What to chart when there's no time to complete all the work

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Hi, 

I was just wondering what to do when you can't complete an important task, because you were given too many admissions. In addition to the other responsibilities, making sure the patients have life saving equipment, addressing concerned family members, completing the admissions include inputting the meds, orders, calls from pharmacy, initial assessment, vitals, notifying MD, assessing wounds, completing piles of charting, and doing I.V.'s, and all the other idiosyncrasies facilities have just to admit,  just to name a few. We can't chart something we didn't do, so how do we chart something when we couldn't get to it? Please don't say 'ask for help' or ask the next shift, everyone knows this isn't possible and under certain circumstances, is futile, due to everyone being busy or having their own pile of garbage they were delt (if you have a great team and a good situation, good, but this isn't the case here). So please, how do you chart something on the eMar if you couldn't get to it? Leaving it uncharted is not a good idea due to leaving one to question whether it was done or not. 

Thanks.

 

 

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

You said it yourself, you can't chart something if you didn't do it. The problem is not your charting, the problem is the things you can't get done. 

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So leave it on the MAR untouched? (sometimes uncharted tasks turn red if not done). Sometimes you can put in a note, so should you leave it 'red' and make it appear like it was not even addressed or enter a note? 
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Are there examples of things that come up repeatedly? Or, what kind of things turn red on the MAR but are not high enough priority to get done? Like SL flush, tubing changes or ? Just curious.

Don't know that I've ever worried about this exact thing. Not at all trying to be sarcastic/snarky but generally speaking either things were high enough priority that they got done (and documented) or not high enough priority and were reported as not done to the next shift.

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Please don't say 'ask for help' or ask the next shift, everyone knows this isn't possible and under certain circumstances, is futile, due to everyone being busy or having their own pile of garbage they were delt

Yeah, I get what you're saying. I know this doesn't help much but my advice is do your very best to prioritize as well as possible. Beyond that, yes everyone does have a pile of garbage and you/I cannot fix it. We can't do everything just because that is someone's pie-in-the-sky staffing fantasy. So...sadly this is a matter of prioritize as best you can and let the chips fall where they may.

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JKL33 said:

Are there examples of things that come up repeatedly? Or, what kind of things turn red on the MAR but are not high enough priority to get done? Like SL flush, tubing changes or ? Just curious.

I had an unstable patient who required more time which was more important than changing a Foley, and that was due to be changed, along with my admissions and IV antibiotics to give. It came up on the MAR, but I couldn't get to it that is why I was asking, if I couldn't get to something, how can I chart I didn't do it, instead of leaving it blank. 

So I'm asking, what can I chart that I did not do something, in a progress note? So based on your reply you are saying just leave it as is, (what's perceived as) undone? Documenting in a progress note is not necessarily leaving something undone. 

 

 

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If you're saying you managed to get the other things done and it was the foley that you didn't get to, that is something I would pass on in report. I would not look for a way to document that it was not changed.

delrionurse said:

Documenting in a progress note is not necessarily leaving something undone. 

Well, it's still leaving the task undone, but not unaddressed. If you're saying that the EMR is now showing the foley change in red because it was not documented as being done then writing a progress note saying it wasn't done is unnecessary.  There's no good answer here. A progress note stating "foley catheter not changed" without explanation is not great because  the obvious thought upon reading that is "why not?" yet explaining in that patient's chart that other patients' care took priority is not appropriate. Another problem with the progress note thing is that if no one has time to change a foley then no one has time to sit around reading a bunch of progress notes either, so it's unlikely that the note is serving an additional communication purpose. And it isn't any type of "CYA" note since it isn't protecting you from anything or really communicating anything that isn't indicated elsewhere.

If you feel you must write a note to address a task not completed then it would say something like, "foley catheter change due and reported as such to oncoming RN." I tend to be of the type who feels that if there isn't time for the tasks there definitely isn't time for a bunch of notes of this nature, but depending on the workflow and expected behaviors at your place it may be appropriate.

There has to be an understanding that these mid-priority tasks will be reported forward to the next shift on occasion when they cannot get done in a particular 12 hour shift.

If things like this are happening all the time to everyone because there are no contingencies/everyone's assignment is always such a wreck that these important-but-not-highest-priority tasks aren't able to get done, that is a admin/corporate/culture problem.

 

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

I would leave it red.  It is in fact unaddressed. The red flags it for the next shift who will have to do it. Don't try to hide what you didn't do.

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JKL33 said:

If you're saying you managed to get the other things done and it was the foley that you didn't get to, that is something I would pass on in report. I would not look for a way to document that it was not changed.

Well, it's still leaving the task undone, but not unaddressed. If you're saying that the EMR is now showing the foley change in red because it was not documented as being done then writing a progress note saying it wasn't done is unnecessary.  There's no good answer here. A progress note stating "foley catheter not changed" without explanation is not great because  the obvious thought upon reading that is "why not?" yet explaining in that patient's chart that other patients' care took priority is not appropriate. Another problem with the progress note thing is that if no one has time to change a foley then no one has time to sit around reading a bunch of progress notes either, so it's unlikely that the note is serving an additional communication purpose. And it isn't any type of "CYA" note since it isn't protecting you from anything or really communicating anything that isn't indicated elsewhere.

If you feel you must write a note to address a task not completed then it would say something like, "foley catheter change due and reported as such to oncoming RN." I tend to be of the type who feels that if there isn't time for the tasks there definitely isn't time for a bunch of notes of this nature, but depending on the workflow and expected behaviors at your place it may be appropriate.

There has to be an understanding that these mid-priority tasks will be reported forward to the next shift on occasion when they cannot get done in a particular 12 hour shift.

If things like this are happening all the time to everyone because there are no contingencies/everyone's assignment is always such a wreck that these important-but-not-highest-priority tasks aren't able to get done, that is a admin/corporate/culture problem.

 

Thanks for your responses. I wouldn't want to put anything on the oncoming nurse when they have so much to do and I already asked them to do a lot already. Maybe leaving it uncharted, in red, would be the only option and take the risk. Their audit reports either come in  'tasks completed', or percentage completed, LOL. This makes computer charting so fictious when there's no truthful option. Maybe enter a progress note (if one will suffice) 'nurse had emergent need with other patient, patient care prioritized', would do. 🤷‍♀️ 

 

 

 

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FolksBtrippin said:

I would leave it red.  It is in fact unaddressed. The red flags it for the next shift who will have to do it. Don't try to hide what you didn't do.

You are exactly right. Don't hide what you didn't do. 

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Specializes in PICU.

You just leave the tasks, meds, etc that weren't done in red.  The oncoming shift will address it.  Everyone has busy days and you will be on the receiving end some days.  Whether it is day shift or night shift, nursing tasks need to get done. Every day the oncoming shift will have tasks due and absorb from the off-going shift.  That is why nursing is 24-7.  You just had a busy day, do not document not done because then there will not be  way for the next shift to complete it.  

Just hand-off in report what needs to be done.  Yes, some people may give you push back but that is nursing life, some days are busy, other days are less busy.

Every unit, shift, hospital is busy.  You can't overly stress, document what you complete and leave the rest, even if it goes "red"

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