Patients Viewing Nursing Notes In Real Time

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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?

On 3/4/2021 at 4:55 PM, 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.

Untypical of you, you are being obtuse. 

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On 3/4/2021 at 5:58 PM, MunoRN said:

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.  

You are persisting in your obtuseness.  And you charting was a lie by omission.

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11 hours ago, Susie2310 said:

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.

 

You can’t really think a generic note like this will make a difference? A personal note from the provider sure but an auto-response? Come on.

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I don’t chart a ton of notes.  I check the boxes I’m supposed to.  That’s it.  I don’t write long detailed notes of my shift.  If you check your boxes properly it tells your story.  
 

If a patient refuses a med, it’s documented on the Emar as not given, reason is a box I check that says pt refused.  I never chart a note about it.  The only times I ever charted about family was when we had no visitors and that I updated pt family member on pt condition.  I don’t chart my interactions with them.  
 

Too much charting can get you into as much trouble as undercharting.  

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15 hours ago, Closed Account 12345 said:

"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." 

For instance, myself I can be smiling, talking on the phone and having a nice conversation with someone even when in terrible pain.  Too many years of customer service....my brain has been trained to push the pain away....the same as one person can be a 3 or 4 when actually there is something terribly wrong...but they have pushed what they are feeling away.  Know of recent circumstance where patient had been having appendicitis symptoms for days refused to go to doctor, finally ended up in hospital.  They refused morphine for the pain just asked for ib tablets to dull it and when examined screamed out in pain.  Had to be rushed to emergency surgery....but as presenting with low temperature and expressing pain as 3 or 4 ER did not think it was acute....when it was almost to the point of having a burst appendix.  So after all that having it recorded in your records does not necessarily mean you were lying or trying to use it to get extra pain meds...it could mean that you are good at doing customer service and hiding the pain...or it may be the patients coping mechanism...and nurses who follow up with care should be aware that the patient may actually be in pain....

15 hours ago, Closed Account 12345 said:

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.

Yes, we had this happen years ago....requesting the nurse contact doctor they would state they had...never got answers to questions.  When questioning the doctor he swore up and down the nurses never contacted him.  If we had seen the notes we would have known who to call on the carpet...

 

19 hours ago, brandy1017 said:

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. 

This I believe is very important...to give informed consent a patient should be able to view all their labwork xrays etc...they should have the opportunity to ask all questions before giving consent to any treatment...its amazing sometimes how a second opinion can change a situation....say one doctor not letting the patient view the results giving a song and dance and the patient suddenly is in surgery...when the patient insisted on second opinion the story had changed....learned the hard way to always insist on seeing the actual results with report before agreeing to any procedure....

Also if a patient or a family member sees the nurses notes and sees that the patient is over the top which can happen in an emergency situation on both sides of the coin...whether it be the patient, the patient's family or the nurse involved because we are all only human and all may be stressed....the situation might be handled and mediated by a third party to get everybody on the same page as getting proper care for the patient, proper respect for the nurse, proper respect for family and make everybody a little less stressed....

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Specializes in Private Duty Pediatrics.

They should find a way in the hospital to redact the nurse's last name on computer charting if the patient is allowed to see the notes.

It's totally different for private duty nurses. The paper chart stays in the home, and the parents have access to the computer chart by logging in on their own computer..

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5 hours ago, Wuzzie said:

You can’t really think a generic note like this will make a difference? A personal note from the provider sure but an auto-response? Come on.

I'm not talking about an auto-response.  I'm talking about a message appended to the radiology results stating that context for the radiology report needs to be provided by the ordering provider, which is followed up timely by the ordering provider interacting with the patient to provide  this context, or, if the ordering provider has already viewed the report when the patient receives it, the ordering provider can use their judgment to include a personal note along with it.  

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40 minutes ago, Kitiger said:

They should find a way in the hospital to redact the nurse's last name on computer charting if the patient is allowed to see the notes.

 

Why?  We're professional nurses with licenses and we always say we want to be thought of as professionals.  Part of being a professional is being accountable to the public for the professional nursing care one provides, just as other licensed professions that deal with the public are held accountable for the service/care they provide the public and don't provide service/care anonymously.  Doctors don't provide medical care anonymously - their full names are on their badges which are visible and not turned backwards or covered up, and their last names are on the patients' medical records.  

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14 minutes ago, Susie2310 said:

I'm talking about a message appended to the radiology results stating that context for the radiology report needs to be provided by the ordering provider, 

How is that any different? You still have a patient with a report that they don’t understand and looks to them like their cancer is back or progressing. What is the value in having that report released? How can anyone think this doesn’t result in harm to the patient? What is the risk in delaying it for say 24-48 hours to give the provider time to review and make a notation?

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Just now, Wuzzie said:

How is that any different? You still have a patient with a report that they don’t understand and looks to them like their cancer is back or progressing. What is the value in having that report released? How can anyone think this doesn’t result in harm to the patient? What is the risk in delaying it for say 24-48 hours to give the provider time to review and make a notation?

I said that if the ordering provider has already viewed the report they can use their judgment to send a personal note along with it.  I would also presume that for significant findings the radiologist would contact the ordering provider promptly, so the ordering provider would be able to contact the patient timely if necessary.

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29 minutes ago, Susie2310 said:

 I'm talking about a message appended to the radiology results stating that context for the radiology report needs to be provided by the ordering provider, which is followed up timely by the ordering provider interacting with the patient to provide  this context, 

Noooo, this is what you said.

7 minutes ago, Susie2310 said:

I said that if the ordering provider has already viewed the report they can use their judgment to send a personal note along with it.  I would also presume that for significant findings the radiologist would contact the ordering provider promptly, so the ordering provider would be able to contact the patient timely if necessary.

You added this as an option. 
 

Your presumption is incorrect. Outside of emergent, life-threatening findings the radiologist do not call the providers with things like possible/probable progression of cancers. They document it in their report which then goes immediately to the patient. The ordering provider may not see it for hours.  Not only that but many times when they do see it there is a team discussion that follows to generate a plan so they can address the findings AND the plan with the patient. Now there isn’t time for that so the patient is left hanging. I’m at a loss as to why anybody could see this as appropriate. 

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49 minutes ago, Wuzzie said:

Noooo, this is what you said.

You added this as an option. 
 

Your presumption is incorrect. Outside of emergent, life-threatening findings the radiologist do not call the providers with things like possible/probable progression of cancers. They document it in their report which then goes immediately to the patient. The ordering provider may not see it for hours.  Not only that but many times when they do see it there is a team discussion that follows to generate a plan so they can address the findings AND the plan with the patient. Now there isn’t time for that so the patient is left hanging. I’m at a loss as to why anybody could see this as appropriate. 

My comments that you are taking issue with were: 

Susie2310   

 Add your Credentials, Experience, etc.

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17 hours ago

   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.

My reply to the above poster was:

"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."

 

Then I replied to your first reply to me:

Susie2310   

 Add your Credentials, Experience, etc.

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59 minutes ago

   6 hours ago,  Wuzzie said: 

You can’t really think a generic note like this will make a difference? A personal note from the provider sure but an auto-response? Come on.

My reply to you was:

"I'm not talking about an auto-response.  I'm talking about a message appended to the radiology results stating that context for the radiology report needs to be provided by the ordering provider, which is followed up timely by the ordering provider interacting with the patient to provide  this context, or, if the ordering provider has already viewed the report when the patient receives it, the ordering provider can use their judgment to include a personal note along with it. " 

Then I replied to your second reply to me:

Wuzzie     

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41 minutes ago

   1 hour ago,  Susie2310 said: 

I'm talking about a message appended to the radiology results stating that context for the radiology report needs to be provided by the ordering provider, 

How is that any different? You still have a patient with a report that they don’t understand and looks to them like their cancer is back or progressing. What is the value in having that report released? How can anyone think this doesn’t result in harm to the patient? What is the risk in delaying it for say 24-48 hours to give the provider time to review and make a notation?

I replied that:

"I said that if the ordering provider has already viewed the report they can use their judgment to send a personal note along with it.  I would also presume that for significant findings the radiologist would contact the ordering provider promptly, so the ordering provider would be able to contact the patient timely if necessary."

My clarifying and adding more information so you can more fully understand my position doesn't signal any negative behavior on my part. 

Wuzzie, it's fine with me if you disagree with me - I have no problem with agreeing to disagree, but I don't see any value in both of us continuing to go back and forth, so I'm not going to continue to debate this point with you any further.  

 

 

 

 

 

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