Since when did anybody think falsifying hemodynamic numbers was ok

Ok so I work in Neuro ICU and yesterday we got an experienced nurse from SICU float to our unit. Her assignment was guy who came in severely hyponatremic and encephalopathic and her other patient was a walkie talkie SAH (subarachnoid hemorrhage) with an EVD (External Ventricular Drain).

For reference, EVDs are always hourly charting. You go in and check CSF output, make sure it’s leveled to the tragus so they’re not over or under draining, and you check ICP and CPP.

Also our SICU takes all the trauma patients, at least to start, so they take EVDs down there too. It’s not like they never see them.

So her walkie talkie EVD patient didn’t want to use the purewick and was getting up to the bathroom like every 1-2 hours, so a bit annoying. And her other patient got extubated but kept getting wild and agitated when he woke up too much, so she had to be in there a lot. I understand her being busy.

However, I was her neighbor and I check in with her around 1200 and 1400. I asked how are you doing and do you need help with anything. She told me she was fine and just needed to catch up in charting.

Later around 15:30 she popped her head into the hallway and asked in I could give the 1400 and 1600 meds to her walkie talkie EVD lady, I said sure.

When I walk in, the patient is also calling to go to the bathroom, and I notice the EVD already unplugged from the monitor, not transducing. Ok maybe she forgot to plug it back in after the last bathroom trip.

I get the patient to the bathroom and while she’s sitting on the toilet I open up the patients chart to scan the meds. Ok, looks like I’m not just giving 1400 and 1600 meds, I’m also giving late meds from 1200. Ok fine, she’s been busy.

I check the EVD charting, nothing chatted for 0600, charge nurse had chatted numbers for 0700, nothing for 0800, the SICU nurse chatted numbers at 0900 and then nothing.
Ok, I usually write my numbers on the window and then batch chart them. Maybe she has them written down and just hasn’t charted them yet.

But I remember the EVD wasn’t hooked up to transduce the ICP when I came it. I decided to check the monitor history, the EVD had not been hooked up to transduce since 1100 (it’s not 15:45).

So when I was done giving the patient meds, hooking her back up, and settling her in I went and let our charge know. When charge talked to the SICU nurse her response was “I was too busy, I just decided to do the EVD Q2 instead of Q1”

Before I left for the day I was curious and checked her charting. She had charted ICP and CPPs for 1200 and 1400, which she couldn’t have obtained because the EVD wasn’t hooked up to the monitor at all during that time.

I’m sure we’ve all made up a respiratory rate or two in our careers (but at least respiratory rate is something you can actually see). But to make up and falsify ICP???

Also I asked her multiple times if she needed anything and she told me no.

Do you know how many times I’ve been in an emergency with a patient and had to ask another nurse to go check my other EVD for me?! If you don’t have time to check it yourself, you ask for help! You don’t just unilaterally decide to ignore the universal standard of care for a device! Have I missed an occasional singular hour on an EVD before, yes, but to purposefully decide to give non-standard subpar care, not ask for or accept help when offered, and then to falsify hemodynamic numbers to partially cover your ass???

TLDR: SICU float nurse decided she was too busy to check EVD hourly and that she would check it Q2. But didn’t have EVD transduced on the monitor for almost 5 hours (so couldn’t possibly have obtained real ICP) and invented ICP numbers for those some of those hours.