At my facility, we have two areas of charting--the MAR and the TAR. The MAR is obviously for medications. The TAR is for treatments and other orders such as vital signs and when to notify the provider. Lately, I've been finding that nurses are deleting orders from the TAR that they don't agree with or because they want to reduce the charting workload. Problem is, they're deleting orders such as to document daily wound notes that are needed to monitor a patient’s conditions. I've also noticed that the nurses deleting orders are those who generally dislike charting to begin with, so it's not really surprising they're getting rid of orders.
What would your approach be in resolving the issue? I don't want to stir up drama but the orders were entered for a reason
I don't understand why you don't subject the offenders to progressive discipline and fire them!. The rest will get the message.
Hppy
Unfortunately I don't have the authority to do so. All I can do is report it to my supervisor. Yes, I'm considered the nurse manager but I'm a low-level manager and don't have much to do with disciplinary action.
I haven't heard the term "conniption fit" in forever. I'm going to have to revive it in my vocabulary!
Well, I was vacillating between that and ”apoplectic with rage”.. but if you’d met this surgeon you’d understand... he really is a conniption kind of guy ?
1 hour ago, hppygr8ful said:
I don't understand why you don't subject the offenders to progressive discipline and fire them!. The rest will get the message.
Hppy
I wouldn’t understand either if I thought this was real ? I mean, look at that laundry list of transgressions ?
18 hours ago, SilverBells said:
Examples of orders being deleted:
Daily wound note on wound/incision condition on a patient with a wound infection
Measure abdominal girth daily on a patient with ascites
Daily weights and vitals for a patient with heart failure
Monitoring for signs/symptoms of DVT, PE or infection for patients at high risk
Aspiration precautions for a patient with dysphagia
Notifying provider for new or worsening signs/symptoms of heart failure
Monitoring for signs/symptoms of bleeding for a patient on anticoagulants or for those with a history of a recent GI bleed or low hemoglobin
Document heart/lung/abdominal assessment every shift fot a patient with heart failure, respiratory failure and history of bowel obstructions
The list goes on and on
Even in my country with strong unions, nurses like this would have been shown the door in less than a nanosecond’s time.
At my facility, we have two areas of charting--the MAR and the TAR. The MAR is obviously for medications. The TAR is for treatments and other orders such as vital signs and when to notify the provider. Lately, I've been finding that nurses are deleting orders from the TAR that they don't agree with or because they want to reduce the charting workload. Problem is, they're deleting orders such as to document daily wound notes that are needed to monitor a patient’s conditions. I've also noticed that the nurses deleting orders are those who generally dislike charting to begin with, so it's not really surprising they're getting rid of orders.
What would your approach be in resolving the issue? I don't want to stir up drama but the orders were entered for a reason
I would say if I got the TAR concept well.
TAR comes with package of interventions that the nurse need to do and some for the particular condition. if that the case then
deleting some of the intervention is one of nursing critical thinking of tailoring the plan for individualize care.
when I got training on Health Information System we were told about the treatment plan ( Care Plan ) the system will generate set of intervention for the patient of course it be applicable for all cases for the particular condition since it was studied and agreed upon these set of interventions. that being Said having nurse use critical thinking to tailor the plan for the individual patient would result in efficient care.
that would be my approach
to reach efficient care rather than effective care.
It's come to the point where I have had no choice but to start writing up nurses for deleting and/or not following orders. One particular individual failed to follow up on an antibiotic order after being specifically instructed to do so. The directions given were very clear; he was given the name and phone number of the doctor to follow up with along with the name of the pharmacy the antibiotic should be sent to. Instead, this nurse chose to spend time questioning why a patient with lower extremity edema requiring diuretic treatment was on daily weights and ultimately deleted those orders. I am writing him up because he has been asked multiple times in the past to focus on what he has been assigned to do, rather than what others are doing.
One example I can think of is a patient was admitted to us with an infected wound. I specifically put in orders for daily documentation and frequent vital signs for a reason. One nurse got rid of the daily wound note and reduced the vital sign checks because they don't enjoy charting and wanted to reduce the workload. This patient is now in the ICU for sepsis. I have every intention of addressing this with this nurse once I see them. Yes, I'm very heavy on documentation, but it's for good reason and this incident is an example of why I do things a certain way.
I'd be writing someone up for that. Those orders are obviously there for a reason, no excuse.
SilverBells, BSN
1,108 Posts
Unfortunately I don't have the authority to do so. All I can do is report it to my supervisor. Yes, I'm considered the nurse manager but I'm a low-level manager and don't have much to do with disciplinary action.