A Wrong Turn: Fraudulent Documentation

Carolyn Buppert, MSN, JD

Disclosures

May 29, 2018

Question

Is This Fraudulent Documentation?

A nurse wrote to us to ask about the appropriateness of a common documentation practice in the unit where she works.

At my hospital, we are supposed to turn patients from side to side often to prevent pressure injury. We are told to chart this action every 2 hours, because "if it's not charted, it wasn't done." The truth is, most of the time we don't meet this standard, because we are so short-staffed. Who has time to do this every 2 hours? Is it dishonest to document that it was done, even if it wasn't?
Response from Expert Carolyn Buppert, MSN, JD
Healthcare attorney

Yes, it is dishonest—as well as fraudulent—to chart that something happened when it didn't. But the hospital is not making you chart dishonestly. You are the one who is completing the documentation, and it's your responsibility to chart accurately and honestly. Never chart that a procedure was done or a medication was given when it wasn't. You could lose your license for that. You could be sued successfully for malpractice if the patient gets a pressure ulcer and someone found out that you were charting that the patient was turned every 2 hours, when in fact this didn't happen.

If there is no time, in your view, to perform the tasks as ordered, then you have several options, none of which is to document that something was done, when it wasn't.

First, you can ask for help. If you can't turn a patient at 10 AM, is there another qualified staff member who can turn the patient? If no one on the unit can help, then inform the charge nurse and/or supervisor. If there are not enough staff to allow nurses the time to turn patients, then your time would be well spent going up the administrative ladder to propose that the hospital hire more staff or restructure assignments. If orders for turning patients are unnecessary—for example, because the patient is mobile and alert and can do it himself—then inform the physician or advanced practice provider who ordered the procedure of your assessment and request that they discontinue the order.

Do you have keep a written schedule for yourself, listing what you need to do every hour? Put "Turn Mrs X" on your schedule for 8 AM, 10 AM, noon, and so on, along with the other things you must accomplish during your shift. The task of turning a patient should be high priority. If you can't do it at 10 AM, then ask an aide or colleague to do it for you and tell you when it is done. If there are no available staff on your unit to perform the procedure within 15 minutes of when it's due, tell your supervisor, and chart that the patient was not turned. That way, the nurse relieving you can check the patient's skin earlier in the next shift; make certain that the patient is turned; and initiate wound care, if necessary.

I read your question as implying that you aren't impressed with the importance of turning patients. It is a low-tech procedure, but that doesn't mean it's unimportant. Frequent repositioning can prevent a serious complication, and it is considered the standard of care in nursing practice.[1]

I am having a hard time thinking of tasks that should take priority over repositioning patients who need turning every 2 hours, unless there is a life-threatening emergency.

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