Joint commission and their ridiculous mandates

[nightdove]

I am so sick of joint commission and their ridiculous mandates on charting. They sit in some office somewhere and I am sure they have never worked in ICU and mandate what we need to chart. They say its best for the pt but in reality it actually takes away from pt care. Most nurses do what they is best for the pt and lie about what they chart. All the nurses are so afraid of getting in trouble for not charting hourly rass, starting a drip per protocol,etc that they do what is best for the pt and just lie to make the chart look good per the damn protocol. Most of us have been doing this for years and will do what is best for the pt. But now we have to lie and make it look good. Besides this it takes away from pt care to have to chart all these hourly rass if a pt is on propofol or versed. The charting requirements are taking away from pt care. Its all ********. Joint commission has nothing better to do than sit in some office and write a bunch of crap for us to do that in no way benefits the pt. Its quite obvious that they are completely ignorant when it comes to actual hand on care. More and more time in front of a computer is less time to spend with pt. Besides that we lie on the charting and do what is actually best for the pt. What joint commission requires is completely, total ********. They say its for pt safety but its just to give them something to inspect to protect their jobs. They have nothing better to do.

[elkpark]

Appropriateness of Joint Commission requirements aside and, no, I don't work in critical care, I'm always disturbed at how people post here that they regularly falsify charting. We may not like the "rules of the game," but this is the game we signed up to play. We're obligated, legally and ethically, to "play by the rules."

[Morguein]

I get what both sides are saying here. I work critical care too; and sometimes, my patients are too sick to leave them in order to document all this real time information that's required. I'd say that pretty much, every day I work, I'm standing at one of my patient's bedside for 90% of my shift. I am lucky if I get to just sit and document for a few minutes. Because, if I'm not in one of my patient's rooms, I'm in another nurse's patient's room. A lot of my documentation is done after my shift is done. I try real hard to get my vital signs, I&O's, CRRT info, IABP info done every hour. Everything else is usually documented much later. As long as I'm looking at my patient and I'm aware of their changes and act on them, I feel like I'm doing the right thing. We don't have the luxury of copying and pasting anything. My director didn't want us to have that option. In fact she asked that we not be allowed to generate our assessment from one shift to the next even if nothing has changed. They felt that we would just keep generating and regenerating information without actually assessing our patients. It's the most ridiculous thing ever! We have to input every single data manually which is very time consuming. So, I'd rather actually touch my patients and do things for them before documenting. We all thought that going to computerized documentation would make things easier and faster; but it seems like it takes longer and they've added soooo much more to document on. If we forget to document on something, we get called at home and are expected to come back to work or come on our day off to document. Some nurses didn't document, because they didn't do it. But, they are expected to document anyway. So, then it starts to look like management only cares about what our patient care looks like on paper/computer. We can complain that we don't have enough staff or time to do everything they want to no avail....BUT we better have "everything" documented. Anyway, I'll bet that Nightdove is a good nurse. I know many nurses who just have all the time in the world to document; and their "paperwork" looks flawless and perfect, but they don't even have a stethoscope or barely touch their patients.

[Graduatenurse14]

I worked as an nursing assistant in a large university-affiliated medical center that was on US New and World Report's top 10 list (another questionable accolade) while in nursing school and is JHCO accredited. I was under the impression that it was another honor and really meant something until I went to work for a private child and adolescent psychiatric hospital that was also accredited that was dirty, non-therapeutic and in violation of several laws. I learned real fast that JHCO accreditation was a joke.

[nightdove]

I really appreciate what you said. It totally reflects what I feel and all the nurses that I work with in ICU. Everyone does all they can for their patients. They are all excellent nurses but it is so stressful making sure you dot the I's and cross the t's. Anyone that says they can do all this perfectly is a liar. But that doesn' t matter. We all went into nursing to take care of patients. The nurses I work with strive to give the best care but having to choose between giving your time to the patient and charting all the ******** takes a toll on any good nurse. I choose the patient and if I have to ******** the charting ,so be it. Everyone I know does it. The patient comes first and to hell with the damn charting.

[Guttercat, ASN, RN]

I really appreciate what you said. It totally reflects what I feel and all the nurses that I work with in ICU. Everyone does all they can for their patients. They are all excellent nurses but it is so stressful making sure you dot the I's and cross the t's. Anyone that says they can do all this perfectly is a liar. But that doesn' t matter. We all went into nursing to take care of patients. The nurses I work with strive to give the best care but having to choose between giving your time to the patient and charting all the ******** takes a toll on any good nurse. I choose the patient and if I have to ******** the charting ,so be it. Everyone I know does it. The patient comes first and to hell with the damn charting.

OK there. Whoa up.

There is a difference between "back charting" and outright falsifying. We all know that it is humanly impossible to chart everything, every day in real time.

For back charting we have to rely on paper "brains," data stored and/or auto-populated from other devices, or our memory (as in the case of assessments and interventions).

That said, I can't count the number of times a physician walks into the room, says no more than hello to the patient (if that), then turns around and charts a full head to toe assessment including subjective data that was never asked.

And yes, charting is much more data-heavy and cumbersome than it was even 15 years ago. I know it feels like we are treating a machine (the computer) instead of the patient.

As a "seasoned" RN, there are things that I simply LOVE about the computerized charting, but I can also see where it truly detracts from critical thinking and problem solving. How many of us have tried to find the box we need to check only to find that that box does not exist? I sometimes wonder just how much we are learning to jettison critical and creative thinking in favor of treating the patient in accordance with what the computer gives us as parameters to "think" by.

[MunoRN, RN]

I am no more of a fan of the JC than anyone else here, but the requirements for titrating drips and frequency of RASS assessments aren't actually JC requirements. What the JC requires is that your facility have policies and protocols for these things and that they be followed, whatever they are. If your policy is to do q4 hour RASS scores then that is what the JC will require. If your policy is to only provide a starting rate, max rate, and parameter goals for a levophed drip then the JC won't require you to follow specific and inflexible titration guidelines, it's only if that's what your facility decided to do.

[annie.rn]

That said, I can't count the number of times a physician walks into the room, says no more than hello to the patient (if that), then turns around and charts a full head to toe assessment including subjective data that was never asked.

I just started a thread about this. So frustrating!

[nightdove]

I am sure you are a great nurse but every hospital is different. We have no cnas or unit secretaries. So much time is taken up doing paperwork. My nurses are the best of the best. They take excellent care of the pts. When they have a pt that is crashing with a low blood pressure they do what they know to do and titrate the levophed based on the patient and what it takes to stabilize them. To hell with looking g at a ******* protocol. But when they chart this event, they chart according to the damn protocol or risk getting written up. Yes the pt lived but obviously the only thing that matters when you have these idiots that just do chart audits is whether you titrated the levophed according to protocol. So if you don't get what I am saying then you obviously don't have to make these kind of decisions at night when there is no doctor around. Charting is important and I would never advocate lying but the bottom line is pt care. All I am trying to say is that all these new requirements really do nothing to help the patient. It's all about the chart. Maybe this would help a new nurse that needs a piece of paper to know how to titrate levophed but for an experienced critical care nurse, its not going to happen. They will do what they know best for the pt. And chart all the titrations based on the ******* protocol instead of what they actually did. And you think this is wrong? The pt survived. And this is wrong?

[**LaurelRN, MSN]

The funny thing is JACHO found that their own standards inhibit the ability of nurses to care for patients and their own inspections create part of the problem in health care. That's why I have left the bedside. I'm tired of not being able to actually take care of my patients. It's more about charting, HCAPS scores and patient/family satisfaction than anything else.