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Topic starter
We have nurse that has discarded some phone notes that should have remained in the patients chart. This nurse is claiming that she has done it accidentally and that it is a system flaw. The way the nurse showed me it is happening will only remove the document from her desktop and not the chart. We have suspicions she is trying to cover her butt by blaming the system. The only way I know of to discard a document is to physically click the discard button. Just wanted to check here to see if anyone else has had any problems with documents being discarded in a way other than clicking the discard button?
Thanks!
Posted : October 28, 2015 3:20 am
Audit logs should show the actions the nurse took. Unfortunately the CPS stock implementation is very cumbersome to review, but it will be there.
We allow only a few select individuals powerful privileges such as removing unsigned documents. Filing in error is limited to certain clinical staff and administrators. I'd suggest it's time to review privileges.
It is very easy to be too permissive in CPS and it takes a good amount of time to compartmentalize groups and effectively align security within an organizational structure.
Posted : October 28, 2015 3:36 am
I agree with the above - look at your audit logs and it clearly states that a document was either discarded or filed in error. There are many times I have to look at this log becuase staff will say they did not discard.
Posted : October 28, 2015 3:37 am
Topic starter
I have ran the audit and have been able to come up with a report to show what she has discarded and then ran another report to show who contributed to those documents before it was discarded to rule out the possibility that it was started in error and then discarded. I have ran the same report on all other nurses and have not found that they are discarding documents inappropriately. I just want to be sure there is no possibility that it could be a system flaw as we will be documenting this and taking further action.
Posted : October 28, 2015 4:01 am
You have a major problem. Agree with the last comment, you need to dramatically tighten up you security. As you might imagine, there are very unfortunate implications of "deleting" documents.
Centricity is very careful about auditing activity in documents. The audit logs can be examined in detail. The document data should be recoverable short of an individual making changes directly to the data base which would require administrative privileges to the SQL server. If you would like some help feel free to contact me directly. There are lots of questions to be addressed. (I will not ask you how current your backups are ?????). [email protected].
Posted : October 28, 2015 5:23 am
If you have a "test patient" for testing purposes, is it ok to discard or file in error documents created for the test patient ? Are activities done to test patients ignored during an audit ?
Posted : October 28, 2015 7:51 am
Activities done on test patients are included in the logs. We are OK with allowing this (as a central support staff) but we have strict rules on test patients for practices/users. We run a weekly audit by patient names (created) to try to find practices that are creating test patients (or doing activity on test patients) and address/escalate as needed.
For example if a provider wants to take a crack at something on a test patient it will impact their MU numbers. The above attempts to prevent (or catch) this type of activity.
Thanks
Mike
Posted : October 29, 2015 3:52 am
Topic starter
Where can I change these settings? I looked under Security by Group permissions but do not find a permission specifically controlling discarding unsigned documents. Maybe I am not looking in the right place??
Posted : October 29, 2015 7:01 am
This issue has always caused me to become a little angry since as far as I know there is really no way to accidentally discard one. You click discard and the click ok to confirm the discard. So as far as I'm concerned its negligence due to the failure to take proper care in doing their work.
Posted : November 1, 2015 10:53 am
I know the setting for restricting filling in error but didn't know there was one for simply discarding documents. Where is it?
Posted : November 1, 2015 10:55 am
We have had similar problems. Since you can't do incremental saves on a phone note, our solution is that the person who starts the phone note signs it (so it can't be discarded) and the subsequent users then document in an append on the original document. Of course, by doing it this way you are not using the phone note the way it is intended to be used, but each users contribution to the document is protected.
Posted : November 2, 2015 6:52 am
There might be a small danger with doing it that way. Once a document is signed the route can be removed so you will never loose the document but it can easily be removed from a desktop and never be dealt with.
Posted : November 2, 2015 7:11 pm
One other idea. You could put a trigger on the document table that sent any dropped rows to a temporary table and then clear anything out of the temp table over say 30 days old. Then you could easily recover the document TEXT only from that table. It would require someone with SQL experience to setup and recover from though.
Posted : November 2, 2015 7:14 pm
Can you go to the Admin section and remove her rights on the user security level (individual) of being able to discard and or move documents? Chart Section
Posted : November 6, 2015 7:17 am
I don't think that stops you from discarding but I'll have to give it a shot.
Posted : November 7, 2015 5:29 am
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