In an effort to establish controls, a new manager decides to spend one afternoon each week double-checking every chart his nursing care staff has completed for the previous week.  (a) In what ways is this attempt at control ineffective? (b) What would be examples of an internal and an external control the manager could set up to improve any problems with charting?

This approach to control could be unsuccessful for several different reasons. First, checking the charts of previous weeks only one afternoon per week might not be enough for you to find and correct mistakes in time. This approach, which only corrects errors that have already occurred, is more reactive than proactive. The third problem is that this type of approach could create mistrust among employees and a feeling of micromanagement.

(b) An internal control that the manager could set up to improve problems with charting is to implement a peer review process, where nursing staff review each other’s charts on a regular basis to catch and correct errors. It is a proactive approach that can prevent mistakes from happening in the first instance. Implementing a chart audit, like a check list or flowchart can standardize and streamline the charting process.

An external control that the manager could set up is to work with the organization’s quality improvement department to develop and implement evidence-based charting guidelines and protocols. The manager can use external expertise to ensure the charting is in line with industry best practices. The manager may also want to consider using a charting software that has built-in alerts and error checking. This will reduce the amount of manual review, and improve the timeliness and accuracy of the documentation.