Our latest delegated task: chart audits

[rstewart]

The powers that be have always behaved as though staff nurses can assume infinately more duties without impacting patient care. Nothing new there. But this latest delegation irks me particularly.

As staff nurses we are responsible for patient care, of course, appropriate charting, noting orders, checking medical adminstration records nightly, doing 12 and 24 hour chart checks to insure orders have been noted etc. ---the usual stuff.

But now the expectation is that we complete chart audit tools which take 15-30 minutes for each patient. Previously the audits were performed at the manager/clinical coordinator level; later they were delegated to the charge nurses. Now with the blessing of administration they have been "dumped" on the staff.

Now I realize that an extra half hour a day for 2 critical care patients doesn't seem like much. However, these audits are just the latest in addtional duties/documentaion which are taking time away from patient care. And our productivity has consistantly exceeded 100% due to chronic understaffing.

When things are slow/census low I don't think anyone would have a problem doing some audits. But I have never heard of making chart audits a staff nurse responsibility. And for good reason; nurses who are unable or unwilling to document properly will "fudge" on the audit tools as well. In fact that is what is happening; nurses are checking boxes without actually performing the audits. So when management audits the audits for blanks......well you get the picture. Those of us who refuse to document an audit was done properly when it wasn't because we had other priorities are regarded as the noncompliant, bad nurses deserving of "nastygrams".

So my question to my fellow staff nurses: Do any of you perform chart audits in addition to a regular or even greater than budgeted patient load? I know we're the only ones in this city)

[NRSKarenRN, BSN, RN]

When I worked Resp/telemetry in hospital staff did audits too.

One of the best reasons for staff RN's to periodically do chart audits is to realize just how important correct documentation is, exactly what's involved and areas for improvement.

Now in homecare, quarterly each RN has 10 charts to audit within a month time frame: 5 of their own and 5 peers. "I never realized I kept missing the same areas on assessment"; "ZXY RN missing hard of hearing box, yet it's documented on intake referral."

Peer to Peer nudging has really paid off in my homecare agency. All the supervisors comments went over like a lead balloon: staff did not want to have peers see their poor work and often improved in their week area after peer audit completed.

Our agency does 100% admission audits; 10% discharge audits on 1,200+ patients/month along with focus reviews on certain diagnosis Medicare is targeting.

[sbic56, BSN, RN]

I had to chart audits in one place. I always thought it was most helpful to do my own so I could see where I was slipping for myself, but we got random charts which I didn't see as being that helpful. Eventually it just got too busy to do it at all and a couple nurses got stuck with it. Granted they were off the floor, but I would never volunteer for that.

[SmilingBluEyes]

I think Karen and Sbic bring up excellent points.

[jnrsmommy]

In our facility, each nurse is supposed to do one chart audit a shift. However, you're supposed to do an audit on a patient that isn't yours. I have an issue with that. One of the focuses of the audit is to read each nurses's note and check for certain criteria. I don't look at pt's charts that aren't mine, so I do my own patients. Then some of the questions on the audits ask if the physician's handwriting is legible in the orders and progress notes, and are they using accepted abbreviations (no to all three). These audits do get turned in to management (I have even gone so far as to make copies of the negatives and attached with the audit), but nothing is ever done about it. Most of the time, I feel like I'm wasting my time doing management's job, when I have pts I could be better tending to.

[TiffyRN, BSN, PhD]

We are required to do 5 short (take about 10 minutes each) chart audits and one VERY long chart audit (it's a whole chart audit and the key is to pick the right patient; one that has been there the minimum required days, had no surgery and didn't come through the ER which isn't hard since we are NICU). We also have to participate in a CQI project once a year which generally frequently requires chart audits (though some are requiring observing clinical practices).

I hate having to do these as I feel it isn't my job (which I know it is because it's part of my job description). I do think we could get it eliminated if we as nurses united (I know, dream on) and insisted on only doing them after our shift was completed but while still on the clock (allowed where I work, but no one does it cause they don't want to be at work longer than required). All those "non-productive hours" as they are called would ruin our budget.

[canoehead, BSN, RN]

I think each profession should be auditing their own charts and that everyone should have a role to play in it. We are all responsible for quality nursing care, and this is one way to ensure it- and to take credit for it. What I really despise is when nursing takes on auditing for the docs. They need to take responsibility for setting their own goals, and doing their own audits or it will be much harder to make changes in their practice. Not to mention, we have plenty to do without acting as secretaries for them.

[Judee Smudee, ADN, RN]

I think having a critical care nurse take his/her eyes off a patient for 30 minutes to do this is a risky policy. On a slow night it might OK. However, on a busy night it is unreasonable. How about a policy that requires each nurse to do maybe 5 charts a month. Let them pick which chart to do and when.