IV stop times

[Josh's mom]

My hospital is now making us document the stop time of all IV piggybacks and IV bolus infusions- both outpt and inpt. I'm just wondering if other places are requiring this.

[imintrouble, BSN, RN]

It is about money/charges. Right now we are only required to chart start and stop times on blood transfusions. If it is a medicare requirement, we'll all be doing it eventually.

[cb_rn]

watch and see if some of the infusion times on the bags don't magically increase when someone smarter than me figures out we can make more money if we run the med in slower (not meaning the nurse runs it in slower, meaning the instructions on the pharmacy label)

[wooh, BSN, RN]

I have to say, this is the dumbest thing I've ever heard. I mean really, if the infusion starts, it has to end eventually. The things paper pushers will come up with...

[tvccrn, ASN, RN]

i work on a tele floor. we do this for observations patients only. the monitor tech generally does it at night, we pretty much look at our paper mars close to shift end, and let her know what time we started the iv's. she has info on how long it's supposed to run for and figures it out that way. we usually only have 1-2 obs patients per nurse, sometime none. so it's not so time consuming. and yes, it has something to do with billing. we also let her know when we give anything iv, subq or im. basically, anything that goes into a patient via any route, other than a natural orifice.

we recently were told that we have to do this as well. the way it was explained to us, doing it the way described above defeats the purpose as "just because that is how long it is supposed to run doesn't mean that is how long it did run. what if you left it clamped, or forgot to start the secondary infusion? this is to make certain the medication was administered at the proper time and in the proper timeframe."

total pita when you are the only icu nurse for 3 icu patients, all receiving piggybacks and one of the three wildly out of control.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We do it in my ER. We actually chart twice,..."Rocephin 2gm IVPB to run over 1 hr, administered at 1600" Then in another spot we have to chart the start et stop time,...you would think that this wonderful computer charting could figure out that if it started at 1600 and ran for an hour it would end at 1700,...go figure.

[RNSoonEnuf]

Our ER is doing this. They are really cracking down on it. Our management has not been shy about letting us know this has to do with reimbursement and liability. If you hang an IV and don't chart a stop time, as unreasonable as it sounds, it can be assumed that your pt received unlimited amounts of fluids. Ya, I know it sounds stupid. But that's how it's being presented to us. Also, they can't charge if they don't have a definite amount how much was given. Incomplete documentation. :smackingf It comes down to $.

[canoehead, BSN, RN]

You could possibly have a patient going home with the IV fluids still running (on the chart) and they could sue for slander.

I remember one charge nurse telling me I had to state the actual vein used when I started an IV because if I didn't they could assume I infused meds into the interstitial space and sue for it. Sure, those 3 litres in the back of the hand would make a huge problem, but someone is suing because of what the chart says, not actual poor outcomes? Tell me more, I smell money.

[caliotter3]

You could possibly have a patient going home with the IV fluids still running (on the chart) and they could sue for slander.

I remember one charge nurse telling me I had to state the actual vein used when I started an IV because if I didn't they could assume I infused meds into the interstitial space and sue for it. Sure, those 3 litres in the back of the hand would make a huge problem, but someone is suing because of what the chart says, not actual poor outcomes? Tell me more, I smell money.

This is enough to give a person a headache.

[sorlando]

I work in an outpatient department and we have been doing this for about a year. It's for medicare reimbursement.

[JBudd, MSN]

We are supposed to in the ER, our chart coders said we can only bill for IV care during actual infusion times; so I guess there is a difference in level of care they can charge for if there are no fluids running. Also, some insurances refused to pay for IVs at all if the charting wasn't "complete"; ie start AND stop times.

I can just see that holding up in court, "no your honor, that infiltration couldn't be from my IV because I didn't chart a stop time, therefore there was no IV, therefore it isn't my fault".

[cb_rn]

You could possibly have a patient going home with the IV fluids still running (on the chart) and they could sue for slander.

I remember one charge nurse telling me I had to state the actual vein used when I started an IV because if I didn't they could assume I infused meds into the interstitial space and sue for it. Sure, those 3 litres in the back of the hand would make a huge problem, but someone is suing because of what the chart says, not actual poor outcomes? Tell me more, I smell money.

Wow. Great point. Wonder where someone could get a job auditing charts for incomplete documentation for the purpose of bringing lawsuits. If the pay is per incident, I could retire early.

[wooh, BSN, RN]

We are supposed to in the ER, our chart coders said we can only bill for IV care during actual infusion times

I find this hilarious as a peds nurse. I spend more time trying to preserve IVs when nothing is running through them (because then the kid isn't tethered to an IV pole) than I do when something is actually running.

There's going to come a time when they'll run out of things to have us document. But I don't think it will be until each and every patient has a chart that looks like:

1045:23 pt inhales, pt blinks

1045:24 pt continues inhaling

1045:25 pt begins exhaling, IV rocephin started

1045:26 pt continues to exhale, pt blinks

1045:27 pt continues to exhale, IV pump beeps