Signatures, or the lack thereof

[mshow00]

In my company we get docked pay (about $200 for a month) if we don't get the signature. If the patient can't sign then we HAVE to have a legitimate medical reason why they can not (being spinal immobilized does not count), and we have to have a proxy signature. It is not that difficult to obtain them and it is easy enough as saying can you sign right here for me. IF for whatever reason everyone refuses/unable to sign it merely needs to be documented in our PCR.

[dahlio]

Signatures are just something I forget about. Going from volley to paid has really changed a lot when it comes to paperwork (and thats a good thing). My service has three boxes. The first, is the person's signature or mark, which also has an optional witness space. The second, is someone signing in lieu of the patient. I.E., AMS, or other medical restriction that doesn't allow them to sign for themselves. Those people include the pt's healthcare provider (only for NFT (not us, but the discharging nurse)), a relative, or a power of attorney. The third box is only for EMS, and can not be used for IFT, which is if the patient is unconscious, and there is no-one able to sign. Both my partner and I are to sign, with a report on why box 1 or 2 could be used.

Seems to work well, but as I said before, I am forgetful. (Been pretty good lately though)

[brentoli]

Our sheets have 3 boxes.

Box A:

Patient Signature

Witness signature, if only signed with a mark

Box B:

Family Signature

Witness Signature

Box C:

Nurse Signature

Explanation for Nurse Signature

Only one box has to be completed.

[Laura Anne]

Hmmm, I am not sure why signatures are so darn hard for people to obtain, but for some reason, it does present itself as a problem for some reason. I don't get it. I guess people just forget. My company is busy, but if you can remember to copy the ins and id cards, get a copy of the demographics sheet, why not a signature? It's just plain laziness on their part, from my understanding.

Only people I cannot obtain a signature is from the obvious. IE: DEAD. 8)

[AnthonyM83]

I timed my first patient's signature this morning. 58 seconds...that's 58 seconds of her fiddling with the pen and me stabling the clip board in an awkward position. Did it kill me? No! But it's definitely unpleasant so I can understand aversion to it.

Then, I had to about 8 minutes to get a signature from the triage nurse because they had three patients lined up and in between each she was running to do stuff. I hate being the EMT following around waiting for her to turn so I can ask for her signature. I'm sure they're tired of it.

Then, I waited another 5 minutes after that (yes, I know it's not that long, but we're at like 15 minutes now) next to registration guy until he reached my patient's sheet and entered her into the computer. Then, gotta find a place to balance my clip board, open up the PCR, write in the MR, fold the facesheet the way the company wants it, then copy the PCR number and call number onto the facesheet, then put it back, then I'm set to go.

Times that by 5 to 12 patients transports a day, every day of work...I totally have an aversion for it...still do it, but it's not exactly easy peasy.

[CBEMT]

However, our call volume from nursing homes has increased since the Medical Director refuses to allow BLS transfer services to transport anything to the ED anymore.

Having fun on the Foley and G-tube runs? Now THERE'S quality use of an ALS unit.

Considering what Canadian BLSers have to go through to get that license, you'd think they'd be allowed to make those kinds of transports. :roll:

As for the signature issue, this is going to COMPLETELY dry up the billing incomes of most of the (FD) 911 services around here. I can only think of two of them that even have a form to get patient signatures on- our state EMS report doesn't.

[JakeEMTP]

CBEMT. I'm in NC as it says under my avatar. Not that that should make a difference.

It's not the dialysis runs we are transporting. Any patient that the staff at the nursing home feels is sick enough to require a evaluation at the ED, our medical director feels, and rightfully so, the BLS transport crews are not educated enough to determine whether or not the patient needs ALS . Therefore he wants ALS on every patient that is being transported to the ED.

There is one reason BLS transport is here and it is to run transport services. The only time we see them at the hospital is when a patient is being discharged. All EMS is ALS only. We don't have or want BLS EMS ( oxymoron anyone? Buelher?). Our citizens deserve and receive better than that.

[CBEMT]

I never said dialysis. I said Foley and G-tube runs- the patients that "have" to go to the ER because the nurses refuse to put them back in.

Nevermind, explaining it kills the effect.

[JakeEMTP]

Nevermind, explaining it kills the effect.

Exactly. However I will try one more time.

WE DON'T HAVE BLS EMS HERE. All our emergency ambulances have paramedics on them. I was trying to point that out. I'm sorry it sucks where you work. I don't recall ever having to take anyone to the ED for a foley replacement.

If they need it replaced and the nursing staff can't do it, which is a rare occurrence, I will.

[wrenEMT]

i'm glad to say most of the time I don't need a patient's signature unless I am getting a refusal. And all the nursing facilities I go into I normally have to get 2 signatures.. medical necessity and one on my report, but I just point and they sign.. In the hospitals it's pretty much the same.. Point and sign my report, I never ever had an issue getting a signature.. I HAVE had an issue finding the damn nurses though.. that sucks.