Time frame for documentation of safety checks

[superpsychnurse]

I work at an inpatient acute psych unit in Nebraska. We are currently receiving the "assistance" of a consultant company. One change that has been implemented is that 30 minute checks are a thing of the past, and everyone is now on 15 minute checks unless they are under special close observation or 1:1. We have 15 minute check flow sheets that list the time for 24 hours in increments of 15 minutes where we have location and behavior code numbers on the side. In each slot we write the number for where patients are and what they are doing. The issue we ran into was with our director (who is an agent of the consultant company) telling us that if that sheet is not perfectly up to the minute with documentation, that we can not go back and fill it in because that is "false documentation." And that not having it filled in is a "terminatable offense". Our argument is that if our eyes observed that patient during that time period we can go back and document it at a later time. He is telling us that his expectation is that one tech is to carry a clipboard with those sheets on them (one for each patient) everywhere they go and make those sheets a priority. Apparently pt. care is to be interrupted to fill out the sheet. I say we can observe the patient and document on them later! Does anyone have any input on what they know to be what is considered timely for filling these in? Is there truly no leeway? Can anyone direct me to any resources or literature on this?? I believe that with all nursing you document AFTER the fact of care or assessment. It is not prudent to think that documentation can take place AS something is occurring. Who can I call???

[Psychcns]

When I worked inpatient 10 years ago, one person was assigned to checks and that is all they did. maybe they could answer the door, but maybe not.. but no patient care. to see if it is doable, time it. can you get to all the patients in the 15 minutes. and other safety things you have to check. your managers have to show you how to make it doable...if not doable, then assign two people to checks...and yes you should fill it out right away. that is your assignment for that hour.

[alb402]

When I worked inpatient 10 years ago one person was assigned to checks and that is all they did. maybe they could answer the door, but maybe not.. but no patient care. to see if it is doable, time it. can you get to all the patients in the 15 minutes. and other safety things you have to check. your managers have to show you how to make it doable...if not doable, then assign two people to checks...and yes you should fill it out right away. that is your assignment for that hour.[/quote']

I work on a 16 bed C&A unit and we do ours the same way. We alternate who is assigned to the "q15 checks" every hour. That person is responsible for making sure they visibly see and check on every patient every 15 minutes and document it immediately. Realistically, it does get busy and sometimes it's longer than 15 mins, but we make every effort to be on time. We've had instances where management has taken these documents and used them to look into incidents on the unit.

[arkool2004]

We also do the checks as previous posters state. One person responsible for rounds w/clipboard that has every pt on list and we document the appropriate behaviors with a corresponding letter from a key on the bottom of the page.

[superpsychnurse]

Thanks so much for the input. At this time they are expecting one tech per unit to do checks and all the pt. care including groups.

[Hygiene Queen]

We do the q15min checks.

Technically, we would have a person responsible for keeping up the rounds, but it's not realistic 100% of the time.

Safety is #1, but sometimes that means that the person with the clipboard has to drop it to be hands on in an emergency.

In that case, the rounds have to be caught up in a big hurry and heaven help us if something bad should happen and it's noted the rounds are not complete.

This is a staffing issue.

I can tell you, having personally done those rounds myself, that it is the most boring job to be signing your initials over and over again for 8 hours straight... it makes for a very very long shift.

We switch our techs out every couple of hours to avoid burnout.

[macfar28]

I'm on a 50 bed unit with 3 hallways. We have one tech assigned to each hallway who is responsible for doing the 15 min checks as well as vital signs, assisting patients with hygeine, therapeutic communication, helping with admits and discharges and running groups. They do hand off their boards when running a group. We nurses assist when we can. The expectation is however that they are done on time and just as you describe, if late, it's falsification and must be left blank. Currently when a check is missed, employees are placed on automatic final disciplinary status for 12 months. We have had employees fired if they missed more than one in that 12 month period. Safety is absolutely critical but I think some common sense that patient care needs and emergencies don't run on an every 15 min schedule is needed.