Have You Ever Falsified An EMS Document ?

[Just Plain Ruff]

we just know what is right and what is wrong. Crotchity would be on this list if he had more of a open mind and not consider his views as gospel. But I digress.

[HellsBells]

One particular case sticks in my mind reading this forum.

I am usually quite particular about checking the equipment list before my shift. However, on one occasion the previous crew stated they didn't do any calls that day and the unit was fully stocked when they checked in the morning. They did have a transfer from the hospital to the airport to return a NICU team to their plane, but nothing else.

I thought to myself, OK ill trust these guys, no need to check the unit. We arrive at our first call, a man with chest pain. I open the rear doors, there is no stretcher in the back... oops.

Turns out the crew had left it in the hospital when they loaded the air teams equipment and forgot to pick it up. So, now I always make sure to do a full check no matter what anyone says.

[Dustdevil]

I thought to myself, OK ill trust these guys, no need to check the unit. We arrive at our first call, a man with chest pain. I open the

rear doors, there is no stretcher in the back... oops.

FAIL! :shock:

[HellsBells]

FAIL!

I know I know, It was stupid, but I learned never to do it again.

[Dustdevil]

I know I know, It was stupid, but I learned never to do it again.

I wasn't referring to you so much as I was the previous crew. Leaving a clipboard or monitor behind is one thing, but a COT???

But this example just shows to go ya how mistakes happen, even with a trustworthy and diligent crew. It's not just the lazy and sloppy slugs who get burned. Sooner or later, all of us will leave a key piece of equipment on a scene or in an ER. I've done both, and I am positively anal about my equipment.

[Arizonaffcep]

This brings a good question for rural responders. What about the 3 man crew who are the only people responding for a code? 1 medic and 2 basics (common where I used to work), respond for a code, everyone's hands are busy, defibing, IV's, baging, tubing, drugs, compressing, etc. etc. etc. Basically, when you push a drug or perform an intervention and mark the time on your glove...heaven forbid the IV gets a little bloody, or the pt pukes on you and the ink gets smudged/illegible in some fashion. I'm sure I'm not the only one who had come across this situation in the past. This being said, would it be considered a "falsification" of the PCR to have to estimate the time(s) of certain activities, even if they got smudged? Keep in mind the very negative connotation of "falsification."

[fiznat]

I have estimated times of drug administrations when documenting codes. Sometimes I remember to hit the "event" button on the LP12 to mark the time but usually I forget or am too busy. When I do this, though, I mark the times as estimated with the squiggly equals sign (donno what it's technically called).

Worse things happen in the field though, we all know about it. I can guarantee you the same thing happens in the hospital as well. Is it any surprise that with the lawyers hovering as they are that providers extend themselves in this way to make sure the paperwork is perfect? I'm not saying its right by any means, but the motivation is certainly understandable.

[crotchitymedic1986]

I dont think that is falsification if there is no intent to deceive. But lets say you get to the ER and find that you only gave 2 atropines and you should have given 3, and you document that you gave 3, then there is a problem. Also, I think if all of your cardiac arrests show that you gave the meds exactly on time, there might be a problem. There is nothing wrong with saying +/-, estimated, or using the symbol described.

[Christopher.Collins]

I have never intentionally falsified a doccument and do not plan to start.

When it comes to PCRs I have been asked by higher ups who review them to do so. For a company whos very stingy when it comes to paperwork Im surprised. For instance under medical nessescity if they felt that I did not put one they feel medicare will accept and pay for (patient had a minor 3/10 toothache for the past 10 minutes)... they will ask me to change it to something like severe toothache, possible/questionable MI? Of course I will always refuse even a supervisors request to alter the truth in my doccumentation... and if they dare take disciplinary action, well again they are telling me to falsify a legal doccument. In other instances if the patient walked to the stretcher they have asked me to change that as well because more often than not medicare will not pay for an ambulance if the patient can walk around on their own. Again I will refuse to ever alter the truth.

In terms of check sheets... all cabinets are stocked and sealed. The drugs that we can administer at the BLS level are also sealed in a container and then sealed in a cabinet. Each seal has a serial number on it with the person who sealed its initials and the soonest applicable expiration date. This information is also kept in a log book in which the supervisor must sign for each seal taken out. So, if I do a check sheet I simply have to check my O2 levels, lights, sirens and radios and make sure that all of the seals are intact. Any equipment/supplies that are found to be missing from a sealed compartment falls upon the last person who sealed it.

At the volunteer level, check sheets are usually done by an officer, engineer or paid driver on a regular or daily basis. If I come in to stay for the day, be it bad weather or an event Ill check over the rig and make sure I have enough of what I need to be on the road for at least 3 or 4 serious runs.

[akflightmedic]

In other instances if the patient walked to the stretcher they have asked me to change that as well because more often than not medicare will not pay for an ambulance if the patient can walk around on their own. Again I will refuse to ever alter the truth.

I agree with you. Many moons ago when I did interfacility, I had employers ask this of me. I refused. To appease them and appease my own standards, I did not lie but I would write this instead:

"Pt assisted to stretcher"

or

"Pt placed on stretcher"

Regardless of their ability to ambulate, I ALWAYS assisted them or placed them on a stretcher.

Let the Medicare denial of claims club interpret however they wish.