Patients Viewing Nursing Notes In Real Time

MunoRN, RN · Mar 4, 2021

12 minutes ago, Daisy4RN said:

I cant see how this would turn out good in most cases. But maybe it is just the places I have worked, I guarantee patients would be walking the halls demanding to know why you wrote this and that. I agree with Chickenlady, no way!

I would have no problem being asked and explaining 'why I wrote this and that'.

Daisy4RN · Mar 4, 2021

9 minutes ago, MunoRN said:

I would have no problem being asked and explaining 'why I wrote this and that'.

And I am guessing that is because you are not at a patients bedside for 12+ hours and/or have not worked with the patient populations that I have. Nope, it wouldn't work!

MunoRN, RN · Mar 4, 2021

I am a bedside critical care nurse, mainly ICU, some ER, some Rapid Response RN shifts.

There's nothing in my notes, including the unflattering stuff, that I haven't already made the patient aware of, and am not opposed to discussing with the patient if I haven't already. What sort of things are you referring to?

Susie2310 · Mar 4, 2021

1 minute ago, Daisy4RN said:

And I am guessing that is because you are not at a patients bedside for 12+ hours and/or have not worked with the patient populations that I have. Nope, it wouldn't work!

A poster on this thread said that they work in psych and that they document as though the patient is reading the information, and gave tips for documenting objectively and diplomatically. I am not suggesting that anyone here does this, but if one documents in an inflammatory, disrespectful way, including subjective perceptions about a patient/their situation in the medical record, I think one must accept responsibility if a patient doesn't respond positively to this when they read their record. In my view it behoves nurses to be mindful of how they are interacting with patients and their family members as this will naturally influence their documentation.

Daisy4RN · Mar 4, 2021

11 minutes ago, MunoRN said:

I am a bedside critical care nurse, mainly ICU, some ER, some Rapid Response RN shifts.

There's nothing in my notes, including the unflattering stuff, that I haven't already made the patient aware of, and am not opposed to discussing with the patient if I haven't already. What sort of things are you referring to?

And you really cannot see the difference between your experience vs that of a nurse with 5-10 med surg etc type patients? No matter how eloquently you can write notes or how mindful you are with pts/families we all know how entitled many have become and with little to zero support/back up from admin I cannot see how this could possibly go well!

MunoRN, RN · Mar 4, 2021

2 minutes ago, Daisy4RN said:

And you really cannot see the difference between your experience vs that of a nurse with 5-10 med surg etc type patients? No matter how eloquently you can write notes or how mindful you are with pts/families we all know how entitled many have become and with little to zero support/back up from admin I cannot see how this could possibly go well!

No, I don't see how the number of patients makes a difference in whether I would be opposed to a patient seeing their nursing note. Again, an example might be helpful.

**CalicoKitty, BSN, MSN, RN** · Mar 4, 2021

26 minutes ago, MunoRN said:

No, I don't see how the number of patients makes a difference in whether I would be opposed to a patient seeing their nursing note. Again, an example might be helpful.

Some (probably at least 1 or 2 every week) of the med-surg patients I have dealt with become very agitated if you say hello to them wrong. They will use the call bell every 10 minutes. They become agitated and verbally abusive at the drop of a pin. So, adding in documenting things like the patient's refusal to do whatever (take medication, reposition, allow cleaning, allow vital signs), would be met with a fight over "I didn't refuse, I said Do it xyz way/only the pink colored pills like I take at home/whatever random excuse". These are the people that will just find another reason to use the call bell every hour to demand what new note you wrote on them or why you didn't write a note about the complaint regarding their fluid restriction. The difference between having 1 or 2 semi-conscious patients and 5-7 "walky-talky but still insist on having their butts wiped" is quite significant. The main opposition is the additional nurses time it will take if it is the nurse's responsibility, and having to deal with that patient (and their family) who got upset because of saying "patient complained of 10/10 pain, vitals stable, laughing on the phone..... offered tylenol, refused and requested more IV dilaudid that was given 15 minutes ago"

MunoRN, RN · Mar 4, 2021

29 minutes ago, CalicoKitty said:

Some (probably at least 1 or 2 every week) of the med-surg patients I have dealt with become very agitated if you say hello to them wrong. They will use the call bell every 10 minutes. They become agitated and verbally abusive at the drop of a pin. So, adding in documenting things like the patient's refusal to do whatever (take medication, reposition, allow cleaning, allow vital signs), would be met with a fight over "I didn't refuse, I said Do it xyz way/only the pink colored pills like I take at home/whatever random excuse". These are the people that will just find another reason to use the call bell every hour to demand what new note you wrote on them or why you didn't write a note about the complaint regarding their fluid restriction. The difference between having 1 or 2 semi-conscious patients and 5-7 "walky-talky but still insist on having their butts wiped" is quite significant. The main opposition is the additional nurses time it will take if it is the nurse's responsibility, and having to deal with that patient (and their family) who got upset because of saying "patient complained of 10/10 pain, vitals stable, laughing on the phone..... offered tylenol, refused and requested more IV dilaudid that was given 15 minutes ago"

If a patient disagrees that they had refused a medication then I would much rather address that at the time than a few months down the road when they dispute that they disagreed, being able to address, and document that disagreement would help protect me far more than having it come up months down the road. That's actually a benefit to this that I hadn't thought of before, I don't see how it's a problem.

I have not shortage of 'difficult' personality patients in the ICU much less the ED, it's also not uncommon for us to have floor patient assignments when we are taking overflow for the floors, but again I don't see how the number of patients has anything to do with issues related to patients having access to notes (which they have always had).

In the example of "patient complained of 10/10 pain, vitals stable, laughing on the phone..... offered tylenol, refused and requested more IV dilaudid that was given 15 minutes ago" that's not a problem caused by the ability of patients to access their charts, that's a problem caused by your note writing. The appropriate way to chart that would be that they rated their pain at 10/10, the only analgesic available at that time was tylenol, which they declined.

brandy1017, ASN, RN · Mar 5, 2021

On 3/3/2021 at 8:37 AM, Tnurse24 said:

Is anyone aware of a new CMS rule that all nursing progress notes are to be made available to patients in real time? This is the default at my hospital, and it is a HUGE safety risk to ER staff who are already vulnerable to erratic and unpredictable behavior as well as wide open to the public. Is anyone else aware of these requirements? What is being done to protect individuals from potential violence or security issues?

I hadn't heard about this, but if I was a patient I would be more interested in my labwork and xrays etc vs notes. If I were interested in notes, it would be the H&P and consult notes, not nursing. I would be more interested in what the tests indicate is wrong with me vs shift notes that mention pt is asleep, call light in reach. Progress notes should be neutral and unbiased and just say what the nurse did for the patient so I wouldn't be worried.

brandy1017, ASN, RN · Mar 5, 2021

23 hours ago, CalicoKitty said:

Some (probably at least 1 or 2 every week) of the med-surg patients I have dealt with become very agitated if you say hello to them wrong. They will use the call bell every 10 minutes. They become agitated and verbally abusive at the drop of a pin. So, adding in documenting things like the patient's refusal to do whatever (take medication, reposition, allow cleaning, allow vital signs), would be met with a fight over "I didn't refuse, I said Do it xyz way/only the pink colored pills like I take at home/whatever random excuse". These are the people that will just find another reason to use the call bell every hour to demand what new note you wrote on them or why you didn't write a note about the complaint regarding their fluid restriction. The difference between having 1 or 2 semi-conscious patients and 5-7 "walky-talky but still insist on having their butts wiped" is quite significant. The main opposition is the additional nurses time it will take if it is the nurse's responsibility, and having to deal with that patient (and their family) who got upset because of saying "patient complained of 10/10 pain, vitals stable, laughing on the phone..... offered tylenol, refused and requested more IV dilaudid that was given 15 minutes ago"

Maybe they should add an interactive patient feature where they could directly email their Dr over their concerns and the computer would flag the Dr to read these notes like it does for physician orders to be reconciled.

Closed Account 12345 · Mar 6, 2021

I think the ability of patients to see the contributions of nurses adds value to our profession. They'll see that we're more than task robots. We have strong assessment skills that impact their plan of care. We use critical thinking to identify unsafe orders or determine if a medication should be held. They'll see documented efforts to improve their comfort and safety. They'll see interdisciplinary communication and advocacy efforts documented.

I.e. 1430: Dr. Smith notified that patient has additional questions about XYZ procedure. MD states he'll be on the unit at 1700 and will speak with patient then. 1715: Dr. Smith on unit and reminded patient would like to speak with him.

Right now, when Dr. Smith pulls a no show in that patient's room, the nurse gets blamed. Viewing notes would allow the patient to shift misdirected frustrations appropriately.

This is a very good opportunity for many nurses to improve their documentation and communication skills.

Learning to eliminate bias and judgment statements in notes, using objective terms when possible, appropriately using quotation marks, fully and accurately reporting patients' symptoms, etc. are all good things.

I would have no problem explaining to a patient why I wrote "visiting with family member, smiling, eating pancakes and bacon" when they reported 10/10 abdominal pain. "Every patient experiences pain differently. Some patients are smiling and pleasant when they report 10/10 pain, and others are pale, sweaty, and doubled over holding their stomachs when they report 10/10 pain. Using descriptive terms in addition to the numeric pain scale helps team members understand how you experience pain so we can individualize your care and serve you better."

Susie2310 · Mar 6, 2021

On 3/4/2021 at 12:46 AM, TheMoonisMyLantern said:

A radiologist's interpretation doesn't provide context and ultimately the attending physician has to determine clinical relevance. I think results should be released with the ordering provider's comments providing context for what the radiologist saw.

A facility can add a note to the released record stating that the ordering provider needs to provide context for the radiology report findings. I've seen this done.