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Sunday, March 2, 2008

Charting: No indication for treatment

I might sound bitter here, but I'm growing pretty tired of doing breathing treatments on a bunch of patients who have absolutely no indication for them. Not only am I wasting my time, but the patient's time and the hospital's money.

Of the 15 patients on my list, seven of them are stroke patients who have never had a problem with their lungs in their entire lives. They are getting breathing treatments for what reason? just because their diagnosis is stroke, or MS and they have to lye in the bed.

I walk into the rooms and the patients is lying supine, awake and alert, showing no signs of respiratory distress. Lung sounds vary from crackles in the bases to diminished to a forced upper airway wheeze indicitive up secretions in the throat. And the majority of them are out to lunch.

And, upon my post treatment assessment, not one of those things I listed in the previous paragraph changes.

Five of the patients have decided on their own they don't need the therapy, so they simply refuse. Good for them. The rest just do as they are told because, "Well, the doctor thinks I still need these."

Instead of just letting doctors get away with ordering these useless therapies, I started charting things like the following:

  • Treatment had no effect
  • No treatment indicated
  • No signs of bronchospasm
  • NARDN before treatment, still NARDN after treatment
  • Clear before treatment, still clear after treatment
  • Pt. wonders why he's getting treatments

A couple of my coworkers and I have been charting like this for about seven years now, and neither one of us has ever been questioned about it.

My theory is that no one ever looks at our charting anyway.


The Anonymous Therapist said...

I've often wondered if anybody ever looks at our charting. I don't think that they do. At Sunny Flats the physicians glance at our ventilator flowsheets because it saves them the trouble of going and touching the ventilator, but beyond that I suspect that most of our documentation is as dust in the wind.

I know back when I worked up North I'd chart like you're saying here, "Patient CTA before tx, CTA after tx, states no change in respiratory status, no changes observed." "Patient declines treatment and asks why he is getting them when he doesn't take them at home." So on and so forth.

I really don't think anybody will ever look at it.

Glenna said...

We have the same although we do have a pretty progressive assess & treat program so I always figure when I do the occasional treatment that I'm writing it for the A&Ters. And hell, it seems like when I'm not in a unit, I AM the A&Ter so I appreciate charting like that. Makes the job much easier to d/c unneccessary tx's.

You know, since I've been doing more A&T I've found that when it comes to breathing tx's it sure looks like even a lot of my fellow A&Ters use the philosophy of "they get nebs unless it's proven they don't need them" where I'm the opposite with the philosophy of "they don't get nebs unless it's proven to me they DO need them." Wonder where that attitude of sticking a neb in everyone's mouth came from?