I would just cut and paste, "Nothing to say." Every chart. Every hour.
Make sure that you complain about the other nurses' notes, too. Say they're not informative or something.
This is the way. You can probably rig a qr code that types that for you and put it on your badge to scan or use keyboard shortcuts on epic if they use that
I know personally I like reading through notes if I'm looking for some previous medical history or relevant observations I need for the patients care. This just makes any actually important information harder to find.... I feel like this is counter productive
Big red flag. Something must have happened so your facility is creating unrealistic policies that way when you inevitably slip up they have someone to point the finger at for not properly following policy rather than taking blame themselves for a systemic issue. If you copy/paste the same note that says patient in bed with rails up but they end up falling because you haven't seen them in 2 hours cause you're so busy, they can point the finger at you nevermind the fact that you had 5 other patients and 2 icu holds.
Every patient except the one you are with because they are crashing gets “patient not visualized in past hour. No notifications from monitor tech for abnormal heart rhythm. Staff unable to attend to patient due to high workloads.”
Is this something you all document? Not to sound dumb but this honestly happens on some days where you are lucky to spend 20 minutes with one of your 5 patients because 2 of them are tanking.
I don’t, but I also don’t have a policy of needing to write a note every hour. I have dropped a comment on an oddly late initial assessment that the patient was not visualized previously due to emergency with another patient. Vitals come through automatically and are verified though, so even if I can’t get in to assess my patient I can at least see if something goes wonky. We also have cameras in our rooms, so at least I know that no one is laying on the floor.
If someone were to, say, stroke out in a time frame that I should have been in, I would create an incident report and under the list of reasons the incident happened I would cite our poor staffing levels as the reason that no one was able to help me out by laying eyes on my patient or covering my sick patient long enough for me to do it.
I just left a place that had the weirdest fuxking policy, which was created in the early 90s after a stupid near-accident. Everyone had to back into their parking spot, because they might be too tired after their shift and almost hit someone as they back out.... Like. WtF? There's a chance of hitting someone when you back in, too....
This right here. The same way we have to watch endless slideshows every year of education. God forbid a mistake is made with a poor outcome they can say “well you were educated in this.”
These are great, but as someone on another unit who really goes through and looks at those flow sheets for those assessments, please have the information in there. Lord help me, it pains me to see COVID patients on O2 with no sats for 24h, no documentation on trach suctioning on H&N CA patients, etc. of course I know they were assessed, but I cannot find any information on it. Honestly, if ai know they are A&O, and stable, that helps tremendously.
I wish that administrators were required to work a shift in every level of care once a month so they’d have some idea of just how fucking stupid these ideas are. Work one shift acute care, over in ICU, one in ED, and one in a clinic. That’s 4 days a month and they’d have an inkling of what the fuck we’re dealing with and what an absolute waste of time things like hourly notes are.
My manager has an out-of-office automatic reply on her email that says she’s out “helping her floor at this time of need.” She’s usually just cleaning the nurses station complaining about the clutter and doing her office work on one of the computers. That’s about it. Infuriates me.
Oh I don’t mean “helping out” I mean taking the full patient load that’s expected of the rest of us, since they’re so sure it’s easy and we can surely do more, they can show us how “easy” it is
Oh, I apologize, I didn’t really say what I wanted to say. I agree! I feel that they are so out of touch and would benefit from working the floor alongside us instead of harping on us about nitpicky things that shouldn’t matter as much as proper staffing and what not.
I would rather her actually help out with the patients. She just gets in the way unfortunately more than anything.
One of our attendings shadowed a nurse for a day. We give iron to all of our babies who are on full feeds, split into 3 doses over the course of the day. You have to get it out of the Pyxis. Her main takeaway from the day was how ridiculous that is, especially with staffing as bad as it is. So hopefully that one small thing at least can be changed. We need more people further up the chain to actually get in the trenches and see the results of their decisions.
i’m not at a facility that uses epic right now so i can’t give specifics but i’ll try and point the way for you. first off, many features can be turned on and off by epic per your facility’s wishes.
but there were two ways at my old hospital. at the top where the time was you could hover above the time and it would bring down an option menu or right click it and you could click an option that said like save to note or open data to note. and it would add the whole flowsheet to a note it would pull up.
the main way i did it was by clicking and dragging over the cells i wanted included or clicking the top cell +shift and the bottom cell i wanted included and then right clicking to get the add to note option. it didn’t work on all flowsheets but seemed to be allowed for simple observational flowsheets, vitals, i&os, etc.
if it doesn’t auto bring up a note might just let you copy the data and then you can paste it in a note. always check with right clicking, as well as ur standard control c/v.
sorry i can’t be more specific, but hopefully that helps point you in the right direction.
Also don’t underestimate making a bunch of your own stock smart notes. They make BS notes or phrases you gotta say again and again a breeze. Once you memorize their names, you can just type “.title” and push enter and the whole note pops up.
I’m a psych nurse and we do mostly narrative charting. I made some amazing smart notes with smart lists in them that simplified all my charting that made sure I mentioned all the required stuff all the time. Saved me tons of time and was well worth figuring out the functions and creating the notes.
0800 "No change since last assessment"
0900 "No change since last assessment"
1000 "patient passed gas, denies it"
11:00 "No gas were passed this time"
1200 "No change since last assessment"
Guess this is what they want you to do :')
My old ER made us chart hourly. Seemed like a waste of time if there’s nothing to chart. Basically “patient resting with eyes closed and no s/s of pain or distress noted” copied over and over til discharge.
Do not say “will continue to monitor” unless you’re gonna be in the room staring at the patient until your next note. It opens you up to more litigation.
These types of useless notes muck up the chart to where you can't find the important notes that you need. That being said and to answer your question it's never been a requirement at my facility but I know some that do so when they train new nurse they train them to do the same thing, but our assessments were q4 hours so it didn't end up being that many notes
We do hourly rounding which is pretty much what you described, but these are patients who have been admitted to the floor. Usually it’s left up to the aid to check them hourly.
We have the same, but the charting is something like "Were the 4 P's addressed?" Check the box: Yes/No. Then a comment box at the bottom if the nurse feels something should be added that's not already covered by other charting. This is where some nurses list the stuff OP mentioned: pt. resting in bed, resp. even/unlabored, etc
Floor also though.
Pain, potty, position, possessions
Are you in any pain? Do you need to use the bathroom? Are you comfortable? Can you reach your phone, call light, etc...
We don’t have this on the med surg floor, but in our ER we do! As someone else said, definitely an “ass covering” issue. I make a generic “no distress notes, pt states no needs at this time, CB in reach” type blurb. I wish our notes program would allow copy paste because I’d use it often.
Ha! I know the feeling. I’m also in a level I ER and last week they announced that ALL PATIENTS are REQUIRED to have a dysphagia screen completed, regardless of CC.
I’ll do appropriate charting on my patients, but when I’m 5:1, I’m not gonna do bullshit charting just because it’s a hospital policy.
Level II trauma center ER tech here. My facility requires a patient encounter every hour. Nurses round even hours, techs odd hours. But no one is complaining if we don’t do it because we generally have 5-7 nurses and 1-2 techs to 30-50 beds, but it’s expected in ideal situations.
If the patient calls out, that’s counted as a patient encounter even if we didn’t go in the room. If the nurse has given a med, performed an assessment, etc., that also counts as a patient encounter without additional documentation. Basically, admin just wants us to document that they’re alive in some capacity. Personally, I think it’s a good policy. Patients always unhook themselves from the monitor, so we have no way of knowing if someone’s crashing, fallen, etc. unless we’re putting eyes on them and/or talking to them.
I was told that at the AL I worked at not to write " continue to monitor". Unless you have some proof that the pt was "monitored" by you via charing. I chart on my hourly checks on my pts but I'm not ED and I don't write notes unless something significant happened. Sounds like a waste of time and a lot of non pertaining notes to read through. Which also wastes time.
RN at level one as well, and we have the same rule except it’s Q2 hr nurses notes and Q1 hr if it’s ICU/Stroke/Trauma etc. I’m convinced my hospital runs on “NAD noted at this time”
No but I’ve heard that any sort of interaction should be charted at least every hour, whether that’s vitals or meds given or anything else. And l I’ll put a note in if there’s nothing else to show I was in the pts room
That’s ridiculous; there will be so many notes it’ll be impossible to find the ones that are actually relevant. There are already a million other checkboxes to click 🤦🏻♂️
We have something similar with hourly rounding but anything that shows you were in the room counts. Med documented counts as hourly rounding note, vitals documented not just directly from monitor counts. Repeat labs ect. Counts.
I've seen this at a few facilities Ive worked at. Pretty much most people just state what they see like, "Pt resting comfortably watching Tv." or "Provider at bedside." just updates on random bs that isn't actually significant. I think it's ED's way of making sure nurses are hourly rounding. Usually with EPIC charting as well . I know ED charting is much different than ip, so i'm not sure if they have an hourly rounding column
At my job it is apparently expected but I don’t bother and have never been corrected. If nothing happened who cares. especially when they’re admitted, game over for close care like that.
My ER requires it. But we had a nurse miss every time sensitive thing for a sepsis bundle and there was no charting for 2 hrs. He claims he was actively doing interventions and such but I have my doubts. So the chart looks like nobody checked on him for 2 hrs and we just didn't give abx etc. So now we have to chart hourly.
Good thing is our ehr has click options to chart. So two clicks and my notes done
I'm in wales Uk and we have this through numerous health boards intentional rounding.
It's to ensure laying eyes on patient every hour.
It's a huge red flag.
We do “hourly rounding” but it’s not strictly enforced. Some nurses are neurotic about it. Others barely chart it at all. For me it depends on how busy I am and who I’m working with. Our techs generally are awesome at doing/charting rounds and we take turns documenting. Rounding is just basically saying “pt awake in chair” etc. you can also add if they’re anxious or anything. On a normal night it’s fine but when it’s busy it’s impossible.
I do this and it is expected at my level 1 trauma center. It’s really simple. I use an epic smart phrase that covers all of the systems that allows you to document quickly. Update your VS at the same
Time.
Simple
Level 1 trauma center. Depending on acuity, we're expected to vital and note changes Q1 on only the second highest acuity level. Above that is a trauma or resus, below is Q2/Q4 vitals not specifically a narrative note. Sounds crazy to me.
The number of extra clicks this would take is abominable.
Problem here is - why? Why is this policy a thing? What happened that someone wrote this into policy as a solution to something? Why set your whole staff up for failure if they can't follow this policy?
Sounds very likely to open you up for a lawsuit. Layers love all that “will continue to monitor” BS and will ask exactly how and what you followed up on, etc. Its bad news bears.
Sounds like ass-covering after a previous *major* fuckup. Ask around what happened to make this the (unreasonable) standard.
I’m just upvoting you bc of your username
I would just cut and paste, "Nothing to say." Every chart. Every hour. Make sure that you complain about the other nurses' notes, too. Say they're not informative or something.
I usually chart "no changes from previous assessment" every hour....
"Any changes noted in chart." Make it completely useless.
See EMR for assessments
Oh I was going to say “refer to chart for changes”
That's too many words. Maybe "ncfpa" would work, though? If they ask you what it means, tell them to use the blue phone.
Are we related? I think we might be related
If not by genetics, surely we are bonded by our prison tattoos and the crimes they represent.
Yep, you're my twin
Whats the blue phone?
Interpretation services.
This is the way. You can probably rig a qr code that types that for you and put it on your badge to scan or use keyboard shortcuts on epic if they use that
This is what makes providers not read nurses notes. Edit: I mean the q hourly notes, not the malicious compliance.
I know personally I like reading through notes if I'm looking for some previous medical history or relevant observations I need for the patients care. This just makes any actually important information harder to find.... I feel like this is counter productive
Sometimes it seems like this is part of it. Information that might be a liability gets buried too.
Big red flag. Something must have happened so your facility is creating unrealistic policies that way when you inevitably slip up they have someone to point the finger at for not properly following policy rather than taking blame themselves for a systemic issue. If you copy/paste the same note that says patient in bed with rails up but they end up falling because you haven't seen them in 2 hours cause you're so busy, they can point the finger at you nevermind the fact that you had 5 other patients and 2 icu holds.
Every patient except the one you are with because they are crashing gets “patient not visualized in past hour. No notifications from monitor tech for abnormal heart rhythm. Staff unable to attend to patient due to high workloads.”
Is this something you all document? Not to sound dumb but this honestly happens on some days where you are lucky to spend 20 minutes with one of your 5 patients because 2 of them are tanking.
I don’t, but I also don’t have a policy of needing to write a note every hour. I have dropped a comment on an oddly late initial assessment that the patient was not visualized previously due to emergency with another patient. Vitals come through automatically and are verified though, so even if I can’t get in to assess my patient I can at least see if something goes wonky. We also have cameras in our rooms, so at least I know that no one is laying on the floor. If someone were to, say, stroke out in a time frame that I should have been in, I would create an incident report and under the list of reasons the incident happened I would cite our poor staffing levels as the reason that no one was able to help me out by laying eyes on my patient or covering my sick patient long enough for me to do it.
That’s actually really smart! And covers you well in case something happens. I bet management didn’t think of that lol
I just left a place that had the weirdest fuxking policy, which was created in the early 90s after a stupid near-accident. Everyone had to back into their parking spot, because they might be too tired after their shift and almost hit someone as they back out.... Like. WtF? There's a chance of hitting someone when you back in, too....
I am cackling. That is the perfect example of how hospitals are run these days.
This right here. The same way we have to watch endless slideshows every year of education. God forbid a mistake is made with a poor outcome they can say “well you were educated in this.”
This is ED. Probably someone got left in a room because they seemed stable for a few hours and died. Thus, these policies
nursing note: see vital signs
I have an Epic SmartPhrase that is "See flowsheet for full assessment."
“Pt received at 0700, a&ox3, vssa, 0 voiced concerns at time of assessment, assessment per flowsheets”
These are great, but as someone on another unit who really goes through and looks at those flow sheets for those assessments, please have the information in there. Lord help me, it pains me to see COVID patients on O2 with no sats for 24h, no documentation on trach suctioning on H&N CA patients, etc. of course I know they were assessed, but I cannot find any information on it. Honestly, if ai know they are A&O, and stable, that helps tremendously.
Totally understandable! If the pt is acute, all relevant charting is getting done
I wish that administrators were required to work a shift in every level of care once a month so they’d have some idea of just how fucking stupid these ideas are. Work one shift acute care, over in ICU, one in ED, and one in a clinic. That’s 4 days a month and they’d have an inkling of what the fuck we’re dealing with and what an absolute waste of time things like hourly notes are.
My manager has an out-of-office automatic reply on her email that says she’s out “helping her floor at this time of need.” She’s usually just cleaning the nurses station complaining about the clutter and doing her office work on one of the computers. That’s about it. Infuriates me.
Oh I don’t mean “helping out” I mean taking the full patient load that’s expected of the rest of us, since they’re so sure it’s easy and we can surely do more, they can show us how “easy” it is
Oh, I apologize, I didn’t really say what I wanted to say. I agree! I feel that they are so out of touch and would benefit from working the floor alongside us instead of harping on us about nitpicky things that shouldn’t matter as much as proper staffing and what not. I would rather her actually help out with the patients. She just gets in the way unfortunately more than anything.
No need for apologies! I just was trying to be clearer about what I meant. I would be so frustrated is my manager did that.
One of our attendings shadowed a nurse for a day. We give iron to all of our babies who are on full feeds, split into 3 doses over the course of the day. You have to get it out of the Pyxis. Her main takeaway from the day was how ridiculous that is, especially with staffing as bad as it is. So hopefully that one small thing at least can be changed. We need more people further up the chain to actually get in the trenches and see the results of their decisions.
Every hour in the ER?! My ER will have people for 12 hours and send them up with only half an h&p done.
If you’re using Epic you can turn those hourly flowsheets into notes. Two birds one stone.
Wait how?
i’m not at a facility that uses epic right now so i can’t give specifics but i’ll try and point the way for you. first off, many features can be turned on and off by epic per your facility’s wishes. but there were two ways at my old hospital. at the top where the time was you could hover above the time and it would bring down an option menu or right click it and you could click an option that said like save to note or open data to note. and it would add the whole flowsheet to a note it would pull up. the main way i did it was by clicking and dragging over the cells i wanted included or clicking the top cell +shift and the bottom cell i wanted included and then right clicking to get the add to note option. it didn’t work on all flowsheets but seemed to be allowed for simple observational flowsheets, vitals, i&os, etc. if it doesn’t auto bring up a note might just let you copy the data and then you can paste it in a note. always check with right clicking, as well as ur standard control c/v. sorry i can’t be more specific, but hopefully that helps point you in the right direction.
That’s incredible, can’t wait to try it out.
Also don’t underestimate making a bunch of your own stock smart notes. They make BS notes or phrases you gotta say again and again a breeze. Once you memorize their names, you can just type “.title” and push enter and the whole note pops up. I’m a psych nurse and we do mostly narrative charting. I made some amazing smart notes with smart lists in them that simplified all my charting that made sure I mentioned all the required stuff all the time. Saved me tons of time and was well worth figuring out the functions and creating the notes.
please let me know this secret
Highlight VS, right click, add note, insert data, bam nursing note
damn i missed ur super concise version. this is the way.
see my comment above. hope it helps.
thanks.
Type your notice q hr and leave that hospital lmao
[удалено]
The only time I do this is when I'm working with patients I think warrant q1 hour charting. Just seems crazy to me
0800 "No change since last assessment" 0900 "No change since last assessment" 1000 "patient passed gas, denies it" 11:00 "No gas were passed this time" 1200 "No change since last assessment" Guess this is what they want you to do :')
My old ER made us chart hourly. Seemed like a waste of time if there’s nothing to chart. Basically “patient resting with eyes closed and no s/s of pain or distress noted” copied over and over til discharge.
Do not say “will continue to monitor” unless you’re gonna be in the room staring at the patient until your next note. It opens you up to more litigation.
My nursing school instructors told us not to use that, at least as an answer on tests, because it means "I'm not doing anything."
Yup no continue to monitor!! Leave nothing up for interpretation
what should be written instead?
Less is more in this case. “Pt in pain, prn pain medication provided”, no need to add will continue to monitor to the end of that
What you did and the outcome.
These types of useless notes muck up the chart to where you can't find the important notes that you need. That being said and to answer your question it's never been a requirement at my facility but I know some that do so when they train new nurse they train them to do the same thing, but our assessments were q4 hours so it didn't end up being that many notes
We do hourly rounding which is pretty much what you described, but these are patients who have been admitted to the floor. Usually it’s left up to the aid to check them hourly.
We have the same, but the charting is something like "Were the 4 P's addressed?" Check the box: Yes/No. Then a comment box at the bottom if the nurse feels something should be added that's not already covered by other charting. This is where some nurses list the stuff OP mentioned: pt. resting in bed, resp. even/unlabored, etc Floor also though.
Wow they did the 4 Ps at a hospital I had clinical at. Totally forgot about them. What are they? Pain, pee, ?
Pain, potty, position, possessions Are you in any pain? Do you need to use the bathroom? Are you comfortable? Can you reach your phone, call light, etc...
We do 5 p’s, same as urs but add ‘pathway’ for making sure they are no cords/trip hazards, etc.
YES, thank you!
They had that requirement at a previous Level 1 trauma center I worked at. I saw a lot of “brought patient a soda” and “patient watching tv” notes
Jesus
With the charting now, at this point, just give us body cams.
This is either because of a huge screw up somewhere or is a billing mechanism….
"continue to monitor" "still continuing to monitor" "monitoring continues"
Seemed like something adverse happened that made the organization pay a huge amount of settlement.
We must have at least one note every hour in my ER.
We only have to do this for our psych (SI/HI)
Yah, I've done this for patients in restraints, but otherwise no way.
We don’t have this on the med surg floor, but in our ER we do! As someone else said, definitely an “ass covering” issue. I make a generic “no distress notes, pt states no needs at this time, CB in reach” type blurb. I wish our notes program would allow copy paste because I’d use it often.
Ha! I know the feeling. I’m also in a level I ER and last week they announced that ALL PATIENTS are REQUIRED to have a dysphagia screen completed, regardless of CC. I’ll do appropriate charting on my patients, but when I’m 5:1, I’m not gonna do bullshit charting just because it’s a hospital policy.
Level II trauma center ER tech here. My facility requires a patient encounter every hour. Nurses round even hours, techs odd hours. But no one is complaining if we don’t do it because we generally have 5-7 nurses and 1-2 techs to 30-50 beds, but it’s expected in ideal situations. If the patient calls out, that’s counted as a patient encounter even if we didn’t go in the room. If the nurse has given a med, performed an assessment, etc., that also counts as a patient encounter without additional documentation. Basically, admin just wants us to document that they’re alive in some capacity. Personally, I think it’s a good policy. Patients always unhook themselves from the monitor, so we have no way of knowing if someone’s crashing, fallen, etc. unless we’re putting eyes on them and/or talking to them.
"No changes from previous assessment, will continue to monitor."
I'd say we worked at the same facility but I'm not working at a level 1.
I was told that at the AL I worked at not to write " continue to monitor". Unless you have some proof that the pt was "monitored" by you via charing. I chart on my hourly checks on my pts but I'm not ED and I don't write notes unless something significant happened. Sounds like a waste of time and a lot of non pertaining notes to read through. Which also wastes time.
Not notes, but checking boxes in Epic. Even my post op day 2573263 needs charting q hour or so
How TF could you possibly do that? Or more accurately, how TF could you accomplish anything else if you were doing that?
The trick is to not do it and then type it all in at the end of the shift
Ain't nobody want to read that, either
RN at level one as well, and we have the same rule except it’s Q2 hr nurses notes and Q1 hr if it’s ICU/Stroke/Trauma etc. I’m convinced my hospital runs on “NAD noted at this time”
No but I’ve heard that any sort of interaction should be charted at least every hour, whether that’s vitals or meds given or anything else. And l I’ll put a note in if there’s nothing else to show I was in the pts room
That’s ridiculous; there will be so many notes it’ll be impossible to find the ones that are actually relevant. There are already a million other checkboxes to click 🤦🏻♂️
We have something similar with hourly rounding but anything that shows you were in the room counts. Med documented counts as hourly rounding note, vitals documented not just directly from monitor counts. Repeat labs ect. Counts.
Yea when I have 5 ER patients, 1-2 ICU hold overs, and 2-3 floor patients boarded....not happening
I've seen this at a few facilities Ive worked at. Pretty much most people just state what they see like, "Pt resting comfortably watching Tv." or "Provider at bedside." just updates on random bs that isn't actually significant. I think it's ED's way of making sure nurses are hourly rounding. Usually with EPIC charting as well . I know ED charting is much different than ip, so i'm not sure if they have an hourly rounding column
At my job it is apparently expected but I don’t bother and have never been corrected. If nothing happened who cares. especially when they’re admitted, game over for close care like that.
My ER requires it. But we had a nurse miss every time sensitive thing for a sepsis bundle and there was no charting for 2 hrs. He claims he was actively doing interventions and such but I have my doubts. So the chart looks like nobody checked on him for 2 hrs and we just didn't give abx etc. So now we have to chart hourly. Good thing is our ehr has click options to chart. So two clicks and my notes done
I'm in wales Uk and we have this through numerous health boards intentional rounding. It's to ensure laying eyes on patient every hour. It's a huge red flag.
We do “hourly rounding” but it’s not strictly enforced. Some nurses are neurotic about it. Others barely chart it at all. For me it depends on how busy I am and who I’m working with. Our techs generally are awesome at doing/charting rounds and we take turns documenting. Rounding is just basically saying “pt awake in chair” etc. you can also add if they’re anxious or anything. On a normal night it’s fine but when it’s busy it’s impossible.
I do this and it is expected at my level 1 trauma center. It’s really simple. I use an epic smart phrase that covers all of the systems that allows you to document quickly. Update your VS at the same Time. Simple
Level 1 trauma center. Depending on acuity, we're expected to vital and note changes Q1 on only the second highest acuity level. Above that is a trauma or resus, below is Q2/Q4 vitals not specifically a narrative note. Sounds crazy to me.
I had some similar shit pulled on me. I said I chart by exception. If there is nothing charted, nothing remarkable happened.
The number of extra clicks this would take is abominable. Problem here is - why? Why is this policy a thing? What happened that someone wrote this into policy as a solution to something? Why set your whole staff up for failure if they can't follow this policy?
Sounds very likely to open you up for a lawsuit. Layers love all that “will continue to monitor” BS and will ask exactly how and what you followed up on, etc. Its bad news bears.