In an effort to establish controls, a new manager decides to spend one afternoon each week double-checking every chart his nursing care staff has completed for the previous week.  (a) In what ways is this attempt at control ineffective? (b) What would be examples of an internal and an external control the manager could set up to improve any problems with charting?

(a) This attempt at control may be ineffective for several reasons. Firstly, spending one afternoon per week checking charts for the previous week may not be frequent enough to catch and correct errors in a timely manner. Secondly, this approach is reactive rather than proactive, as it only addresses errors after they have occurred rather than preventing them in the first place. Thirdly, this approach may create a sense of mistrust and micromanagement among staff, leading to decreased job satisfaction and productivity.

(b) An internal control that the manager could set up to improve problems with charting is to implement a peer review process, where nursing staff review each other’s charts on a regular basis to catch and correct errors. This approach is proactive and can help prevent errors from occurring in the first place. Additionally, implementing a chart audit tool, such as a checklist or flowchart, can help standardize the charting process and ensure that all necessary information is included.

An external control that the manager could set up is to work with the organization’s quality improvement department to develop and implement evidence-based charting guidelines and protocols. This approach involves input from external experts and can help ensure that the charting process is aligned with best practices and industry standards. Additionally, the manager could consider implementing a software system for charting that includes built-in error-checking and alerts, reducing the need for manual chart review and improving the accuracy and timeliness of documentation.