Sick of core measures

Tweety, BSN, RN · Oct 25, 2009

Yes. Core Measures are the thorn in our side, along with all the other crap we have to worry about. We're not a magnet facility either.

husker_rn, RN · Oct 25, 2009

I agree. We've been told that if we don't get it right we will be fired. Much of it concerns things the docs need to order; my question is are they, too, being held accountable if they neglect something........and we all know the answer to that one. We're not a magnet either.

flightnurse2b, LPN · Oct 25, 2009

we're not magnet either and we have core measures also.

they are helpful in some ways but more hurtful in others.

i've been written up by the core measures nurse before.

and working nites, try getting a discharge done on a CHF patient or something--it takes hours!!!!

and you're def right about the doctors, we're always calling a doctor @ 0300 to get an order for an aspirin and NS @ 50/hr for instance on all stroke admits, but they so seldom check off the right orders that i have to or it will be my butt!

MedSurgeMess · Oct 25, 2009

I work at a magnet facility. When we began to have to do core measures, it wasn't because it had anything to do with magnet status. We were told that CMS and some other insurance providers would not pay if the core measures that they set had not been completed. Now, I guess I'd rather just do that on everyone than have to sort through and try to determine if they are Medicare/Medicaid and some of the other insurance providers who have jumped on the core measure bandwagon. At my facility, only the billing dept and case managers in some cases, know which insurances you have. Yes core measures are aggravating, but they part of it, so might as well get used to it until joint commission or CMS or TPTB decide we need more stuff to do

springfieldrn · Oct 25, 2009

Core Measures are here to stay. As already stated they are part of reimbursemnt, as in if we don't prove we provide the standard of care for the dx the hospital may not get fully reimbursed, which translates into a paycheck, or lack there of.

PostOpPrincess, BSN, RN · Oct 25, 2009

We have core measures.

We are magnet.

We do it with good support and good auditing.

No write ups. That's so silly.

We are not for profit.

It's not so bad as long as it is not punitive, when it becomes punitive. I don't participate.

november17, ASN, RN · Oct 26, 2009

We do the core measures. Generally the assistant unit manager (clinician) takes care of making sure everything on the core measures list is completed. And yes, it is generally stuff that is more geared towards stuff physicians need to order than nurses. There is some educational stuff but we have pamphlets we go over with the patient and that takes care of that (the clinician puts them on the chart and we give them to the patient when they are being discharged). And there are no write ups involved in the process as far as I know.

WindyhillBSN · Oct 26, 2009

Yes, why write people up, that puts more pressure on us...as if 2 hours to d/c a CHF patient weren't enough.

blondy2061h, MSN, RN · Oct 26, 2009

What's a core measure? We're trying for magnet now, and I've never heard of this.

WindyhillBSN · Oct 26, 2009

Core measures- CHF, Acute M.I., Pnuemonia, Stroke, and I'm forgetting one more, there are certain medicines and dicharge instructions/education that they have to be given, along with medications. If you miss something they "get" you.

flightnurse2b, LPN · Oct 26, 2009

What's a core measure? We're trying for magnet now, and I've never heard of this.

they're pathways of care for patients with certain admission diagnoses, such as stroke and CHF.

for example, if your patient gets admitted with a stroke, they must have a specific set of interventions met by day 1, 2, 3, etc... and tests performed and resulted by a certain time... and specific discharge measures that must be reviewed with the patient by the designated core measures nurse prior to their discharge.

so by day 1 (i have some of these memorized), the patient admitted with a stroke MUST have:

NIHSS q 2 h x 24 h

GCS q 2 h x 12 h

vital signs q 2 h x 12 h

ASA 81mg unless plavix is ordered or stroke is hemorrhagic

NSS @ 50ml/hr unless otherwise specified

MRI of the brain

MRA of the carotids

psychiatric consult

PT/OT/ST consult

SCD's or TED hose

Lovenox mg/kg QD unless contraindicated

CT of the head x 2

etc, etc, etc..... the trick is though, to get the admitting doctor to check off the proper orders!

then, each day there are new goals and interventions recommended that then nurse must sign off.

if you miss one, the core measures nurse will huff and puff and blow your house down.

last write up i got was because the nurse in the ER timed the NIH off on the paperwork from when the pt was admitted so my times were off for when they finished and i was the one who got in trouble for not having an NIH done at a certain time.

then, when they get discharged, there is a whole other process that takes an hour or two to complete.

it really is the best, evidenced based practice for care of the pt with specific diagnoses--but it's a pain for the nurse and administration really likes to dangle it over your head if you miss something when half the time it's the physician who hasn't ordered it.