RosalindaRN

I know that many hospitals, including the hospital I am employed by, have moved into “disaster” or “crisis” charting. For my hospital this means charting Q12h on each patient and charting changes in condition (I.e. the patient went into respiratory distress and went from RA to 15 L NRB). Previously we had charted Q4H and charted changes in conditions as well. Additionally we are no longer charting on patient education or ADLs which is something we had previously been expected to chart on at least once a shift. What kind of changes are you all seeing to charting at the hospitals you work? Are you concerned at all that the changes in charting could be putting your license in jeopardy? In nursing school I know we were all taught “if it isn’t charted, it didn’t happen” so I wonder if we really are protected in the event a patient or patient family member decides to pursue legal action. Thoughts?

To clarify, the patient came in with altered mental status. From the orders the physician was putting in (lactic acid, abx, etc.) it seemed like they were more concerned about possible sepsis than stroke. The patient was not a stroke alert in ED. I should also add that the 2nd CT was positive for a hemorrhagic stroke.

To answer your question, yes, this is the process for activating a stroke alert at my hospital.

I recently had a situation where I noticed my patient was becoming increasingly agitated, word salad was present, and left sided weakness was present. The patient had a head CT without contrast completed approximately 3 hours prior that was negative for stroke. Despite the recent negative head CT, I was concerned that my patient may be actively having a stroke. I made my charge nurse aware of the situation. She assessed the patient and also suspected stroke. At this point we sent a STAT page out to the hospitalist. 15 minutes passed by and there was no response (per my hospital policy, 15 minutes is the time frame a hospitalist is expected to return a STAT page). My charge nurse called the house supervisor at this point and made them aware of the situation. The house supervisor made the decision to ask a provider from the emergency department to assess my patient for possible stroke. The emergency department doctor came, assessed the patient, felt that the patient was having a stroke, and ordered a head CT with contrast. This CT came back positive for stroke. Around the time all of this was happening, the hospitalist (who I had tried to page at the start of all of this) arrived on the floor and stated that he did not feel the patient had a significant change in condition and that it was wrong to call a stroke alert and involve the ED doctor. He stated that it made his night harder and that we should have just paged him a second time. Although the patient did come in with word salad and left sided weakness it was, in my opinion, worsening. The patient was also becoming agitated which was new. I feel that I was looking out for the best interest of my patient and I don’t know what I should have done differently. I’m a relatively new nurse so I just wanted an opinion from someone who has more experience than myself.