Looking Over Your Shoulder in Healthcare: Chart Audits

Part 2

Carolyn Buppert, NP, JD

Disclosures

December 08, 2011

In This Article

Licensing Boards: Complaints and Investigations

When a Board of Nursing or Medicine receives a complaint about a clinician, investigators may review medical records. Furthermore, in some states, where documentation of physician involvement is required, Boards of Medicine or Nursing may conduct periodic audits to determine whether the rules are being followed.

Here is an example of how a lack of documentation led to investigation of a clinician by a Board of Nursing:

An NP working at a nursing facility ordered clotting studies on a patient with a history of atrial fibrillation on warfarin therapy to reduce the risk for embolic stroke. The results of the clotting studies were subtherapeutic for several months. The NP kept ordering the tests but did not raise the dose of warfarin. In a report to the Board of Nursing, an auditor for Medicaid cited the NP as incompetent. The NP responded to investigators that she didn't raise the warfarin dosage level because she was concerned that the patient, who had an unsteady gait, would fall and suffer intracranial hemorrhage as a result of the anticoagulation. The Board of Nursing eventually accepted that argument, but the process was expensive and stressful to the clinician. Had she documented her thinking in the patient's progress notes, it is doubtful that the auditor would have reacted as he did.

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