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?

[Davey Do]

@thoughtful21

Got your instructions from the other thread.

Thanks, thoughtful!

[sirI, MSN, APRN, NP]

10 minutes ago, Davey Do said:

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.

Hey @Davey Do

I'm not sure what you mean "the summonsing thing".

Do you mean when you are specifically speaking to a member and want them to receive an alert that you are talking to them?

If that's what you mean, you need to start typing the icon @ then start typing their name. A box pops up to complete the name. It will look like your name above after I typed 'Hey'.

@Davey Do

[Davey Do]

Gee- I feel bad now for throwing a temper tantrum. Hope you'll forgive me.

I'll read the thread over and do the requested cartoon but it will be later on. Today is my first full one off after my three 12's, the sun is shining, and there's yard work to be done.

Thanks again!

[sirI, MSN, APRN, NP]

OOPS, I see you have already rec'd the instructions. ?

[kbrn2002, ADN, RN]

On 3/24/2019 at 7:04 PM, CalicoKitty said:

I get annoyed because it isn't easy in our system to chart the pain level when administering the medication. It is relatively easier to do the 'reassessment' from the MAR, but there is no scale that I can see when administering it. Maybe I'm missing that.

I get annoyed because it is in our charting software. ASA, neurontin, any steroid med, allopurinol, etc. all automatically trigger a pain scale with administration. Fortunately the orders are easy to modify to remove that.

[kbrn2002, ADN, RN]

12 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.

Same here. Say I give a hospice resident Roxanol for SOB, I clearly chart it's for respiratory and not pain yet the follow-up assessment literally will not save unless I chart a follow up pain assessment. I wouldn't be at all surprised if someday some poor nurse will get raked over the coals for falsifying a follow up pain scale just because our charting software gives us no choice but to chart something.

[UrbanHealthRN, BSN, RN]

As a former night-shifter, I'm just thinking of all those patients who constantly have their (very important and very healing) sleep disrupted because of some check mark box on a computer screen somewhere.

I can think of some patients who, based on their clinical situation, would definitely get a verbal pain reassess from me. But then there were others whose main indicator of pain was their inability to fall asleep, and once they got the right dose of pain medicine, vital signs would be stable and they'd be sleeping soundly, which I'd document accordingly. I wouldn't bother to get a new pain scale number at that point. Can't fit that into a tiny check mark box though!

P.s. And I work peds, so Lord help you if you disturb some parent's sleeping kid to find out if the pain went away. Then you're just trading in a good JCAHO score for a crappy HCAHPS.

[Davey Do]

23 hours ago, TriciaJ said:

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

[brandy1017, ASN, RN]

11 hours ago, ArrowRN said:

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

I know you mean well, but frankly, I'm sick and tired of the damn computer micromanaging me and telling me all the crap I need to document on at "this" time! I'm sure I'm not the only one. I chart the pain assessment when I get around to it; we probably have more important things to do than reassess pain at a specific time because that's what we are told must be done. Not to mention we probably have nothing else to offer them and nowadays they are lucky to get tramadol! Oh wait, let's try aromatherapy the new sure thing, I bet that will relieve their pain, not!

Instead of prioritizing patient safety we are prioritizing computer charting. That is the real problem. Quick, jump an hour's up, time to chart, but hey another patient is having a real problem that needs our attention and sorry, not sorry, the pain reassessment will have to wait. All these reminders do is put unneeded pressure on us and may nudge some people to falsify charting just to keep from being written up. I don't think another reminder is what we need.

[JKL33]

6 minutes ago, brandy1017 said:

All these reminders do is put unneeded pressure on us

?

TOXIC. PRESSURE.

[JKL33]

@Davey Do Brilliant!! ?

I have one small qualm with #5, though: I see you have a ??‍♂️ patient there with the dry heaves. That specific state of affairs is most often accompanied by significant vocalization. Significant. Like yodeling while lifting a grand piano and summoning the dead all at the same time. This also involves the timbre of prescient disappointment in the fact that there will be nothing to show for all that noise. ?

[Davey Do]

Just now, JKL33 said:

the dry heaves. That specific state of affairs is most often accompanied by significant vocalization. Significant. Like yodeling while lifting a grand piano and summoning the dead all at the same time.