Audits help manager track compliance
Nurse managers say they find chart audits extremely effective in tracking staff compliance with The Joint Commission's standard on verbal orders.
Kathy Hendershot, RN, ED clinical director at Methodist Hospital in Indianapolis, for instance, uses a random, generalized chart audit. India Owens, MSN, CEN, director of emergency services at Clarian West Medical Center in Indianapolis, also uses audits to track compliance. While Owens considers her compliance initiative to be a work in progress, she reports that compliance in her department has risen from 30% to about 75%.
"Any time there is a medical error in the ED, we check to see if there was a written or verbal order," Hendershot says. "If it is not signed, we will scrutinize it." If the order is documented as verbal, she will make sure it has been documented correctly.
"Also, we will routinely ask the staff if they understand what the policy is," Hendershot reports. "We will randomly select staff and ask if they understand what an RBVO [read-back verbal order] is. If they fail the test, we will go back and re-educate them."
This is not an easy "test," she says. "When we ask them what it is, they have to say, 'Read back' for the correct answer," Hendershot explains. "When surveyors were coming along, they would ask them, and they'd say, 'Repeat back,' and we'd be 'dinged' on that clarification."
"The way we've done audits is through inpatient admissions: How many of them have their completed meds reconciliation form on their chart from the ED as they go upstairs," Owens explains. In addition, she says, "our secretaries scan every chart into a computerized medical record, and they double-check the charts [for medication reconciliation]. They have been empowered to 'slap nurses around' if it is missing."
Nurse managers say they find chart audits extremely effective in tracking staff compliance with The Joint Commission's standard on verbal orders.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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