense. if the pt is clearly terminal you sort of have to reflect it. But if they are really boarderline and do not meet the markers then they really should be discharged anyway.

We need to be accurate, but in life there is plenty of gray areas....welcome to the joys of charting.

Valerie Salva, BSN, RN · Mar 29, 2009

Things sure have changed since I was in hospice (the mid 90s). We were told to be sure and note improvments in the pts' conditons as a result of our interventions- we were told that this was to illustrate that the pt required our continuing intevention in order to slow and or ease their decline. Showing that our interventions were addressing pain and sx mgmt was of the greatest importance.