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?

[smf0903]

On 3/24/2019 at 5:02 PM, EllaBella1 said:

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

We got dinged on our JCAHO assessment for not having the reassessments at exactly the 30/60 minute mark. Talk about anal. “Sorry bed 5, can you cool it on the vfib so I can go reassess bed 3’s pain after that 650 of Tylenol?”

[thoughtful21, BSN, RN]

Technicolor yawn!!! ??? That's awesome, Davey! I've never heard that one before. I'm gonna be thinking of that next time I have a vomiting patient.

[Tomascz, ASN, RN]

We're working with a system the VA gave up on some time ago, that's how bad it is. All of us have always been required, even on paper to follow up on administration of PRN's and not just for pain. You have to document whether or not the drug did what it was given for so that we know whether or not to make changes or stay the course.
There's a whole list of stuff, including Lactulose, that I have to pick out the reason for giving for off a drop down menu that contains symptoms like psychoses and SOB and nausea or nausea with vomiting and 30 or 40 other possibilities and so on. If there's pain involved, there's another box where I put the pain level and another little square I have to check just to make sure the person checking all the boxes is actually awake and aware. That's followed up with a score card on the BCMA where I have to put the follow up assessment for pain, or nausea or whatever, assuming I remember. Quite often I'm left with entries from the last three shifts or more, not mine
Just to see if anybody is actually reading this stuff, I sometimes get creative with my reasons for giving things (never narcs since I might actually have to give an account) but I like to stretch it a little. Since hepatic encephalopathy is not on the list of reasons, I often give Lactulose for "psychosis" and it always "relieves symptoms". It relieves symptoms for constipation as well, so its kind of a toss up as to whether my patient is crazy, or just full of s***. Either way it does the job. So far, in three years, I've never been asked for an explanation for anything.
Pharmacy is who sets the parameters, and we're still on good terms so I guess no one's offended.

[JBudd, MSN]

9 hours ago, UrbanHealthRN said:

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.

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.

Fortunately we have the option of three scales, the 0-10, Wong Baker, and FLACCS. We are allowed to use Flacc if the pt is nonverbal, etc. Hey! being asleep is (mostly) nonverbal! I have used the Flacc on adults quite often, and no one has evver said a word.

[MelpyRN2B]

I work hospice and we give narcs for air hunger. How do you reassess pain when it wasn't given for pain?

[CalicoKitty, BSN, MSN, RN]

18 minutes ago, MelpyRN2B said:

I work hospice and we give narcs for air hunger. How do you reassess pain when it wasn't given for pain?

You reassess for what it was administered for. In that case, maybe RR or Sp02 or Work Of Breathing or something

[MelpyRN2B]

Our charting doesn't allow for that part! Only sees the use of narcs for pain.

[Here.I.Stand, BSN, RN]

9 hours ago, MelpyRN2B said:

I work hospice and we give narcs for air hunger. How do you reassess pain when it wasn't given for pain?

Exactly. ?

[159Nursesrule, ADN, BSN, CNA, EMT-B]

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.

Wouldn't that be falsifying documentation?

[Sour Lemon]

5 hours ago, 159Nursesrule said:

Wouldn't that be falsifying documentation?

That's a "risk" I'm willing to take ...much easier to explain and justify than literally thousands of other things would be.

[kbrn2002, ADN, RN]

On 3/27/2019 at 2:24 PM, MelpyRN2B said:

Our charting doesn't allow for that part! Only sees the use of narcs for pain.

I complained about that earlier in this thread. Are you by chance using PCC? That's what we use and the software literally won't let you save the follow up assessment without entering a number in the pain scale check box.

It also automatically generates a pain scale pop-up for every single med that might be used for pain whether they are used for pain or not like ASA for cardiac prophylaxis and steroids either orally or eye drops. At least with those orders we can easily update the order to remove it.

[MelpyRN2B]

2 hours ago, kbrn2002 said:

I complained about that earlier in this thread. Are you by chance using PCC? That's what we use and the software literally won't let you save the follow up assessment without entering a number in the pain scale check box.

It also automatically generates a pain scale pop-up for every single med that might be used for pain whether they are used for pain or not like ASA for cardiac prophylaxis and steroids either orally or eye drops. At least with those orders we can easily update the order to remove it.

We use epic.