punishment for not having an H&P

SandraCVRN · Apr 20, 2009

Let's not give anyone any ideas now, OK

We are not allowed to go to the room unless there is an H&P, the pt is an inpt, or it's truely an emergency. The docs grumbled for a while, but now are used to it. We don't go to the room without the consent signed, H&P signed & and resigned (update to H&P), and pt seen and marked.

maeyken · Apr 20, 2009

We need an H&P before we enter the room as well. If it is missing the doc has to go fill it out before the patient leaves say surgery. We don't have any punishments like that though. I'm not sure what they would do... probably just a verbal reprimand or something. It doesn't really happen that I know of. I think your hospital needs a better system...

MamaCheese · Apr 20, 2009

That's lame We have the same rule about the updating of the H&P but the only one that gets reprimanded if it's not done is the surgeon. The holding room nurses are supposed to check all that stuff before they are brought to the room by the CRNA but it doesn't always happen. I do my best to check but it's not my job to babysit the surgeon. Or so I keep telling them :icon_roll

Akpywackett · Apr 21, 2009

If the patient is a day-stay, not an inpatient or emergent, and there is no H&P, I don't take them to the OR. My facility seems to think that the "H" is the diagnosis and the plan is procedure on the consent. But I've got to see a "P" as in physical from somebody, surgeon or anesthesia. Ideally, I want and H and a P from my surgeon dated within in 30 days and an update within 24 hours.

It's not the RN's job to do them. But it is the RN's job to make sure they're on the chart. And if they're not...they don't go back. Make a surgeon late while they complete the H&P a few times and suddenly accurate and current H&P's appear. I think ensuring those things are on the chart are part of patient advocacy and hence a circulating RN's responsiblity.

linda2097 · Apr 21, 2009

It's not the RN's job to do them. But it is the RN's job to make sure they're on the chart. And if they're not...they don't go back. Make a surgeon late while they complete the H&P a few times and suddenly accurate and current H&P's appear. I think ensuring those things are on the chart are part of patient advocacy and hence a circulating RN's responsiblity.

Surgeons are not idiots. They know they are supposed to write an H&P. Nurses are not their bosses. If an H&P is missing, the surgeon should be punished, not the nurse.

It's like giving a ticket to a passenger in car for letting the driver speed.

It's like punishing the nurse if the surgeon cuts the aorta by mistake.

It's like punishing the nurse if the surgeon is clueless about how to do the procedure and needs the sales rep to walk him through it.

Surgeons should take responsibility for their job requirements.

Akpywackett · Apr 22, 2009

No it's like none of those things.

Part of the job of the circulating nurse (RN) is to make sure the paperwork is in order, verify that the patient knows what's about to happen to them, and stop the proceedings if anything is amiss. It's part of the system of checks and balances that safeguard our patients from wrong site, side procedures.

Akpywackett · Apr 22, 2009

The surgeon's job is to complete the H&P. The RN's job is to make sure it's there and says what it's supposed to. Diagnosis and planned procedure.

linda2097 · Apr 22, 2009

So you have no problem if the nurse is punished because the surgeon consciously chose not to write an H&P because he was too lazy?

Editorial Team / Admin · Apr 22, 2009

So you have no problem if the nurse is punished because the surgeon consciously chose not to write an H&P because he was too lazy?

We are not to take a patient into the OR if they do not have an H&P. So if someone takes a patient without it, then yes, they should be disciplined for violating policy. It's actually laid out that way. Surgeons have pagers- use them, get them there to write it. After enough delays, they'll get the idea and it'll be there.

The only exceptions are traumas or true emergencies that waiting that little bit of time will drastically reduce chances of a positive outcome.

Fun2, BSN, RN · Apr 22, 2009

We should, and are suppose to make sure it is all in order, however, blocking the pay raise shouldn't be allowed, unless it is a constant problem with a particular nurse. Then obviously, that nurse is not doing the job correctly multiple times.

However, the surgeons should be punished somehow as well. They know then need a consent and an H&P. There shouldn't be any problems getting one.

muffin7 · Apr 22, 2009

Sounds illegal to me.

Management should make it clear to the surgeons that the nurse will not take the patient in the OR w/out an H&P. Very simple way to get the surgeons to do their jobs.

Of course, with the exception of emergency trauma cases.