Write Up's and Potential Termination for Pain Reassessments

[MiralaxOnIceRN]

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?

[Alex_RN, BSN]

On 3/24/2019 at 2:43 PM, Sour Lemon said:

It was beaten into my head so much as a new graduate that it's automatic now.

I just fill in the form to be in compliance.

I, too, am 100% compliant. I chart the assessment and reassessment at the same time, usually. I also keep a running tally on my brain with the times given. First check mark = Assessment done. Second check mark: Reassessment charted.

[HomeBound]

At a place I worked, we were dinged for not assessing the effectiveness of miralax. You had 4 hours in order to do this. If the patient didn't defecate in those 4 hours, you must chart that the intervention was "ineffective".

Well....what if my patient took a nice large constitutional at 4 hours and 1 minute?

This is garbage that is most likely driven, IMHO, by risk management. Someone, somewhere, sued the hospital for being constipated. And that led to piles. Or a bright bloody stool. Or a tummy ache (because they refused to comply with bowel regimen while taking allllllll the narcotics)

I think I've told this story before--that a Nurse Spy in my ER emailed me that I hadn't reassessed the effectiveness of that life saving tylenol on a patient I had for ....oh....45 minutes? She wanted me to go back into EPIC 5-6 days later and chart something.

I wrote back..."Don't recall the patient. Don't recall if I saved their life with tylenol. But if you want---I will go back and chart I did assess them...and I will also chart a blank progress note that I was notified by YOU to do this fraudulent thing."

Crickets from that point on about my pain assessment skills. Or lack thereof.

In the ICU, yes---we reassess pain much more frequently than the ER or pretty much any other unit. But we also are 1:1. I can do that. My monitor is tethered so I can stick my head around a corner and ask a quick "how's the pain?" or do a CPOT. Not hard.

But having 8 pts? No way. No. WAY.

This is the legal department issuing edicts in order to "save the hospital" from lawsuits.

[NurseBlaq]

I despise number counting management who have no idea what bedside nursing is like. They're treating money and numbers, we're treating actual people based on acuity. Management never takes acuity into account, nor patient needs. Nursing is becoming a human factory. Assembly line admissions, discharges, computerized nurses programmed to chart and do trivial tasks that have no benefit to the human patients, while management gets bonuses because a certain amount of boxes where checked. Wait where was I again? Oh yeah, I despise management who counts dollar signs and check marks instead of patient needs and avoid staff input.

[KarenMS]

Our system frustrates me most when I give acetaminophen for fever, check the “not given for pain” box on scanning it, then still am required to chart a pain level one hour later. And there is no option for “not given for pain” on the reassessment, I just have to randomly assess pain for a med that wasn’t documented as given for pain.

[brandy1017, ASN, RN]

On 3/24/2019 at 4:43 PM, 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.

Oh my God, you made me laugh! Thanks, I really needed that!

[ArrowRN, BSN, RN]

I would never work at a place like that. They fail to recognize that is a system issuse and NOT an RN failing to do their job issue. At our hospital what we have done is in the computer system, in the MAR pain assessment are now built into it when administering the medication and there is a reassessment reminder that shows on the main patient list page when its due, so you can be reminded of it as soon as you login. Even now it's still not perfect and some people still miss it. All this came from a suggestion from a nurse to our Computer Comittee.

We have gotten vast improvements in our reassessment since then. I am on our Computer resourse comittee and I am thinking of ways to make it better because even I too miss doing it in a timely fashion. We use EPIC by the way. Your manager needs to asks you guys to come up with solutions for the problem not threaten with lame threats of being fired and bullied.

See if you can find out who is the person in charge of Nursing Informatics and ask them is there is some sort of reminder solution and if it can be added to the MAR, document your solution so you can get credit. Start up a committe in your unit or hospital to find a feasible solution that does not involve threathening a nurse.

A low tech starting point would be to just print out a pain scale reminder and place it on each nurses computer like a laminated card or something.

Bring the solution to your manager, implement it, then ask for a raise! lol

[NuGuyNurse2b]

Same at my place, re-assessments are required or it's a write up.

[JKL33]

1 hour ago, ArrowRN said:

They fail to recognize that is a system issuse and NOT an RN failing to do their job issue. At our hospital what we have done is in the computer system, in the MAR pain assessment are now built into it when administering the medication and there is a reassessment reminder that shows on the main patient list page when its due, so you can be reminded of it as soon as you login. Even now it's still not perfect and some people still miss it.

I suppose some of the time it is a true "miss." Alllllll the rest of the time, it is a matter of time and priorities.

All of this pain reassessment stuff sounds good (and also sounds very bad to try to argue against it) but it just isn't good on the balance of everything. I feel sort of appalled to read that people chart the assessments either right away or without looking at the patient, yet at at the same time, that is the exact monster created by stupid ideas. Those who choose not to cheat the system just suffer with feeling that they are always behind, always "missing" stuff, never doing things right. WHICH.SUCKS.

Care improvement processes would be understandable if they still incorporated appropriate prioritization.

[I sense a terrible rambling rant coming on so I'll stop....]

[JKL33]

8 hours ago, KarenMS said:

Our system frustrates me most when I give acetaminophen for fever, check the “not given for pain” box on scanning it, then still am required to chart a pain level one hour later. And there is no option for “not given for pain” on the reassessment, I just have to randomly assess pain for a med that wasn’t documented as given for pain.

And was in fact documented as not having been given for pain.

?

[thoughtful21, BSN, RN]

14 hours ago, TriciaJ said:

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

Yes, please @Davey Do! Maybe a FLACC scale with little vomiting faces? ??????

[Hoosier_RN, MSN]

22 hours ago, Jedrnurse said:

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."

1000% this!!!!!

[Davey Do]

44 minutes ago, thoughtful21 said:

Yes, please @Davey Do! Maybe a FLACC scale with little vomiting faces? ??????

I haven't read this thread yet and I will do any cartoon requested but first I need to know something and this will be the third time I've asked:

How in the Sam Hill do you do the summonsing thing?

Cartoon will follow after I get what I want and, yes, someone peed in my Cheerios this morning.