Nightly chart checks - last 24 hours only or go through ALL orders?

[Iggy123]

RN's (me included) are confused about this...most nurses just do 24 hr chart checks only for new orders within the last 24 hr time period. Others report that we have to check ALL orders from the beginning of pt's admission and ensure everything is correctly transcribed so that no errors are made. This includes meds, tests, etc basically every doctor's orders. How does it work at your hospital? Just curious to hear what other RN's do...

I thought the point of 24 hr chart checks is that staff are doing them every night so theres no point of having to go through allllll the way back. And it takes a super long time if this is required

[WyndDrivenRain, BSN, RN]

The last hospital I worked in was ALL orders every night, it was a royal pain, but we caught stuff all the time. I feel your pain.

Sue, RN

[Chaya, ASN, RN]

Each shift has to do a shift check of all orders for the 8-12 hours they were there.This means that when the 24 hour check is done, each order has already been checked. Night shift then is re-checking the previous 24 hours. (At least that's how it's supposed to work...!)

[mamamerlee, LPN]

It's called a 24 hour check for a reason.... If you only work intermittently you would not check multiple days/weeks - just since the last 24 hour check was done. It's not possible to check multiple charts for multiple 24 hour periods.

If you are concerned that orders are being missed, the responsible party is the one who did the first chart check after the missed order. Not someone 3 days or a week later.

Do not make extra work for yourself or it will become a policy that you have to check back 48 or 72 hours!!!

[PAROPPY, BSN, RN]

At my hospital checks are done on the night shift EVERY night. We only go through the previous days orders because checks are being done every night that the pateint is there. It would be totally redundant to go through every single order from the time of admission.

[I<3Nursing]

We do all computer charting and do chart checking (reviewing) for the last shift, but I also read over all orders, which is VERY easy with computer charting, but having previously worked with paper charting know it can be very difficult. I easily read through them all write down what I want to check to make sure is done, and check the Kardex to make sure it has all been transferred. Making sure all the orders are done is my job as the nurse, because when the Dr comes in the morning he doesn't care that the nurse before me didn't do their job, that responsibility falls on me :)

[mcpkin]

I do 24 hours only, unless the nurse from the previous night did not do one. Then I would go back to the last red signature. We have mostly 8-9 pts at night, no way to go through all the orders.

[McBx3]

At my previous job, we were only required to do 24 hr checks... BUT after getting reamed by a doctor for not giving a med that another nurse had missed 3 days ago during chart check, I started checking back as far as I could (when time permitted).

[ohgoodnessgracious]

We used to do just 24 hour nightly chart checks, meaning we just checked the charts itself. All our orders are computerized so another division comes in and looks through notes to see if what doctors are putting in make sense for the patient. Our chart checks only include whether or not entries were dated, timed, and signed and we also have a sheet that you check out to see that IVs are current, restraints are current, etc. Day shift does this now, to tie in better what changes were made during night shift.

[wishiwereanurse, BSN, RN]

We still employ paper charting, so what I do is, I check first with the previous 24hr orders, then I look at the folded, empty papers 'cuz sometimes docs would write there then fold the paper back, and if you're not too meticulous, you can miss them...

[babyNP., APRN]

I'm a little confused on this...

Do you not check your orders when you get report from the outgoing RN?

For me personally, I check "all active orders" on the chart but orders that are already done I wouldn't...because they've already been done or don't apply. It's computer too, does that make a difference?

[Meriwhen, ASN, BSN, MSN, RN]

If charts are being checked nightly, then why is there a need to go back to the beginning of the chart every single night? Do they really think that orders checked--and completed--from two weeks ago are magically going to change when no one's looking?

We do the last 24 hours...we may go back an extra day or so if it's a complicated patient, there were issues, or there was no indication a check was completed then.

[RNKPCE]

After reading this thank god for computerized physician order entry(CPOE). I have never worked without this and hope to never have to. Our orders and charting are all computerized. We still have to look and make sure stat meds have been given and no meds have forgotten to be charted or tasks done. But if not done it is obvious.

I couldn't imagine looking back over the charts of some of our long term patients.