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Thursday, July 25, 2013

The Chart Nazis

I think there is way too much emphasis on charting in healthcare, and not enough emphasis on the patient.  The longer I work in healthcare the more I realize this.

Just to give an example, my colleagues and I have maybe one or two experiences over the past 15 years where a patient, or patient family, complained about patient care.  Every one of those complaints was based on ignorance on the part of the patient or family member, and not on poor care by one of us RTs.

My colleagues and I get on average 2-3 notes a week alerting us to a charting error.  Once we master one area, the chart Nazis, as I like to call them, will find some other area of charting to focus on.  It's a never ending battle.

It's not just where I work either. I think even as you look at government regulations over healthcare, all, or most, of them tell a physician how to treat a patient with a given diagnosis.  There is no emphasis on the individual patient.

For example, all patients admitted with pneumonia must be sick enough to need one of the following in order to meet criteria for admission (translated means: criteria for reimbursement):

  1. SpO2 of 92% or less upon admission, or an abg
  2. Albuterol nebs or mdi every 6 hours
  3. Antibiotic
There is no emphasis on the individual patient there.  There's this assumption that every patient is the same, or some kind of entity.  Individualism is lost in healthcare.  And this, my fellow RTs, is what is wrong with healthcare.  

Physicians are not encouraged to think outside the box.  For example:
  • What if the pneumonia patient doesn't have bronchospasm?... too bad.
  • What if the patient is too sick to go home but doesn't need oxygen or antibiotics... too bad. 
Personally, I think the current state of healthcare is unfortunate for the patient, because he's not going to get the care he really needs.  I think it's bad for the respiratory therapists and nurses, because the emphasis will not be on patient care, but whether those three things were done and charted correctly. Of course RT bosses will emphasize accurate charting, which is (ahem) where the dollars are.  

So when the chart Nazis come out in groves, now you know why.  

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