What Do You Chart When . . .

Mr. Fizzel might actually be or have been a nice person, socialized to treat other people with respect, and understanding normal boundaries. Currently it's difficult to tell, with his dementia. He has been continually entering other residents' rooms without permission, seeking the exits in the facility, and taking what the staff considers an unreasonable amount of attention to redirect him. He is not very redirectable. He sometimes requires one-to-one monitoring, and the staff for that is not readily available.

The other night, the medication nurse approached me in a rather excitable state and described Mr. Fizzel attempting to place his hand on another resident's breast. It was clear to her that the destination of his hand was mammary gland, and only her physical intervention prevented this purported grope.

This type of situation is very difficult to deal with in a politically correct manner. The professional is wrong no matter what you do. It feels like moving through a swamp.

All staff members who witness an event where there is any question of suspected abuse or neglect are considered "mandated reporters" who are required to call "state," the 800 number provided to initiate an investigation. But we are cautioned not to call state unless we have a plan for intervention. Confusing.

Also confusing are the guidelines for charting in these situations. I charted that Mr. Fizzel's hand was outstretched, palm open and fingers extended in the direction of another resident's breast, and that contact was prevented by the nurse. The director of nursing removed that page from the chart, making it necessary to chart again according to her guidelines. The use of the word "breast" was objectionable, and the assumption of the destination of his hand was objectionable, although, from the nurse's description, any fool could see what was transpiring.

The bosses were friendly about it. I emerged from an hour-long meeting [sleep-deprived] more confused than when I went in.

The usual rules of charting are clear: be specific. I love to chart about wounds. Describe the dimensions of the wound, the color of the wound bed, describe the wound edges and surrounding tissue, the color, consistency and [sorry!] odor of the fluid emerging from the wound, and the treatment, all in full living color. Wallow in it.

Rules for charting an interaction between patients: vague. "The resident reached in the direction of the other resident's left upper trunk." Period.

Argh!