Babylon, NY -- Death pronouncements at most hospitals require a bedside patient evaluation to verify the absence of spontaneous respirations, but a death last week with a final respiratory rate of 20 documented in the electronic medical record (EMR) has officials at Methodist Hospital scrambling for answers.
"We have no idea how a dead person could have a respiratory rate of 20 documented in our EMR," said Lance Dugan, the Methodist Hospital CEO with no experience in medical documentation.
An outside consulting firm with specialized training in after-death EMR documentation has been hired to lead the investigation, but hospital nurses believe they already know the answers.
"If you look at the drop down menu for respiratory rate it says, 'You have set your default respiratory rate to 20. Would you like to change it?'", said a nurse at the hospital who wished to remain anonymous because diagnosing EMR issues was not within her scope of practice.
"Most nurses created a default respiratory rate during EMR orientation last year. Some nurses chose 16. A few chose an odd number like 17 to make it seem believable. But, I'd say 90% of us chose 20 like we did on the old paper charts."
Many EMR systems allow automation of daily charting activities. A closer look at the Methodist Hospital EMR discovered a glitch that doesn't prompt the nurse to change her default respiratory rate vital sign field in the event of a death pronouncement, a critical error I.T. officials said would be fixed by the end of the day.
"We have asked our vendor to modify the respiratory rate field to include a default option for death pronouncements," said Mary Jennings, an I.T. representative with no experience in medical documentation.
"In addition, some nurses have suggested we change default respiratory rate settings to simply low or high and that change is currently under serious consideration."
The New York State Nursing Board has come out in support of default respiratory rate settings in EMR vital sign fields and feels Methodist Hospital is to blame for not providing respiratory rate death options in their electronic record.
"Our New York nurses are simply too busy to count to 20. We will continue to push for all technology that provides for more automated charting opportunities and less bedside activities for our members," said Nancy Schneider, a nurse with no experience in medical documentation.
"Your charting shows a respiratory rate of 20. The lie detector determined that was a lie."
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"We have no idea how a dead person could have a respiratory rate of 20 documented in our EMR," said Lance Dugan, the Methodist Hospital CEO with no experience in medical documentation.
An outside consulting firm with specialized training in after-death EMR documentation has been hired to lead the investigation, but hospital nurses believe they already know the answers.
"If you look at the drop down menu for respiratory rate it says, 'You have set your default respiratory rate to 20. Would you like to change it?'", said a nurse at the hospital who wished to remain anonymous because diagnosing EMR issues was not within her scope of practice.
"Most nurses created a default respiratory rate during EMR orientation last year. Some nurses chose 16. A few chose an odd number like 17 to make it seem believable. But, I'd say 90% of us chose 20 like we did on the old paper charts."
Many EMR systems allow automation of daily charting activities. A closer look at the Methodist Hospital EMR discovered a glitch that doesn't prompt the nurse to change her default respiratory rate vital sign field in the event of a death pronouncement, a critical error I.T. officials said would be fixed by the end of the day.
"We have asked our vendor to modify the respiratory rate field to include a default option for death pronouncements," said Mary Jennings, an I.T. representative with no experience in medical documentation.
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| Respiratory rate of 20 in deceased patients is quite common. |
The New York State Nursing Board has come out in support of default respiratory rate settings in EMR vital sign fields and feels Methodist Hospital is to blame for not providing respiratory rate death options in their electronic record.
"Our New York nurses are simply too busy to count to 20. We will continue to push for all technology that provides for more automated charting opportunities and less bedside activities for our members," said Nancy Schneider, a nurse with no experience in medical documentation.
"Your charting shows a respiratory rate of 20. The lie detector determined that was a lie."
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