Write Up's and Potential Termination for Pain Reassessments

Nurses General Nursing

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Just when you think nursing can't be scrutinized anymore than it already is, we are now being threatened write ups and termination for failing to reassess a pain score. This includes medication like colchicine, gabapentin and asprin. I've been a nurse for 10 years and I consider myself a pretty good one, but I am very uneasy about keeping my current job, which I've been at for 4 years because of this.

What do you think?

Specializes in school nurse.
17 hours ago, EllaBella1 said:

My old unit got dinged at our JCAHO assessment last year for not reassessing our PRNs. Everything is so micromanaged these days.

The Joint Commission needs to veer from cause du jour to cause du jour to perpetuate their own existence. If all the "high priority" problems were magically solved, they'd find new ones. Mind you, there's always room for improvement, I just don't see much improvement with new layers of paperwork/computer charting. Yeah, yeah "If it wasn't charted, it wasn't done."

How about, "Just because it was charted, it doesn't necessarily mean it WAS done."

25 Votes
Specializes in Travel, Home Health, Med-Surg.

The recheck after prn meds has at least been around 20+ years. What is new is the punitive measures for not charting it, and also adding in scheduled meds for reassessment. JHACO, hospital P/P, and other gov. regulations cause more harm that good at times. When I started hospital nursing over 20+ years ago this type of issue would be addressed verbally and that would be it, because at that time there was more common sense and managers/admin realized this was a minor thing compared to the prioritizing of actual pt care/charting, and that because of time constraints everything was not going to get done/be perfect. We have no more autonomy over our individual daily practice so are just forced to do and chart whatever someone is auditing at that time; and done at the patients expense. Just sad!

10 Votes
18 hours ago, EllaBella1 said:

My old unit got dinged at our JCAHO assessment last year for not reassessing our PRNs. Everything is so micromanaged these days.

Yeah, it's just more crap to do. It negatively impacts patient care. But what do I know, I've only been a nurse 35 years.

14 Votes
11 minutes ago, Daisy4RN said:

The recheck after prn meds has at least been around 20+ years. What is new is the punitive measures for not charting it, and also adding in scheduled meds for reassessment. JHACO, hospital P/P, and other gov. regulations cause more harm that good at times. When I started hospital nursing over 20+ years ago this type of issue would be addressed verbally and that would be it, because at that time there was more common sense and managers/admin realized this was a minor thing compared to the prioritizing of actual pt care/charting, and that because of time constraints everything was not going to get done/be perfect. We have no more autonomy over our individual daily practice so are just forced to do and chart whatever someone is auditing at that time; and done at the patients expense. Just sad!

Exactly right, I always have followed up on the prn's, that is good nursing. But, checking boxes on a computer does not a nurse make. Add to this hourly rounding. It must be charted on the hour, why? because that is where they look for it when they do record reviews. Used to be you charted what you did when you actually did it. Camera's and special tags you where so that they track your steps. Nursing is getting really bad.

7 Votes
17 hours ago, Sour Lemon said:

This has been "a thing" for at least ten years. That's when I first started nursing, so I don't know about before then.
It was beaten into my head so much as a new graduate that it's automatic now. I even do other people's reassessments when I have downtime.
That doesn't mean I actually speak to the patient or even look at the patient. I just fill in the form to be in compliance.

Yep, while you are spending time checking boxes to please the upper dandys, you could have been doing some nursing. My new goal is to be the most compliant employee possible forget nursing.

5 Votes
17 hours ago, JKL33 said:

Plan B.

Figure it out, put it into action.

Yep, just go along. They want me to check a box, OK.

2 Votes
17 hours ago, Sour Lemon said:

This has been "a thing" for at least ten years. That's when I first started nursing, so I don't know about before then.
It was beaten into my head so much as a new graduate that it's automatic now. I even do other people's reassessments when I have downtime.
That doesn't mean I actually speak to the patient or even look at the patient. I just fill in the form to be in compliance.

I do this all the time, it is easier with paper charting. The system is set up so you have to cheat and lie to survive. In the fictional book The House of God, published in 2010, residents/interns called it "buffing the chart". Not specific to pain assessments, but just to make sure the chart looks complete for the attending.

4 Votes
58 minutes ago, Forest2 said:

Yep, while you are spending time checking boxes to please the upper dandys, you could have been doing some nursing. My new goal is to be the most compliant employee possible forget nursing.

They need to be pleased so I can continue to collect a paycheck. I'll do even less nursing if I'm unemployed.

4 Votes
7 hours ago, Jory said:

I have heard the staff nurses talk they want a pain reassessment on ALL meds where you can register a response.

This even includes antiemetics.

Yes, we are beginning to be dinged about charting f/u assessments for antiemetics. How do you rate nausea? We don't have an easy way in our system... Plus, nausea comes and goes, and is affected by many different things. Are they gonna come up with a 1-10 scale for nausea too? Puhlease...?

I definitely understand following up to see if the medication worked, to take good care of the patient! But..

The charting on our system has become so cumbersome, and it's not even patient-centered. We have scheduled pain checks, and reminders to check pain after every pain med, in several different places on the computer. They end up overlapping, and we double-chart, and we ask the patient about their pain so often that they're probably sick of it and/or over-focused on it. It becomes more about checking boxes than focusing on your patient.

I'm already not a fan of the 1-10 pain scale...which is a whole 'nother discussion. Pain doesn't relate to numbers very well for me. And I can just image asking our nauseated patient to give us a "number" for their nausea.

I'm rolling my eyes here, but if anyone has a good way to chart on assessing/reassessing nausea, I'd love to hear it.

4 Votes
2 hours ago, thoughtful21 said:

I'm rolling my eyes here, but if anyone has a good way to chart on assessing/reassessing nausea, I'd love to hear it.

Agreed.

The problem with the system is for post-surgical or patients with intractable pain, we all know it's best to give it on a schedule. So even though that strong opiate may be for "7 to 10", but you may want to give that on a schedule, so your reassessment is going to be "1 to 4" or however it is ordered, but you are still going to give the stronger opiate until appropriate to taper town.

I don't understand the Joint Commission's take on it. If a patient has pain, treating it is the intervention. When you round on the patient next, you are going to reassess the pain. It makes no allowance for the fact most patients can call out.

I can understand the documentation in certain units (ICU, Hospice, Surgery)...but not on floors where most patients can walk/talk.

They went to far with it.

4 Votes
Specializes in Psych, Corrections, Med-Surg, Ambulatory.
3 hours ago, thoughtful21 said:

Yes, we are beginning to be dinged about charting f/u assessments for antiemetics. How do you rate nausea? We don't have an easy way in our system... Plus, nausea comes and goes, and is affected by many different things. Are they gonna come up with a 1-10 scale for nausea too? Puhlease...?

I'm rolling my eyes here, but if anyone has a good way to chart on assessing/reassessing nausea, I'd love to hear it.

There's GOT to be a Davey Do cartoon to address this. Davey...?

5 Votes
Specializes in Travel, Home Health, Med-Surg.
3 hours ago, thoughtful21 said:

Yes, we are beginning to be dinged about charting f/u assessments for antiemetics. How do you rate nausea? We don't have an easy way in our system... Plus, nausea comes and goes, and is affected by many different things. Are they gonna come up with a 1-10 scale for nausea too? Puhlease...?

I definitely understand following up to see if the medication worked, to take good care of the patient! But..

The charting on our system has become so cumbersome, and it's not even patient-centered. We have scheduled pain checks, and reminders to check pain after every pain med, in several different places on the computer. They end up overlapping, and we double-chart, and we ask the patient about their pain so often that they're probably sick of it and/or over-focused on it. It becomes more about checking boxes than focusing on your patient.

I'm already not a fan of the 1-10 pain scale...which is a whole 'nother discussion. Pain doesn't relate to numbers very well for me. And I can just image asking our nauseated patient to give us a "number" for their nausea.

I'm rolling my eyes here, but if anyone has a good way to chart on assessing/reassessing nausea, I'd love to hear it.

The last hospital i worked at wanted a reassessment of every prn med given. So for nausea a nursing note would go something like this: pt had relief of nausea after Zofran. Although pt educated many times re the correlation between stuffing their face with junk food and nausea pt continues to have family bring junk food to beside. RN will continue to monitor and provide further Zofran as needed.

Seriously though for a pt with nausea we would put a nursing note that simply said, pt denies nausea at present, states relief of nausea, or something to that affect. (I have also used the above note also but more diplomatic of course).

3 Votes
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