Writing on Fetal Heart Monitor Strips

fergus51 · Aug 9, 2004

I was actually cautionned not to mark on strips as a new grad. Something to do with the liability issues. I admit I didn't really understand or care much, I just always use hospital stationnary (paper towels) then transfer that to the chart.

SmilingBluEyes · Aug 10, 2004

The caution stems from being careful NEVER to write OVER any part of the strip containing the FH or contraction tracing. You are supposed to write in the blank spaces in between. This is even covered in the AWHONN Advanced Fetal Heart Monitoring workshops.

mother/babyRN, RN · Aug 10, 2004

Even when I worked with central monitoring, there were times when I needed to note when I did something because there was just no time to chart it..I do write on fetal strips such as when meds are given, first push, etc , NEVER write in red..I do remember that from legal classes BUT I agree with SmilingBlueEyes, things sometimes happen so fast PLUS now, without central monitoring and both wanting and needing to concentrate on the patient, you can look at the times on the strip and correlate your notes when you are trying to keep up with flow sheets and the like..We have been delivery nurses for awhile and like her, I have no plans to change that anytime soon, if ever..I think if you want to do it fine. If not, fine. One thing I have learned from the get go is to chart the time difference from the time printed on the monitor to the time of the clock in whatever room you are in or end up in. That is especially important if it means more than five minutes between them AND we use the time of birth on monitor time only so the notes and birth time will correlate....Our policy in the facility I am currently in, is to write a note every five minutes while a patient is pushing. Am I going to say, excuse me, I have to let go , ignore you and update my notes? Nope, but I will probably write important things on the monitor strip as they occur (hang a new iv, etc.) and keep on helping the patient and her family with their neat new experience....

mother/babyRN, RN · Aug 10, 2004

When I worked with central monitoring we didn't just have to type our initials every fifteen minutes, we had to document fh, baseline, variability , etc...Where I am now, the time frames are much more relaxed and I admit to doing things a bit more frequently than currently required...

tantalus · Aug 10, 2004

It's very unusual to have electronic charting at the bedside in the UK....Hospital stationery (hand-towels) invariably get lost in the rush to clear (often by orderlies) a L&D room for the next recipient..Therefore it's customary in the UK to chart on the strip...it explains things right there in front of the analyst when looking at the fetal heart rate/contraction state.

All maternity records are kept for 25yrs in the UK and the strips are just a part of this.

Another note. I have always worked in environments where all equipment was given the once over at the beginning of each shift...including monitors, including clocks on monitors. The people responsible for this task...RNs and Midwives...therefore only ourselves to blame for poor equipment, whether it be clock setting or just plain tidiness!!!

SmilingBluEyes · Aug 10, 2004

Amen, tantalus. A person after my own heart.

webbiedebbie · Aug 10, 2004

I worked L&D in the 80's and we charted on the strip, so I am very used to it and depend on it. Worked as a travel nurse in a unit that had central monitoring and bedside charting on computer. It was a pain for me to have to put my password in each time I wanted to chart. Plus, it seemed difficult to have to read through all of the notes to find something a doc was looking for. Seemed easier to me to just grab the strip and visually find exactly what was happening at the time I did the intervention.

I learned that the fhm strips are legal documents. However, I have been told by many hospitals that the strips "get lost".

I was always having to go back and finish up charting in the computer at the end of the delivery, because I didn't have time to go into the computer and document each time....easier for me to jot on the strip and then finish my charting from the strip.

rdhdnrs · Aug 11, 2004

Thanks for all the information.

Lisa

CA CoCoRN, RN · Aug 11, 2004

At my hospital, we use GE Quantitative Sentinel(QS), now known as Centricity (?). They actually always had it and used it in a limited fashion (it was there before I got there), but a couple of years ago, they decided to upgrade. It's taken a while, but now everyone uses it competently.

Going from paper to 'puter was HARD for some folks. Heck, it was even hard for me though I'm net and computer saavy. We had to change our state of mind and routine.

I've said all that to say this: I still chart on the strip. We keep all our strips, even though QS archives them. However, when at the bedside, the easiest thing to do (if you're busy and can't log in or you're doing multiple tasks) is to hit that 'Mark' button, jot what you did and after the commotion is over, go back and chart the events. The 'Mark' button makes it easy, because on the electronic strip hitting the button also creates a mark to identify your time of action. So I'll hit 'mark', jot what I did/happened BRIEFLY on the strip, then elaborate when I sit down to type my full note....just like when I'd write it out by hand.

Now that we've been doing the electronic charting a while, I must admit that my strips can look awfully blank, save for the arrows made by the 'Mark'. That's because I mark it...and type right then. And each typed entry is time/date stamped anyway....so you can't really "fake" when you charted the events. Sometimes, if things are slow, I may not even 'mark' the strip...I'll just log in and type at the time I'm working. The time/date stamp assures any auditor of the time of the entry and if it's "late".

I like the elct. charting because it makes a patient's care review a LOT simpler and easier. No decifering handwriting or hunting through misfiled notes. If something happened on that day, it's going to be exactly where it should be...if they charted on it.

Heck...some of the doctors are even getting in on the act. Our system allows ALL disciplines to elct. chart. :coollook:

finallyRN · Aug 11, 2004

We also have electronic charting (Quantitive Sentinal) I still make little notes on the strip when I am buzy then go back to chart in the computer. The strip is still part of the permanant record.

BETSRN · Aug 14, 2004

I always chart on the strip and then transfer my information to our labor flow sheet. We have electronic documentation but we still chart on the strip anyway. However it is very improtant that all your information is transferred over to the flow sheet. I know we always have this dic=scussion on other bnoards but I still feel that the copy of the monitor strip that is printed from a disc is never as clear as the actual strip.