state is threatening to go after license over precharting

BETSRN · May 3, 2005

Those nurses who like to judge others, I say this: you don't work my area, it isn't YOUR practice, its mine. I think its so so sad how quick nurses are to place judgment on another nurse and are so self righteous. It is a huge problem in our profession IMO.
Those here like me who may have check'd a 'TEDS intact' box 2 hrs ahead to save time...watch out because the documentation police are watching.

Bottom line............there is NEVER an instance when pre-charting is ok! It's plain and simple NOT LEGAL. How can anyone chart anything on a patient if they have NOT done whatever they are charting?

It's not a matter of nurses being "quick to judge." In this case we nurses should ALL be quick to judge. It is wrong: plain and simple.

allnurses Guide · May 3, 2005

Maybe that's true in other circumstances, but I don't agree with this characterization when it comes to precharting. It's supposed to be a legal document, and an accurate record of what happened. If precharting is caught, like in cases where the patient already died, etc. then no court or regulatory authority is going to side with the nurse. You would automatically be "judged" as doing the wrong thing.
So, I'm not sure nurses are really being judgemental or self righteous in this case. The entire system is counting on nurses to provide accurate documentation. If you don't follow the rules, which are there for good reason, it's just plain wrong. It goes far beyond being "self righteous," IMHO.

You are right . . . I'm not being "self-righteous". This is just the law.

I have had to fill in at times in our LTC . .. of course I'm unused to passing meds to so many people and I don't know their schedule, which patients wake early and come to the nurse's station, which ones are in the dining room, which ones eat in their rooms . . . the nurses who do this all the time have a system in place for passing meds. I am always late with meds. I just chart that they are late and why. If I worked there all the time and had a system down for passing meds and still was late due to the large volume of patients, I would pass meds late and chart why. I would not help the facility continue unsafe staffing and lie and pre-pour and pre-chart.

I truly think if more nurses refused to help continue unsafe staffing, things might change faster. It has to start with each individual nurse.

steph

mtymom · May 3, 2005

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.

Kudos to Chris! I AM NOT in management, education, or QA and I NEVER precharted on ANYTHING! It is very wrong and irresponsible. I carried around a little notebook and I would write down things as I did them. That way I knew they were done. How can you justify any precharting? It is flat out LYING. What if you charted that you gave an IV piggyback at a certain time and you went in to do it but you had a code blue and didn't get it done until an hour later? The next shift could come in and see that you put that you gave it at that time; give it when it should be given the next time. You have just cause a medication error! It could be a matter of life or death. How can you justify that? Little things could turn out to be big things.

When I worked in the hospitals we would give report to the oncoming nurses 30 to 45 minutes in advance then they would watch the floor so we could finish our charting. It was required that it be done that way. I would think most places wouldn't mind paying the overtime to finish charting so they would not have to pay extra in malpractice insurance if something went wrong because of precharting. I will get off of my soapbox now and I really am not a hater. I just worked too hard to get my license to make some stupid mistake and have it taken away.

bobnurse · May 3, 2005

Pre charting leads to things not being done........Say you prechart a dressing change, forget to do it.........So the next shift thinks you have done it, and the patient ends up suffering.

Pre-charting is poor practice. It can lead to errors including patient harm. I happened to come into a situation like this one time. I came in early, 2 hours early to help a short shift. I was given patients and went to write a "rec'd patient note" and saw they had pre-charted nurses notes 2 hours ahead. The precharting was like, patient asleep.......it was night shift. So i left and came back. I didnt want nothing to do with it...............

bottom line is taking shortcuts puts your patients at risk. I dont know how many times ive seen things charted but not actually completed. The patient is the one to suffer..........

BETSRN · May 3, 2005

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.

You know, I went back and reread the original post as it is here above. Although the poster says she is not talking about herself, she goes on to say that she has precharted as well.

To the original poster.............I would hesitate to hire you anywhere. The fact that you don't seem to think that precharting is wrong is what bothers me the most. The fact that you would in writing (as above) tell us that you prechart is of a serious nature.

There is never a time that this is okay. I hope, after all this discussion that you would rethink your ethics. It saddens me to think that as professionals, one would even consider precharting. You are not only putting your patients at risk but you are risking your license. Do you not care at all about your own backside? I guess not.

I ahve to say, I fel sorry for you and the patients in your care.