Persistent Falsification of Data

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A coworker persistently falsifies fingerstick data. Yesterday evening on her shift she had 6 fingersticks. There were only 2 recorded fingersticks in the glucometer. All data entered for patients was fictitious. One resident is at our facility because of her uncontrolled diabetes and this nurse doesn't even check her blood glucose levels or has checked it and gotten a reading of 510 and entered 310 on the MAR.

DNS was informed via email and responded to me more than 3 weeks ago. I have sent her probably 7 emails over that time frame outlining the issue. The same nurse is passing meds that are scheduled for 4:30pm at 12:30am. 8 hours late. 3 Weeks and nurse still working and continues same behavior.

I sent this email to DNS this morning. Names were changed.

Francine,

]Evening of 8/19/14 between 3-11pm there were only 2 recordings on the glucometer. 3:54pm 409, 3:27pm 193.

]Smith has 2 finger sticks recorded in the MAR 198 & 249.

Jones 184 recorded

]Roberts 156 recorded

]Johnson 206 recorded

]Taylor 192 recorded.

]

]2 Readings recorded on the glucometer but 6 fingersticks recorded for residents in the MAR.

]

]I am confident that the glucometer records all fingersticks taken.

]

]Fingerstick readings remain for an extended period even if the batteries are removed/replaced.

]

]It seems strange that whenever someone besides Norma works in the evening Smith's blood sugars are in the high 300's low 400's & Johnson's fingersticks are much higher when someone else is working. Furthermore would it not seem coincidental that Johnson's finger stick on both 8/14 & 8/15 is exactly 200 and on 8/18 her HS blood sugar was recorded on the morning of 8/19 at like 12:30am with a reading of 206 and the next day 8/19 her blood sugar was also 206? Should the 3-11 nurse still be working the floor at 12:30am?

]

]The unit is down 4 beds and has relatively stable residents at this time.

Charlie

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My only response to this would be to mind your own business.

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Specializes in Pediatrics, Emergency, Trauma.

My question is, how were you able to verify with the glucometer?

I'm just curious how you were able to get all of the data collection together.

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Are you charge when this is all happening? If so, I would be sure with your mananger what your next steps should be.

If you are not charge, but your care of said patients are affected by this--ie: you take report and come on after nurse in question, then this should go directly to the charge nurse. However, you need to take your own FBS before you use a sliding scale to begin with in the a.m. (or before bed, or meals, whatever the order is). If your patient's blood sugar is really high, or really low, then you need to at that moment get your charge and show it right then and there.

If this doesn't apply to you, and you accidently have seen that blood glucose monitoring is inconsistent, then you have been made aware the people who need to be. Just be sure that your own FBS are seen by charge.

There could be a couple of things happening. Do your CNA's take sugars? If so, that could be the disconnect. And you would do the nurse a world of good to let him/her know that perhaps her FBS information is not on the up and up. Then he/she can be more mindful of taking the FBS without the help of the CNA. Which may or may not have already occured with your coworkers, as if there's consistent FBS information, chances are they were not delegated.

Not all CNA's want to get out of work. So I am not painting CNA's in a poor light, as without them any number of us (myself included) would be up a creek. So my second thought process is that there are more than one resident who are relatively short term who need to know how to take their own FBS with their own glucometer.

If you are auditing charts, then you need to sit down and speak with DON as to ALL the errors you find, not just this one. And education and policy change going forward if you find consistent errors of this type.

Finally, there are nurses who push the "clear" button to turn the glucometer off for the next finger stick as opposed to letting the machine shut itself off. Or if you have a scan and dock, if the scanning is not done correctly (ie: over-riding the scan process) it will not download when docked, and you may find 552 FBS recording under 00000.

And the med thing--it says more about staffing than actually a nurse's competence. If you are one med nurse with 60 patients to find, medicate, etc. I can see how hours later one is still trying to pass meds. In my opinion, it sets nurses up to fail.

Again, process issues that need to be dealt with.

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A person is being treated by a diabetic specialist. When I work and check her blood sugar it is over 500. When this lady works it is 300. I now work night shift except for every other weekend. When working the night shift you must use a test solution and record the high & low result in a log. I followed the person and noticed the high number after she told me in report it was 300.

Patient was going out to specialist and glucose readings needed to be printed to furnish to MD. I knew the data was not accurate. After I noticed the incorrect data I realized she doesn't even check the residents and records whatever she wants.

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Specializes in Cardiac Step down/ LTC.

First of all Glucometers DO NOT always save previous results. I find on average they only save the last 2-3 results. Even with the downloadable accucheck machines, they do not always download the results. I always document on the MAR and add a note what the reading was.

You better be sure of your accusations against this nurse. To me you have not provided any concrete evidence in your posts. It sounds like you actually have it out for this nurse for some reason. Have you pulled her aside and talked to her/ask her about these so called falsifications? I also hope that the name in the email you posted is not actually the nurses real name.

If a person is an uncontrolled diabetic there readings are going to be all over the place. Depends how much and what type of food they ate, hydration status etc. I really think you have a bug up your butt about this nurse and it's real crappy of you, to not discuss it with her first.

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A person is being treated by a diabetic specialist. When I work and check her blood sugar it is over 500. When this lady works it is 300. I now work night shift except for every other weekend. When working the night shift you must use a test solution and record the high & low result in a log. I followed the person and noticed the high number after she told me in report it was 300.

Patient was going out to specialist and glucose readings needed to be printed to furnish to MD. I knew the data was not accurate. After I noticed the incorrect data I realized she doesn't even check the residents and records whatever she wants.

Not to mention, blood glucose of 300 or above would warrant a call to the MD for sliding scale insulin. That must have been done, or the resident wouldn't be going to the diabetic specialist. Regardless if it is 300, 350...and most just register "HI" if over that--so you have no way of knowing if the FBS was 500 or 1000, unless you sent out for labs.

Consistently, this resident has FBS well over what it should be. With all that being said, there are many, many variables in a finger stick. And diabetes that is uncontrolled. What you could suggest is that you draw labs on this resident for a week or 10 days, and see what the fasting blood sugar actually is.

Be careful what you accuse others of. One could say that with a FBS of 500 or "HI" that the resident wasn't sent out right then and there. And that would be on you.

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Not to mention, blood glucose of 300 or above would warrant a call to the MD for sliding scale insulin. That must have been done, or the resident wouldn't be going to the diabetic specialist. Regardless if it is 300, 350...and most just register "HI" if over that--so you have no way of knowing if the FBS was 500 or 1000, unless you sent out for labs.

Consistently, this resident has FBS well over what it should be. With all that being said, there are many, many variables in a finger stick. And diabetes that is uncontrolled. What you could suggest is that you draw labs on this resident for a week or 10 days, and see what the fasting blood sugar actually is.

Be careful what you accuse others of. One could say that with a FBS of 500 or "HI" that the resident wasn't sent out right then and there. And that would be on you.

Our glucometers store readings for 30 days. They supply digital readings from 50 - 600. Sliding scale for this patient goes to 400. Above 400 give xx units and notify MD/APRN. I always follow procedure. When I get an abnormal reading I notify MD and supervisor to obtain STAT order for additional coverage.

Last week patient went to specialist and came back with increased Lantus order and new Humalog order. Now she gets standing 10 units plus sliding scale coverage with meals.

I worked this weekend her Fingerstick was over 400 at HS both evenings. I was off Monday and went in last night at 11pm. As mentioned in OP there were only 2 readings from 3p-11p on the glucometer neither of which were attributed to any residents recorded MAR. There was a reading of 409 that is what the baseline for this particular resident at that time of day. 198 was recorded in her MAR.

With these particular glucometers you can take out the batteries and change the sensor head but the memory remains.

Contrary to what people have insinuated, I am only concerned with this person getting quality care. How can proper coverage be prescribed if data furnished to MD is not accurate?

It is obviously easier for the nurse to record lower blood sugars than deal with having to follow protocol by notifying MD. However, if accurate information was consistently furnished this persons coverage could be managed so that she is not always critical.

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As a supervisor, I think you informing those in charge is a good thing. We had a nurse on nights that took her own BG and used it for her residents. She knew she had to have some number in the glucometer. Easier to sit on her butt and take her own.

Falsifying BGs is a very dangerous thing. What happens if she records a 300, gives sliding scale based on that and the resident at that time was at 80? You covered your own butt by notifying the right people. Its possible they are watching her at this point and not including you in on the investigation.

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Specializes in Critical Care/Vascular Access.

If I were you, I would first of all compile concrete evidence that this patient's blood sugar is not being recorded and treated correctly, then I would bring it to management's attention without pointing such a direct finger at the nurse you are accusing. Present the evidence, with times and numbers but don't use the other nurse's name, and then if they care they will figure out who is to blame by looking at the data.

When you call someone out by name, it does come across as though you are taking aim at the individual coworker and not just trying to provide good patient care.

If you do this and they still don't seem to care, then you have done all you can do so just continue doing what you do, even if that means cleaning up after sub-par coworkers. If the management has a habit of letting this kind of stuff go and you can't deal with it, find new employment.

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My only response to this would be to mind your own business.

Hmm...is patient safety not her business? A patient would not be receiving adequate care if the data is wrong. Care is based off the data.

"I've saved some sunlight if you should ever need a place away from darkness where your mind can feed." - Rod McKuen

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Hmm...is patient safety not her business? A patient would not be receiving adequate care if the data is wrong. Care is based off the data.

"I've saved some sunlight if you should ever need a place away from darkness where your mind can feed." - Rod McKuen

Making accusations/reporting other nurses tends to make the reporter look like a trouble maker. Sad but true.

Mentioning it once to administration should suffice. After that, it is on administration's shoulders. It's not an individual nurse's responsibility to police other staff.

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