MD's writing orders for "variance reports"

[babiesX2]

At the hospital I work at, it is common for a group of Dr.'s to write in the orders "variance report regarding fill in the blank." I've never worked at any other hospital so therefore, I do not know if this is a common practice for Dr.'s at other hospitals. I'm not debating the fact that in most scenarios a variance report is warranted. I learned in school that variance reports are not part of the medical record, and it should not be mentioned anywhere in the notes. If it is mentioned in the med record, it can then be admissable in court. Anytime I have one of these variance report orders, I write on the variance report the required pt info and in the description of events section, I write -- Today, Dr. Soandso wrote the following order, "Variance report regarding blah, blah, blah." (I write the order exactly as it was written.) I turn the report over to my nurse manager, and I let her handle it from there. I've never been reprimanded for this by nurse manager. We get these orders frequently. Thankfully, I've never made a mistake that led to being written up.

I find it especially troubling that the group of Dr.'s who write these orders have been on the local news compaining about our facility because they want seats on the board of directors but the hospital won't allow it. This group of Dr.'s also own a one-day surgical hospital that competes with our non-profit hospital.

[Katnip, RN]

Risk management might want to know about this. I can't imagine it would make the hospital too happy.

[jmgrn65, RN]

i agree with above poster, risk management needs to be aware because if the doc is writing an order to write a report that makes it a legal part of the chart because it is noted in the chart. So i would make sure that risk management knows, I bet the doc's know they shouldn't be doing that.

[babiesX2]

Due to serious financial struggles (which the hospital claims is due to the competing private one-day surgery hospital), a series of lay-offs took place recently. Can you guess who got canned. . . yep, risk management. Nice, huh?

[Charity, RN, APRN]

We have online "occurance reports" that anyone can file. If a physician wants one completed, he or she can do it themselves. Our docs do it all the time. If I actually saw an order as you describe, I would call the physician and remind him/her that it is an inappropriate order to be placed in a patient's chart.

[babiesX2]

I should have said this earlier. My thinking on their writing this in the orders is that they want it to be a part of the medical record and they think it makes the nursing care bad and takes responsibility off them. 90% of these write ups are petty BS.

[beautifulb]

The funny thing is though, is that anyone can write a variance report. So if the MD wants one written, then they can do it themselves. Have you talked to your nurse manager about this?

Nowhere where I have worked (many different jobs and 5 states) were their Dr.'s orders for a variance report. From what I understand, the person who finds the error, variance, incident, ect. they would be the one to file a report without mentioning it in the chart and then sent to risk management.

So who is now covering for risk management?

Sounds like an interesting situation over there.

[HappyNurse2005, RN]

NEVER seen an order like that...

[canoehead, BSN, RN]

If they want a variance written they are more than welcome to. Can you put a copy of the form in the chart with a note saying "form provided as requested"?

[cardsRN]

is a variance report like an incident report that's not part of the medical record? just curious 'cuz we don't use that term at my facility...

thx

[Nightcrawler, BSN, RN]

I saw this once when I was doing a summer internship. The doc wrote an order for a incident report to be filed by ----- nurse regarding -------. I don't remember the specifics of what had happened with the patient, but I do know that when the charge nurse looked into the matter that the doctor had altered a previous order- on the master but not the carbon when they were matched up, and then wanted the nurse written up for not following the order. A incident report WAS written, but on the doc!!!!

[babiesX2]

If they want a variance written they are more than welcome to. Can you put a copy of the form in the chart with a note saying "form provided as requested"?

One nurse did that and another order was written to write her up for not following orders. It is ridiculous.

is a variance report like an incident report that's not part of the medical record? just curious 'cuz we don't use that term at my facility...

thx

Yes, variance report is the same as an incident report. I learned in school to never make mention in the chart that a variance/incident report was filed because then it becomes part of the medical record. It is an unscrupulous attorney's dream.

Risk management is being handled by each unit's nurse manager.