Looking for advice

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  1. Do you think this is an ok practice by managment?

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      Yes, please explain
    • 20
      No
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      Other

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Hello everyone,

First of all, I'm disappointed I even have to come here to write this, but I'm looking for advice about a situation that is going on at the home health agency I currently am employed by.

A little background, we still do all of our charting on paper so when we go out to do a SOC we fill out a paper oasis that gets entered into a computer system by an administrative assistant and they generate the 485 plan of care that the admitting nurse then checks over for errors and sends to the physician who is signing the orders.

So here is my situation, the management at my agency decided they wanted to check to make sure the RNs were checking the 485 thoroughly before sending it to the physician so they instructed the administrative assistant to purposely include errors on the 485 so see if they were caught before they sent them to the physician.

So here is my question...I am in 100% agreement these should be double checked before they are sent to the physician, but having management instruct the data entry person to purposely faslify these documents to try to catch an error to me is ethically wrong. Especially since we were never approached and asked to make sure we were checking them they just out of the blue added orders and changed medications to see if we were "on our toes". Several of the plans of care got signed and send off to physicans with errors that weren't caught. The RNs at this agency are very busy, they function as both visiting nurses and case managers with a case load of no less than 20 patients at a time. The point of mentioning that being that they already have a lot to keep straight and purposely trying to set them up for failure seems wrong to me. I fully understand that anything I sign my name to I am responsible for; but we are all human and things can get missed and it seems unfair for management to do this.

Thoughs on this? Am I alone in thinking this is ethically and quite possibly legally wrong? I would really appreciate any insight into this. I have already starting looking for different employment simply because this is not an environment I'm willing to continue working in, but I'm just looking for some thoughts from those of you who are in the sane areas nursing

Thanks for any thoughts in advance!

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Well, then, I guess this explains why the last signed doctor's order was changed when it was placed on my patient's 485.

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Specializes in Hospice.

I would think that an agency doing something like this out of the blue is a real "gotcha" and I would not accept it as an employee. Our DON does chart review on a regular basis and brings deficiencies to our attention. If there are specific issues either agency wide or with select individuals, then they are dealt with. The agency presupposes good faith efforts from employees and the respect is mutual.

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This is so crazy, here I am on the Internet, a speechless person. Can't even type.

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Quick response from my phone to hopefully give you perspective and make your day go better..

I'd bet the farm you misunderstood. I think think more than likely they instructed the data entry staff not to correct the existing errors, not to intentionally create errors of their own making.

From my experience as a manager, there are staff who chronically make the same errors and/or omissions and data entry staff (I've worked on paper and witnessed this many times over from both sides) are correcting errors of licensed clinical staff. Huge waste of resources when it's all added up. We used to try different measures to improve clinical staff's omissions and errors, this is a very familiar story that plays out in every agency.

Does it make clinicians bad for these errors and omissions? No, we're all human. But we still need to attempt to improve and having you progress your own *uncorrected* work might help clinicians both catch and prevent the same old errors.

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First off thank you for your reply and I wish that were the case, but I didn't misunderstand anything. I promise you I would have never thought anyone would do this either but here we are. After it came to light and management was confronted about it we were told that the purposeful errors were in fact added by the data entry to remind us to thoroughly read over the plans of care before sending to the physician for signature. Which yes, this is obviously very important, but to me, there are much better ways to go about getting this point across than purposefully adding and subtracting information from a patients plan of care.

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First off thank you for your reply and I wish that were the case, but I didn't misunderstand anything. I promise you I would have never thought anyone would do this either but here we are. After it came to light and management was confronted about it we were told that the purposeful errors were in fact added by the data entry to remind us to thoroughly read over the plans of care before sending to the physician for signature. Which yes, this is obviously very important, but to me, there are much better ways to go about getting this point across than purposefully adding and subtracting information from a patients plan of care.

In that case, short of resigning which I would strongly consider, present a unified process improvement that your team clinicians agree with and will take personal accountability.

I would definitely tell your manager that, besides being absurd, a non clinician planting errors threatens patient safety.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

The whole reason to have double- and triple-check systems is to reduce the chance of error. To put in a deliberate error actually removes a layer of safety and defeats the purpose of double checking. This is the most out-to-lunch thing I've ever heard. To whom is the agency accountable? JCAHO? I think it would be worth dropping a word to them. On your way out the door.

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Specializes in Adult Primary Care.
The whole reason to have double- and triple-check systems is to reduce the chance of error. To put in a deliberate error actually removes a layer of safety and defeats the purpose of double checking. This is the most out-to-lunch thing I've ever heard. To whom is the agency accountable? JCAHO? I think it would be worth dropping a word to them. On your way out the door.

Yes to this!

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Specializes in Educator, COVID Paperwork Expert (self-taught).

I'm sorry they are doing this; unfortunately I worked for a home health company that was toxic as well, and more than willing to throw nurses under the bus. Other than the advice above, I suggest CYA in EVERYTHING...confirm anything you are told with e-mails, print them out and keep them in a file at home. I was thrown under the bus by two regional managers and unfortunately hadn't kept the proof. I'm in a new job now (that was the beginning of the end for me too), and tho I trust this management...I'm still keeping emails, schedules, etc. Take care.

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Update: we were told it's a perfectly acceptable practice because it's techniqually just a data entry error and it doesn't became a legal document until the RN signs it.

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Update: we were told it's a perfectly acceptable practice because it's techniqually just a data entry error and it doesn't became a legal document until the RN signs it.

Surely you aren't going to go along with this are you? Done deliberately does not constitute an "error". Any agency that has the time to falsify documentation, has the same time to process documentation correctly. Do you want to continue working for this 'out in left field' organization?

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