How do you avoid double/triple charting? Tips.

Nurses General Nursing

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My employer now demands double charting so that is what I give them.

I refuse to double chart. You can actually write in a column of the ob's chart 'refer to ....... chart for (whatever)'. I don't double/triple chart on computers either - I don't care what the policy is. It is such a g/damn waste of time. If nurses keep doing it, employers will keep demanding it. Tell your NUMs that you won't be doing it, point out how time wasting it all is.

And, from my viewpoint, if someone can't flick through a patient's details and pick everything relevant out in one go, then they should not be nursing.

This might not be the wisest course to take. Keep at it like this and you migth find yourself out of a job. Subtlety is required here.

Specializes in Emergency, Telemetry, Transplant.
Why is it,legally, not a good idea to repeat the VS?

This is paraphrased from an article I read a while back. (not an exact quote, sorry I don't have the specific reference).

Anyway, their point was if the VS charted in the flowsheet do not match the VS in your NN or they time listed on the two are different, then this could throw the validity of that charting into question. Again, not my opinion on the matter, just what this particular article said.

Say, for intance, the aide goes in a gets admission VS. Charts BP 128/62 on the flow sheet. You include that in you NN. Aide realizes that they put the wrong pt's VS in the flowsheet. They put the correct value of 198/92 on the flowsheet a few hrs later. They don't notify you of that the original value was incorrect or that the new value was high. So, something bad can happen to the pt and you original NN is shown to be in error. Obviously there is a series of errors here, but now you also have a NN that proves that you were not paying close enough attention to the situation.

Specializes in Emergency, Telemetry, Transplant.
I refuse to double chart. You can actually write in a column of the ob's chart 'refer to ....... chart for (whatever)'. I don't double/triple chart on computers either - I don't care what the policy is. It is such a g/damn waste of time. If nurses keep doing it, employers will keep demanding it. Tell your NUMs that you won't be doing it, point out how time wasting it all is.

And, from my viewpoint, if someone can't flick through a patient's details and pick everything relevant out in one go, then they should not be nursing.

I agree with you that it is silly and a waste of time to double chart. However, I am not going to tell my NM to 'shove it' (or something similar) if she demands that we double chart. We should work through the correct avenues to get rid of double charting, but you solution to the problem seems to be a quick path to losing one's job.

Meh. I have to write narratives where I work, along with signing the mar, and an assessment sheet.

Whereever possible, if I sign that I did something in a specific way on the mar, then I Will write: 2400, Meds given via Gt with 5cc h20 flush (see MAR). Or at the beginning of my note "Full pt assessment completed, (see Assessment data sheet) Results WNL. I see NO reason to re-write everything I have just written on the assessment section...and my agency has never required that. The reason that I will say (see assessment data sheet or See MAR) is that in the event my note was ever reviewed by "The powers that be", then they will know for sure that their is another section to my paperwork that goes with the narritive...how do i know if the office would supplie all necessary documents otherwise?

So basically my narritive is AS short as I can humanly make it...I give a timeline for what I do, when and why, as well as any abnormal events that would not be charted elsewhere...Such as "Gt care provided per order (see MAR). Trace amount serosanguinous drainage on old dressing. No visable open areas, redness or swelling at gt stoma, pt denies tenderness." I see no need to write out "Gt stoma cleansed with 1/2 str h202, rinsed with distilled h20 and dabbed dry. New sterile 2 by 2 applied...if I had to sign my name to a mar sheet that said that this was exactly what i did.

I am open to critizism if anyone sees an issue with this..I am always concerned with my charting.

Perhaps a good follow-up question would be.."Why does my employer ask me to double and triple chart?" I would like to know too!

Specializes in Pedi.
Meh. I have to write narratives where I work, along with signing the mar, and an assessment sheet.

Whereever possible, if I sign that I did something in a specific way on the mar, then I Will write: 2400, Meds given via Gt with 5cc h20 flush (see MAR). Or at the beginning of my note "Full pt assessment completed, (see Assessment data sheet) Results WNL. I see NO reason to re-write everything I have just written on the assessment section...and my agency has never required that. The reason that I will say (see assessment data sheet or See MAR) is that in the event my note was ever reviewed by "The powers that be", then they will know for sure that their is another section to my paperwork that goes with the narritive...how do i know if the office would supplie all necessary documents otherwise?

So basically my narritive is AS short as I can humanly make it...I give a timeline for what I do, when and why, as well as any abnormal events that would not be charted elsewhere...Such as "Gt care provided per order (see MAR). Trace amount serosanguinous drainage on old dressing. No visable open areas, redness or swelling at gt stoma, pt denies tenderness." I see no need to write out "Gt stoma cleansed with 1/2 str h202, rinsed with distilled h20 and dabbed dry. New sterile 2 by 2 applied...if I had to sign my name to a mar sheet that said that this was exactly what i did.

I am open to critizism if anyone sees an issue with this..I am always concerned with my charting.

Perhaps a good follow-up question would be.."Why does my employer ask me to double and triple chart?" I would like to know too!

You make a good point. I'm sure the answer to that question at my facility would be something to the tune of "Because this is X hospital and this is how we do things here."

Since we went to electronic charting, we chart EVERYTHING. I work in neurology/neurosurgery so it is full neuro assessments, pupil size, EOM, strength, GCS every 4 hours along with full head to toe assessment once a shift. Pretty much everything I write in my note is documented on the flow sheet. I think nursing notes are a complete waste of time unless something major (transfer to ICU, emergent OR case) happens. For a standard post-op patient getting pain meds, fluids and ADAT, is it really necessary for me to write a note "Alteration in comfort" and then re-write that the patient has been c/o 7/10 pain (already documented in the q 4 hr pain checks we are required to do) and was medicated with morphine with good effect ("action taken- pharmacologic, response to action- pain improved.") and that the patient has poor PO intake (I&O documented on the flowsheet) and is receiving IVF per order (again, documented on flow sheet and MAR) and got Zofran once for c/o nausea (MAR).

When I'm writing my notes, I quite often want to write:

Problem: Alteration in comfort r/t craniotomy

Assessment: See nursing flowsheet

Plan: Continue with current plan of care.

Do I actually do this? No. My manager micro-manages everything and goes into people's charting to audit their notes. Recently there was a staff meeting where we were yelled at for there being missing notes for patients who'd been inpatient for a long time (pt had been inpatient for > 1 month, things not changing on a day-to-day basis). It's not worth the fight so I just grin and bear it and write my notes like a good doobie even though they are a complete waste of time.

I agree that double documenting is more liability though. I read a note yesterday on a patient of ours who is currently in ICU that said "moves all extremities equally." Patient had a hemispherectomy years ago and has a baseline R hemiparesis with significant spasticity on the right. My personal favorite, though, is one of our services that just copies and pastes the same note every day. "NOE"- No overnight events is their favorite thing to write. Never mind that the 2 year old patient with hydrocephalus had bradycardia to the 50s, was barely responsive, needed a stat CT and then to be tapped. Still NOE.

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you make a good point. i'm sure the answer to that question at my facility would be something to the tune of "because this is x hospital and this is how we do things here."

rofl!!! sounds about right, haha!

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"i agree that double documenting is more liability though. i read a note yesterday on a patient of ours who is currently in icu that said "moves all extremities equally." patient had a hemispherectomy years ago and has a baseline r hemiparesis with significant spasticity on the right. my personal favorite, though, is one of our services that just copies and pastes the same note every day. "noe"- no overnight events is their favorite thing to write. never mind that the 2 year old patient with hydrocephalus had bradycardia to the 50s, was barely responsive, needed a stat ct and then to be tapped. still noe."

oh...i catch myself slipping into that behavior once in awhile...i have all my very habitual daily phrases that i seem to write the same on almost every note...but i don't think i am quite that bad :madface: lol. i need to slow down and think about what the heck it is i am actually saying once in awhile ;)

i had often wondered myself if double documenting increased liability because each time you do it, it opens up another opportunity for an inconsistency that they can nail you on. i haven't heard it officially before now....good to know.

Specializes in CICU.
Say, for intance, the aide goes in a gets admission VS. Charts BP 128/62 on the flow sheet. You include that in you NN. Aide realizes that they put the wrong pt's VS in the flowsheet. They put the correct value of 198/92 on the flowsheet a few hrs later. They don't notify you of that the original value was incorrect or that the new value was high. So, something bad can happen to the pt and you original NN is shown to be in error. Obviously there is a series of errors here, but now you also have a NN that proves that you were not paying close enough attention to the situation.

Here is my question - Why would anyone chart (or re-chart in this example) VS that they did not take themselves? If I chart a BP, O2 sat, etc. it is because I took the measurement myself. The CNAs chart the ones they take...

Specializes in critical care, PACU.

Unfortunately, most double charting is not because of you, it's because of the rules management dictates.

Like when we do neuro assessments every 4 hours, the manager makes us chart out everything over again, even if there is no change. We can't just select no change. Meh.

Specializes in PACU.

I have always been pretty scant in my documentation unless there's something whacky and never had an issue. Even when something is wrong, I write what needs to be said and nothing more. The more you write the more chance there is for an error or contradiction. The only thing I am quite thorough with is the assessment page, and even then it's focused on important/pertinent systems.

I do try to be detailed in my transfer/discharge notes to CYA a bit. I can't tell you how many times I've had a comfortable, happy patient who the second he/she sees the floor RN or more frequently his family turns into a crying mess in 87/10 pain fixing to puke out his eyeballs. It may sound dark, but it really makes me chuckle deep inside when some dude acts like a little wuss in front of his girlfriend for sympathy. Even when I hurt like crazy I'm not going to act like a little girl in front of a woman, esp. after I just turned down the other 50 mcg of fentanyl the nurse just offered me less than 2 minutes prior because "I feel fine."

Specializes in Pedi.
Here is my question - Why would anyone chart (or re-chart in this example) VS that they did not take themselves? If I chart a BP, O2 sat, etc. it is because I took the measurement myself. The CNAs chart the ones they take...

I believe the poster who said this was referring to referencing VS (as documented by the aide on the flowsheet) in a NPN or Admission Note. "Upon admission BP 128/62" which, if that is what's documented, is the BP as you know it. The reference was to a nurse charting this in a note and the aide then going back and modifying the result on the flowsheet without informing the nurse that the original documented pressure was an error and that the patient was actually hypertensive. This is just one of the reasons that I always do my admission VS myself.

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