Writing on Fetal Heart Monitor Strips

SmilingBluEyes · Aug 9, 2004

I do chart on strips for a lot of reasons...the main one is, it's nearly impossible at times to keep up on the flow sheets, esp. when things are happening fast, e.g. fetal distress. It's far quicker to chart interventions directly on the strip in some cases. I later chart these things (the time stamps on strips help, too) on the chart itself. Also, our strips are archived as medical records. To me, that is essentially saying these strips serve as the BABY's chart before birth. They ARE used in courts of law for review on cases, as well as by our risk managers when a case is being reviewed.

I was taught from day one, these are reviewed just as charts are and indeed, in some cases the chart and strip are compared and times/events noted. Charting on the strip means to me, I was actually at the bedside at the time I noted, doing whatever I have noted on it. I chart when a doctor is present and what he/she is doing as well. Also chart when anesthesia is present. It is helpful incase a mother/baby react to anesthesia and interventions are needed at that point. NO time for fumbling thru flow sheets at the time I am pushing ephedrine to up a mom's hypotensive blood pressure. I have also been known also to initial the strip periodically if a person is on the monitor a long time, just so it is seen a nurse is monitoring the strip, not just keeping a patient on the monitor without watching it. Monitoring would, to me, appear useless if no one is watching and acting on it (if need be).

Just an aside, I don't necessarily believe excessive fetal heart monitoring is a good thing or improves outcomes. But IF we have the patients ON the monitors, for whatever reason, then in my mind, we BEST be watching and documenting on them. That is how I have practiced for 7 years now and I have no immediate plans to change.

purplemania, BSN, RN · Aug 9, 2004

if you chart on the strips you have to keep every inch of them, or it is like pulling sheets out of the chart and throwing them away. Many facilities keep all the strips anyway, but just thought I would toss that in. Our unit charts electronically, from the bedside, so it is not necessary to actually write on the strips and is discouraged since information then would be in two places, and harder to piece together for congruency.

SmilingBluEyes · Aug 9, 2004

We DO keep all strips. And we don't have electronic charting.

missmercy · Aug 9, 2004

In our L&D, we would jot events on the strips to remind us of what was happening at that moment in time when we went to chart later. It was helpful to have a reminder of when mom got up to the BR, when the scalp monitor was applied, when monitors were repositioned, if mom was restless, vital signs at a specific time -- our "short hand" helped us keep our charting accurate and complete

allnurses Guide · Aug 9, 2004

Our P&P's state we have to at least initial the strip every 15 minutes and we have to chart interventions as Deb says. We keep the entire strip. We do not have electronic charting.

steph

MommyLauraRN · Aug 9, 2004

We have OB TraceView computerized EFM. We still use paper flowsheets (for the time being) but I still do a lot of my documenting on the computer strip and then go back and double document on the flowsheet. Our monitors have a button that you can hit and it marks an arrow on the strip--that way to can hit it when you do something and then go back and document what you did under the exact time if you are doing a lot of things at once (bolus started, 02 on etc.) Our unit plans to get the electronic flowsheet to go with our program but the software is like 150K and who knows when they'll cough up the money :chuckle

palesarah · Aug 9, 2004

currently, we document on both the strips and chart (Deb summed it up pretty well). We are going to electronic charting very soon, and the paper strips will no longer be kept as part of the medical record as the strip will be recorded electronically. So writing on the strip will no longer be accepted.

The transistion is going to be tough, I think.

rdhdnrs · Aug 9, 2004

Deb,

The only problem I have with writing on the strips is if the time is wrong; rectified, I suppose, by making sure the time is right whenever you turn it on. I have just never gotten in the habit of writing on them. I may need to change my practice. I have made notes on them in emergencies.....

Lisa

SmilingBluEyes · Aug 9, 2004

That is why I always check the monitor's functioning before each use. I do this by running the self-test feature on our Corometrics monitors and check the time stamps before the patients go on---- EVERYtime, for just that reason. That way, I know I have a functional monitor that is documenting things at the right time at the start of caring for the patient. Takes care of that problem, redhead. Never fear, I am far from perfect, having learned this the hard way. It just sucks to have a patient on the monitor, only to discover something is wrong w/it. I am anal, aren't I? rofl.... :rotfl:

L&D_RN_OH · Aug 9, 2004

I occasionally chart on the strip just as a reminder to chart in the computer. We do save our strips, although if they are not labeled and we cannot id them, they get tossed. They are downloaded every morning onto disc anyway.

bam_bam · Aug 9, 2004

We don't have electronic charting. We write everything on our strips. We have corometrics with a keyboard so we can type on our strips. we are encouraged to type instead of handwriting because typing was done at the moment and handwriting could have been done later. We have a new policy coming out as I type that we have to type our initials every 15 min to verify that the strip was evaluated. And we don't have central monitoring (very small unit).