lowetidern

Dany102, it is our company's policy to take photos of "any alteration of skin integrity" on every patient upon admission. That means anything from rashes to wounds and anything in between. CMS requires that we report any pressure ulcer present on admission. The crazy thing is that company policy states this documentation must be done within 8 hours of admission; CMS gives us 3 days!! We've shot ourselves in the foot on this one. And no, I do not have a say in the matter. In fact, photos must be taken again on discharge (pressure ulcers) and if they are not present on the chart, CMS can and will reduce reimbursement by 2%.

Caliotter3, your words ring true. I have had the same thoughts, however, not nearly as eloquently described as what you have done here. The words I used to my husband were more like, "damned if I do, damned if I don't" in referring to reporting the request for falsification. I made my decision not to comply with her request and I intend to stand firm regardless of any retaliation effort. Perhaps it is time for me to move on and make a change. I won't make an emotional decision in haste, however, it is something that I will likely contemplate over the next few days. This incident would not be the sole reason for my departure, merely the straw that broke the camel's back. Wish me luck!!

Thank you, Karou. I don't think she will retaliate. I do think that she thought I would be willing to do it because of our friendship...kind of an "I'll cover your back if you cover mine." It really bothers me but sometimes I don't think she gave any thought to the potential detriment to my career and license...or hers, for that matter! I knew in my gut I was making the right decision, but sometimes situations such as this can make you question your own sanity. I appreciate you guys responding!

Thanks, Pangea. That's exactly what I did on the documentation that accompanied my photos the following day.

I have a quick story and then a question to ask my fellow nurses... I am a wound care nurse in a LTAC hospital and have been with the same company for the past five years. Our company has hospitals all over the country. A little more than a year ago my very good friend and charge nurse with this company was promoted to CNO at one of our hospitals about two hours away. Long story short: my husband received a very nice job offer in the same city she was transferred to and, eventually, we moved and I accepted a position in the same hospital. She is now my CNO - my boss. It is our corporate policy to take photos of any alteration of skin integrity within eight hours of admission. If the wound nurse is not available, the charge nurse is responsible and then the wound nurse reassesses the patient on their next day back. This happens quite often on night shift and weekends. We admitted three new admits the other night and the night charge nurse took photos, however, those photos were lost on the camera. The following day, I retook the photos and did my documentation as the policy states. The loss of the original photos was reported to the CNO. Two days later, while doing a routine chart audit, it was noticed again that the chart was not corporate compliant due to those missing photos. The CNO and Nurse Manager told the quality coordinator to tell me to turn off the time/date stamp on the camera, retake the photos, and then back date the documentation of the photos to the night the photos SHOULD have been taken. I refused. Am I crazy, or is this blatant falsification of documentation? Nothing about this idea sounds good or right. Forget the fact that my "friend" has suggested this, but the legal ramifications could be BIG!! I am asking for your thoughts, opinions and/or ideas. Should I be looking at this from a different perspective? Am I making a mountain out of a mole hill?