Respiration counts

This needs to be addressed with whoever is documenting the inaccurate vitals. If it's another nurse or an aide, bring them with you when you do your own assessment. Make believe you are giving them the benefit of the doubt by saying something like, I wanted to bring you in here so we could look at this patient together. I noticed that you documented a RR of 18/min, but I just counted 40/min and it's such a significant difference that I'm concerned he's getting sicker. Can we check his RR together and can you let me know if this is how he was breathing when you did his vitals?” I'm almost certain that pointing out that you are actually doing your own assessment and explaining the importance of an accurate RR will help this person pay more attention to accurate counts- at least with your patients. If the incorrect assessments persist then I'd suggest writing it up and asking your manager to address it.

Also, does your unit ever present safety stories at staff meetings or morning huddles? Most of the time RR are inaccurate because staff don't realize the significance of accurate documentation. The case you described with the ICU patient should be presented as an educational lesson to all staff about the importance of noticing trends in vitals and the implications of inaccurate documentation.

Thank you. I will think about how to address it. It's not just one person. I struggle with being only 8 months into my first nursing job and not wanting to step on the toes of people there for years. I will think of a tactful way. And perhaps gather more data before I make generalizations. Like, after techs take vitals I could go count respiration and see if it's close (for those that I suspect aren't counting). Not wanting to get anyone in trouble, but documenting 18 on a patient who is desatting and in distress really bugs me.

If I go behind and document the actual respirations then it'll look like 18-35-18-32-18-40, etc. Which is ridiculous looking.

I absolutely would document my findings regardless of how it may look. May I kindly say that would be the least of my concerns! :) In addition, as soon as the 18-35-18-32-etc pattern is visible in the chart, it's pretty easy to open the convo and undertake the "let's go to the bedside" suggestion from a PP.

The real problem is that when assistive personnel document inaccurate "normal" VS, you have no indication of a change or a problem when reviewing them. Although you have tons of other pressing duties, you may need to just go and immediately double-check the patients whose VS you suspect are inaccurate - you establish yourself as an RN who...requires accuracy. It won't take long if you address it nicely/pleasantly and in real-time. It's too bad...since they should no more be writing down a made-up RR than a made up BP or anything else.

If you can't make any headway with "pleasant" attempts, you'll have to address it to your manager. It really shouldn't be tolerated any more than any other falsification in a medical record would.

Good luck!

Initial the chart when you take the vitals, the resp rate will be consistent in your entries, and everyone else knows some people don't bother looking. I would also go (once) to the other person and point out the inconsistency, and ask if maybe there was an error. After that, I'd think about putting in incident reports.