Redlining.

[manchmal]

I responded to a real old thread but I am not sure if it will show up and I really want info. So...who can tell me what "redlining" is, its history, etc. Nursing school trained us in a 21st century digital world and all the jobs want me to know what nursing was like before computers. There's an article topic for someone!! Anyhow...can any night shift RNs respond to what I'm going to paste here, which was a question I posted below someone who had discovered a med error redlining:

"I know it's an old thread but I have a similar question about "redlining". Night shift at my facility goes through the day's written or computerized orders and signs (after the staff that pulled the orders off or acknowledged then) and "verifies" they were written into the MAR correctly, etc. Then they sign their name in red ink. I was trained in a digital charting environment and I'm a new grad, so this is new to me. Anyhow. My question is for anyone who has experience with this "redlining." Say you are redlining and you find an error -- like the original poster here. Obviously, you notify doc and fill out incident or med error report. So DO YOU STILL SIGN YOUR NAME if the order was NOT executed correctly? Say a patient was discharged with a wrong dose of a med, and you are to "redline" a printout that has an order for a different dose. I don't know what "redlining" means. I have recently said I was not going to sign my name on an order that was not executed correctly, and I was told to sign it. When I repeated I was uncomfortable with it, I was told "okay, fine, write ERROR and sign it." To me, that is vague and weird to have hanging out in a pt chart without explanation. So I wrote something like "not dispensed as written ERROR" and signed and dated. I cannot find policy on this but people seemed annoyed I wouldn't just sign it. However, I don't see the point in a red verification signature if it doesn't mean everything was executed correctly! I want to know what exactly I'm agreeing to when I sign orders after another RN has already executed them (correctly or incorrectly). HELP! :)"

[beckster_01, BSN, RN]

We used to do this before we switched to electronic. What I would have done was sign my name, but add a notation stating that an error was found, and that it was corrected, similar to what you did. If other people have a problem with that, that is their problem

[Kooky Korky, BSN, RN]

You did exactly right, OP. I have been told to sign a certain paper at my facility. It didn't make sense to me, I didn't know what I was agreeing to by signing. No one else understood it, either, including any supervisors I asked. I said I really couldn't sign it if I didn't know what I was signing. I was apologetic but persistent. They changed the procedure. Stick to your guns, make it make sense to you, know exactly what you're signing.

In your case, make sure that the errors have been corrected!

[Jess_Missouri_RN]

We are not computerized yet and still sign off in red on the night shift. I write "chart checked" with my signature. I do have problems signing an order that was written on day shift and have only come across a few errors but I make a copy of that order to attach to the incident report and contact the supervisor and also bring it to the attention of the nurse that made the error. Kinda makes me mad when they don't sign off on their orders and pass the buck to the night nurse, but hey whatever.

[SitcomNurse, BSN, MSN, EdD, RN]

We redline as part of the CQI. The night nurse checks the charts and signs in red, which indicates she reviewed the order for all the things that can go wrong:

5 R's (which seem like 80 R's now)

transcription errors occur, and charts get missed. Every nurse around here knows that if the day nurse didnt get to it, it wasnt left on purpose. It may actually be an omission. The chart could have been off the unit at another department, and the order written without notification of the nurse on duty. It happens. The night nurse is an integral part of the whole functioning of the unit, and without them telling the days... you wrote insulin on Schmidt instead of Shmidt... we would be dropping like flies.

I feel for you Missouri, in NY we dont tolerate that 'dumping' stuff.

[Jess_Missouri_RN]

We redline as part of the CQI. The night nurse checks the charts and signs in red, which indicates she reviewed the order for all the things that can go wrong:

5 R's (which seem like 80 R's now)

transcription errors occur, and charts get missed. Every nurse around here knows that if the day nurse didnt get to it, it wasnt left on purpose. It may actually be an omission. The chart could have been off the unit at another department, and the order written without notification of the nurse on duty. It happens. The night nurse is an integral part of the whole functioning of the unit, and without them telling the days... you wrote insulin on Schmidt instead of Shmidt... we would be dropping like flies.

I feel for you Missouri, in NY we dont tolerate that 'dumping' stuff.

I can say it's not too common and I know who to check after because it happens often with certain people. What I like to do (if time permits) is grab the charts while getting report so we can both check the chart together for any errors or "oh look an order, didn't even know the doc was here" type of thing because hey, stuff happens and it gets busy on our floor during the day and I know this but some things are so obvious but like I said you learn quickly who you need to check after and I do this early in the shift so I'm not waking a doctor at 2am to read labs that were drawn at 5pm...lol. Had to do that once and doctor was not so happy and not entirely day shift fault, should have caught it early but didn't and it wasn't passed on in report.

[manchmal]

Thanks!! In this instance, it WAS signed by day shift, and they didn't catch the error. So I figured that WHATEVER my signature meant, I didn't want it to appear in 6 months time that I was the third "checker" to sign when there was a dispensing or prescribing error. Where I am there are three sigs -- LVN or RN who takes off order signs, another RN signs, then night shift signs. In this case, the pt was already gone with a mistaken quantity and dose of meds, so I couldn't "fix" it at 0300. Wasn't a serious mistake (ie the pt was fine when they got ahold of them on days). The pt was fine. In cases where there was a mistake on dosage or whatever (wrong thing in MAR) and I could fix it, I did that, but was still unsure whether to write. I know you don't mention med error report filing or incident report in the chart, but it sounds like I could write "error -- not executed" or similar. Or just "not verified." I'm glad others think I did the right thing. In my mind, the incident report is sufficient and I wanted to leave the chart with no red sig, but people were insisting "well it HAS to have a red signature on it." ok, but I want to know what the red sig means! I'm glad I stuck to my guns on this one, though it always feels bad when you're new and not super confident and someone insists you do something with the rationale "we always do it that way." They will prolly be annoyed I wrote what I did in bright red ink, but I tried very hard to just leave it alone! From now on I may write "MAR verified" or "DISCHARGE MEDS NOT VERIFIABLE" and then sign. So everyone is clear what I am saying when I sign. :)

I did tell the original nurse who signed. Felt bad doing incident report as it was a confusing order but I had to, as the mistake was already made and hopefully they will fix process so it isn't made again.

[Jess_Missouri_RN]

Thanks!! In this instance, it WAS signed by day shift, and they didn't catch the error. So I figured that WHATEVER my signature meant, I didn't want it to appear in 6 months time that I was the third "checker" to sign when there was a dispensing or prescribing error. Where I am there are three sigs -- LVN or RN who takes off order signs, another RN signs, then night shift signs. In this case, the pt was already gone with a mistaken quantity and dose of meds, so I couldn't "fix" it at 0300. Wasn't a serious mistake (ie the pt was fine when they got ahold of them on days). The pt was fine. In cases where there was a mistake on dosage or whatever (wrong thing in MAR) and I could fix it, I did that, but was still unsure whether to write. I know you don't mention med error report filing or incident report in the chart, but it sounds like I could write "error -- not executed" or similar. Or just "not verified." I'm glad others think I did the right thing. In my mind, the incident report is sufficient and I wanted to leave the chart with no red sig, but people were insisting "well it HAS to have a red signature on it." ok, but I want to know what the red sig means! I'm glad I stuck to my guns on this one, though it always feels bad when you're new and not super confident and someone insists you do something with the rationale "we always do it that way." They will prolly be annoyed I wrote what I did in bright red ink, but I tried very hard to just leave it alone! From now on I may write "MAR verified" or "DISCHARGE MEDS NOT VERIFIABLE" and then sign. So everyone is clear what I am saying when I sign. :)

I did tell the original nurse who signed. Felt bad doing incident report as it was a confusing order but I had to, as the mistake was already made and hopefully they will fix process so it isn't made again.

In the instance you're talking about I just write "chart checked" with my name. If the order was already signed off by another nurse than the mistake would fall back on them, since the point of the sign off is that the order was verified and executed by the nurse signing the order. My deal is writing "med error" or something in a chart, if the order was corrected it should also show on your MAR that it was fixed and given or fixed and not given, whatever the error was so I don't see the need of writing about the error in the chart, I don't know, that's me I guess.