state is threatening to go after license over precharting

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This is not me I am talking about. They could get me on same charges if they searched enough charts but lucky I have not done it in a while. I know two nurses who were found to have charted things before they did them and state inspectors called it fraud and are threatening to bring them up before the board. The facility has gone to bat for them and stated such extreme measures are not necessary. All they say that is necessary is a education program. The facility is right because half the nurses I know would lose their license(including me) for precharting on one occasion or another. For instance, say it is 1pm and the patient is on a q2 hr treatment. I know it is very hard to get back to chart something at 3pm so I will sign off on the thing I know I will do at 3pm. I don't think I have ever signed off on anything in advance that I did not do. In the future I will take the risk that it never gets signed off rather than sign it off ahead of time. Apparently, presigning is a much more serious crime.

We have computer charting that will NOT allow you to chart "in the future". Our facility still has the paper chart, but we are phasing it out. The docs are supposed to enter their own orders now. (Yeah right!!)

My facility is going to start computer charting for the nurses soon. They have 3 or 4 computers right now that the CNA's use. They are not portable computers you have to go into a room to use them. My question is "How does one do a med pass with a computer that is not planted on the med cart?

Do you pass your meds first and then go down the hallway to the computer to chart them? How exactly does this work? Thanks

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Specializes in Going to Peds!.

Ours are rolling workstations. They have no hard drives in them. They connect via wifi to the hospital's mainframe servers. They spent about $7G per station. Our unit alone has about 5 stations in addition to our desktops. You are supposed to chart the med as "done" or "given" either when you give it or just after it's been given. Same with I&O's. You put in the IV bag details as you hang it. The computer figures out how much of it is gone by end of shift.

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Specializes in Hemodialysis, Home Health.
I'm just a student, So I can't give an opinion one way or the other, but I do have an example from clinicals where precharting could have caused a serious problem. I had a patient that was a quadreplegic. He was scheduled for a 10am pain reliever. The nurse initialed the MAR before she gave it, then noticed they were out of that drug. Then she got busy and forgat to order it. While the pt. could not feel pain, his body still reacted to it. His BP and pulse increased and he started sweating. At 1200 his BP was 140/90 where his 0800 had been about 110/70. I reminded her 3 times about the med as well as told my instructor. When I left at 1330 she still had not ordered the med, but according to the MAR, it had already been given. My instuctor told me to inform the pt about his increase in BP, and to remind the nurse to give him the med. I'm not sure what happened, that was my last clinical at that facility.

While I agree that some of it can be really nit-picky, I do find the above example to be an excellent one in showing the risks and dangers in precharting.

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Precharting meds is something I never do, just to darn dangerous. Precharting an icebag is one thing but a medication is another.

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Specializes in OB, M/S, HH, Medical Imaging RN.
The dummies did it the day the inspectors were in the building. To me it says they really did not realize it was wrong because no one does something that is not on the up and up when the state is looking over their shoulder. If you chart something as done at 3pm and the patient is discharged at 2pm they sort of got you don't they.

I can't believe nurses would pre-chart. That's so fraudulant! I do hope they receive some kind of punishment. They definately should have known better. I bearly have time to catch my charts up after the facts, I definately don't have time to make things up ahead of time. Sounds like they're not doing their job anyway. :angryfire

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I have to admit...I guess I've done it before when signing off my TAR in LTC..of course I went back to circle the treatments or other orders not done.

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My facility is going to start computer charting for the nurses soon. They have 3 or 4 computers right now that the CNA's use. They are not portable computers you have to go into a room to use them. My question is "How does one do a med pass with a computer that is not planted on the med cart?

Do you pass your meds first and then go down the hallway to the computer to chart them? How exactly does this work? Thanks

I like the computer charting idea from a quality management standpoint. Precharting would definitely not be acceptable in an ISO 9000-compliant workplace, and your computer system seems to prevent this. On the other hand, walking is waste motion and having to walk to a room to use the computer makes the nurses less efficient (and probably more tired).

Henry Ford said that pedestrianism is not a highly-paying line of work and that no job should require anyone to take more than one step in any direction. This was feasible in a factory but not of course in a hospital-- but the Henry and Clara Ford Hospital was designed to minimize the walking that nurses had to do, so they could spend more time with patients.

I can't give advice without seeing your situation (and I can't give engineering or consulting advice over the Internet) but I think an ideal setup would involve your swiping a bar code on the medication container and on the patient's wristband (assuring that they match) when you administer the medication, and the computer logs it as done. In fact, if the patient is able to do so, the patient should do something like initial a touch screen that indicates that he has taken the medication. (The more checks the better, as long as they don't become overly cumbersome.)

In summary, I think the computer idea is excellent but the implementation is not so good, if it forces you to walk to use it. Walking is waste motion and it takes time away from patient care.

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It looks like they are letting us off with a warning but it is not for sure at the moment. However, they really had everyone shaking in their boots. Like I said if they went over enough charts they could catch me at it also. Minor stuff like icebags and TEDs, I never precharted anything that would do harm. Let me tell you precharting RESTRAINTS really gives them fits.

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The chart is a legal document.

"If it isn't charted, it didn't happen" begs this: "If it is charted, it happened."

If you chart that you did something before you do it, you are lying on a legal document.

What's the motivation to do so, to save time? "Report given, orders reviewed" can't be written just as it happens? Puhleeze!

This is pretty basic, it violates the nursing principles of integrity and honesty.

Yeah, it seems like small potatoes, but where do you draw the line? How much hedging does it take before you are accepting a lie as truth?

If you didn't do it, but you chart that you did, "I was gonna" is not acceptable for a professional.

It should not be tolerated.

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What are you in Chris, managment, educator or QA?

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I think its hard for new nurses or students (or those you mention Oramar) to understand the pressures staff nurses are under to do it all and 10 minutes ago...including documentation. We figure out shortcuts or we never get out...and believe me management doesn't want to pay us OT for documenting so most of us here have had to fudge a few times with a little early documentation of 'some' type..or we'd be OT every day...and this does NOT give us points towards good evals believe me.

The difference between the ivory tower and the real world...unfortunately...is that compromises are made. Hope all nurses find a place where they're given the tools, opportunity and support to really DO everything 'by the book'...but I haven't found that place yet. ;)

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I think its hard for new nurses or students (or those you mention Oramar) to understand the pressures staff nurses are under to do it all and 10 minutes ago...including documentation. We figure out shortcuts or we never get out...and believe me management doesn't want to pay us OT for documenting so most of us here have had to fudge a few times with a little early documentation of 'some' type..or we'd be OT every day...and this does NOT give us points towards good evals believe me.

This is prima facie evidence of deficient management systems. If the hospital's management team designs a system in which RNs must cut corners to get the job done, the management team is ignorant and/or incompetent. And they probably get paid far more than skilled and hard-working RNs.

Management's job is to create a system (with participation from front-line workers) that will work smoothly and assure high quality, not to sit in corner officers and show each other colorful PowerPoint slides.

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