The flowsheet must be consistent with hospital policies, avoid making the nurses record duplicate data, provide a clear record of patient information, and be easy to fill out. Please consider the following examples:

1) Content of the flowsheet will be based on hospital policy and procedures.

Example: In the policy on IV Therapy, Initiation and Maintenance, it states that the redness, swelling and signs of localized infection will be documented. Therefore the flowsheet needs to contain a place for these to be documented.

2) Hospital policy and procedures will dictate frequency of charting.

Example: In the policy on IV Therapy, Initiation and Maintenance it states that the IV site will be assessed every 4 hours. Therefore the flowchart should have a place for this assessment in a Q4hr. time slot.

3) The order in which items are charted will be dictated by hospital policy and procedure.

Example: In the policy on Guidelines for Neurological Exam by Nursing Personnel it lists the Glasgow Coma Scale assessment in the following order: eye opening, best verbal response, and best motor response. Therefore the Glasgow Coma Scale assessment will also be charted in this order.

4) Nurses will not be expected to have policy and procedure documentation

Example: Diprivan or propofol an infrequently used medication drip must be titrated based on the Ramsey Assessment Scale.

Therefore the flowsheet will contain the Ramsey Assessment Scale.

Example: Intracranial pressure monitoring is an infrequently used type of equipment. Documentation requirements for it will be included in the flowsheets.

5) Charting will be kept consistent from one document to another.

Example: The placement of the right and left pedal pulse checks on the flowsheet will be found in the same order as on the frequent assessment sheet.

6) Medical diagnosis of a patient is the responsibility of a doctor, not a nurse. Check boxes which call for a medical diagnosis should be removed.

Example: In the abdominal assessment box obese is one possible diagnosis for a distended abdomen. Since this is not a nursing responsibility, such check boxes should not be on the flowsheet.

7) Redundant check box assessment adjectives will be removed.

Example: In the renal assessment box pale, straw, and amber are all descriptions of yellow urine. Therefore they will be removed and only one color for yellow will remain.

8) To promote consistency throughout the hospital system the assessment charting will be based on charting by exception.

The computer charting is based on this documentation system.

9) The flowsheet will not contain any blank pages.

The book-like format dictates that the flowsheet will consist of a multiple of 4 pages. Therefore the new flowsheet will have 12 pages.

I have changed the flowsheet based on the above guidelines and the policy and procedures.

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