Question regarding this situation on restraints?

kids · Apr 4, 2012

Student for not reporting an issue with their patient that was outside their experience/knowledge base to the instructor, to get clear guidance on how to procede.

Esme12, ASN, BSN, RN · Apr 4, 2012

I have to ask first....what is a PCN?

Merlyn · Apr 4, 2012

Persons:
PCN
Teach
SN
Situation:
A patient has restraints on. SN will be working under the PCN. PCN did not communicate with SN about documentation of restraints.
At end of shift, SN is off the floor.
-Next Day-
As it turns out, PCN documented the restraints at the end of her shift, with each one documented q2hrs but being recorded all at one time – potentially making her look bad.
Teach finds out that patient had restraints and asks SN if he/she documented. SN answered back, “No, I always thought the PCN does that.” Teach responds back there must be communication between SN and PCN regarding documentation about restraints. SN is then lectured, taught how to document restraints, and will be under disciplinary action.
Who is at fault?

PCN the SN is just learning. PCN has to take into account that the SN doesn't know the policy. But the SN should have ask someone about the restraint policy.

Double-Helix, BSN, RN · Apr 4, 2012

If the student didn't know that she was responsible for documenting about the restraints, then she shouldn't be held responsible for not documenting. Although she should have asked the RN if she was unsure.

The PCN (primary care nurse?) should have talked to the student about what she was responsible for documenting. Was the documentation in the EMR? If so, the nurse might not have realized that the student was able to document in the EMR.

There really doesn't need to be anyone at fault. It's a learning experience. The proper information was documented (maybe not in a timely manner, but it was done). The student will learn to ask about restraint documentation next time. End of story. Why is there need to place blame on anyone?

Esme12, ASN, BSN, RN · Apr 4, 2012

Both....the primary care nurse should have informed the student what is required documentation for a patient in restraints but the student should have spoken up about the restraints if they were not familiar with the requirements for documentation or had never cared for a patients in restraints. Both parties assumed that the other knew what was to be done......and we all know what assUme spells.

It comes down to communication. Communication is very important in caring for patients.

The student nurse introduces herself to the PCN. HI! My name is....

The primary nurse...Good to meet you....You are working with Mr. X today?

Student: Yes, is there anything special I should know, may I have a little report on him?

NUrse: Sure, Mr. X blah, blah, blah and has been very confused, So he has bilateral wrist restraint on....have you never cared for a patient in restraints before?

Student: Ummm...no. (looks worried)

Nurse: Thanks Ok, Here let me show you what you need to look for, how to tie and untie them, and where to document them. Don't worry I'll be checking all day too.

So there is no blame........ just learning how to communicate and learning from our mistakes.

nurseprnRN, BSN, RN · Apr 4, 2012

i'm not sure i'd blame the student here for not asking about a policy for restraints. why would it even occur to a student that such a thing exists? how would she know that?

that said, though, it is ok to chart late if you document the time you chart it. in this case, i am guessing that the student charted the whole time she was there, and then left. the primary nurse (p.s., op-- "pcn" is penicillin) then looked at the student's documentation and realized there was nothing on the restraints.

assuming the primary nurse was actually aware of the restraints while the student was there (and not conspicuously absent down the end of the hall all morning), it is perfectly acceptable for her to chart after the student, "1600. restraints checked and secure, circulation good, (and whatever else) during student nurse care, checked at 0800, 1000, 1200, 1400, and 1600. j smith rn" this documents that jsmith rn was also doing those assessments.

or something like,

"0800 restraint check (or whatever) during student nurse care, jsmith rn, late entry, 1600, 3/4/12"

"1000 restraint check, during student nurse care, jsmith rn, late entry, 1600, 3/4/12"

"1200 restraint check,during student nurse care, jsmith rn, late entry, 1600, 3/4/12"

"1400 restraint check, during student nurse care, jsmith rn, late entry, 1600, 3/4/12"

"1600 restraint check, jsmith rn "

either of these are acceptable for late charting.

as to the rest of it, lesson learned. always clarify who charts what, who checks it, and who's responsible for what. and have the primary nurse check your charting as you go along until you get the hang of it, not just leaving at the end of the shift and she has to find it and fix it.