Practice What You Preach – King Tut!

writerpen

"What’s that word?" …

"No, not that word… THAT word." …

"Look like twice? Err… maybe toast?"

Does this scenario sound familiar to anyone? “Dr. Cursive” just wrote an order and it’s your job to interpret the results note the orders.

By noting the orders you’re verifying their presence, following all policies and procedures, doesn’t violate any laws, not contraindicated for that particular patient, follows the 7 rights of medication administration, etc, etc.

The problem is. You’re not exactly sure what you’re reading. (It’s English right? )

You did take the ‘hieroglyphics’ class in school didn’t you?

We are taught that if it’s illegible, or there is a question regarding the order, we are to call the physician to clarify. (Yeah.. that goes over like a lead balloon)

Here’s the problem.

We nurses love to point the finger and rat out ‘that physician’. In some hospital systems the physician get a 2 strike warning. After the second notice, if they have not improved their hand writing skills, they are required to attend a formal class on hand writing etiquette! (No I did not make that up)

What about our fellow nurses who do the same thing? Ever follow a nurse after change of shift and try and review their narrative note… And realize that we nurses create our own type of hand writing communication in the form of broken-words, run-off one syllable sounds, and abbreviations that JCAHO would have a heart attack reading.

It’s funny, and if you’ve experienced this I know your chuckling inside. Hell, I’m one of the hieroglyphic-guilty charting fools. My handwriting is atrocious. Even I have a difficult time reading my own hand writing.

It’s also not funny. It’s a down right serious problem. The potential for error and questionable practice is literally smacking you in the face.

Patient safety walks shoulder to shoulder with patient advocacy, and if we don’t chart properly and legibly we put our patients at risk.

I wrote this blog to give myself a wake up call.

Chart legibly. Even if the doctors don’t.

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16 thoughts on “Practice What You Preach – King Tut!

  1. great round up!
    In response to pinky, fundal pressure is indeed still happening. 17% of Listening to Mothers respondents said that a care provider pushed on their bellies during second stage of labor. Sure, some of these women probably interpreted the question to include suprapubic pressure, but I doubt all of them.
    I think it is important to remember that there is wide, wide practice variation across hospitals and providers. What is forbidden or out-of-favor in your hospital could certainly be going on in other hospitals, and there is no way for us to really know what is going on where. I had an interesting experience recently taking part in a birth that was being filmed for one of the TV birth shows. Her labor had stalled (no surprise there, with a camera crew in her living room) and so while she slept (at 7 cm!) we had plenty of time to talk to the film crew. The show’s producer and I got to talking about this exact phenomenon – where something will be the hard-and-fast routine in one hospital and he knows that at the hospital just down the road they’re doing things differently. He actually used fundal pressure as one of his examples. There’s one hospital where he has seen it happen frequently and another where they take a much more laid back approach to second stage with spontaneous pushing, laboring down, plenty of patience, etc. I loved this guy’s perspective as one of the few lay people who really has seen how birth is handled in multiple settings with many different providers.
    This comment was originally posted on The Man-Nurse Diaries

  2. great round up!
    In response to pinky, fundal pressure is indeed still happening. 17% of Listening to Mothers respondents said that a care provider pushed on their bellies during second stage of labor. Sure, some of these women probably interpreted the question to include suprapubic pressure, but I doubt all of them.
    I think it is important to remember that there is wide, wide practice variation across hospitals and providers. What is forbidden or out-of-favor in your hospital could certainly be going on in other hospitals, and there is no way for us to really know what is going on where. I had an interesting experience recently taking part in a birth that was being filmed for one of the TV birth shows. Her labor had stalled (no surprise there, with a camera crew in her living room) and so while she slept (at 7 cm!) we had plenty of time to talk to the film crew. The show’s producer and I got to talking about this exact phenomenon – where something will be the hard-and-fast routine in one hospital and he knows that at the hospital just down the road they’re doing things differently. He actually used fundal pressure as one of his examples. There’s one hospital where he has seen it happen frequently and another where they take a much more laid back approach to second stage with spontaneous pushing, laboring down, plenty of patience, etc. I loved this guy’s perspective as one of the few lay people who really has seen how birth is handled in multiple settings with many different providers.
    This comment was originally posted on The Man-Nurse Diaries

  3. Aaaaaaaaaaaah the only time fundal presure is applied is when the Doc is doing an SROM. We do not do funal pressure for delivery. You order superpubic if you so like. I sugest getting on the bed to do it correctly. But super pubic should not be asked for or done. That is old. Very very old. ANd it is not standard of care. ANy nurse who is asked to do fundal pressure at a delivery is in a bad place.
    This comment was originally posted on The Man-Nurse Diaries

  4. Aaaaaaaaaaaah the only time fundal presure is applied is when the Doc is doing an SROM. We do not do funal pressure for delivery. You order superpubic if you so like. I sugest getting on the bed to do it correctly. But super pubic should not be asked for or done. That is old. Very very old. ANd it is not standard of care. ANy nurse who is asked to do fundal pressure at a delivery is in a bad place.
    This comment was originally posted on The Man-Nurse Diaries

  5. That’s why I love typing my notes instead of writing. I especially love reading doctors’ notes now because I can understand them!

    *loving EPIC*

    Now if we can just train the doctors to enter their own orders in the system instead of writing it in the chart soon.Hmm.

    Oh, by the way, you make me think twice about how legible I sign my name.

  6. That’s why I love typing my notes instead of writing. I especially love reading doctors’ notes now because I can understand them!

    *loving EPIC*

    Now if we can just train the doctors to enter their own orders in the system instead of writing it in the chart soon.Hmm.

    Oh, by the way, you make me think twice about how legible I sign my name.

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