Dirty Detox

Patient charts are considered legal documents and altering them is a serious issue.

One nurse made an embarrassing chart entry.
  • He did something very wrong, then documented it. A few days later a supervisor said there was a different problem on the chart's page. Someone else had made a very minor mistake. We were all going to redo the whole page. It was odd the page had a tiny mistake and a huge one, and we were going to fix the tiny one.
  • Everyone was asked to copy their entries onto a new page. There were sticky notes with the order of people who needed to write. Ultimately, the chart page was completely altered to suggest that events had been different than they actually were. The negligent nurse was protected by some very elaborate deception.
There may be a bit more.
(To the best of my recollection...).
  • The first nurse had used poor judgment to deny meds to a client. That client was medicated a little differently because her liver was not healthy. The nurse's chart entry reflected his mood and his judgment. (i.e. bad mood, poor judgment).
  • The reason given for recopying the page was a minor mistake by a new nurse. The new nurse was very insecure, and very vulnerable to social pressure (i.e. manipulatable).
  • The problem is (if I recall correctly) there was no reason for anyone to have charted the client after me. The client left, the nurse made his entry, I made mine, that should have been the end.
  • Apparently the new nurse was pressured to "just write something" (intentionally wrong) on the page, so there would be an excuse to make the page over.
  • That nurse was not treated well, and she probably would have acquiesced just to please someone. She left Clitheroe under extreme pressure and stress.

  • Client charts always contain sensitive personal information.
  • In Clitheroe's Residential, charts are read like novels by some staff. Staff members would spend their free time reading charts and waiting for opportunities to share the "exciting" parts. In 6 months working Residential I never had the need to look in the chart of a residential client.
  • Reading charts is not necessary for most staff at Clitheroe, except counselors. Clients at Clitheroe are thoroughly screened. Difficult clients, and people with extreme histories are not accepted by the Salvation Army. They go to Akeela.
[Detox is very different from Residential, and it is necessary to read charts thoroughly there.]
  • A certain percentage of clients at Clitheroe are referred by law enforcement. That is fairly sensitive information, but it is sometimes noted on the daily census. Every morning copies of the daily census are passed out, put in mail boxes, put in log books, etc. One person who was an informant in a high profile criminal case was admitted as a favor to a law enforcement agency. Next to that person's name, on every census for 60 days or so, were the initials of the referring agency.
  • Many clients from that time period discovered that one of their peers was an informant, information that common sense says should be treated delicately. Compare the careless attitude of senior staff regarding confidential information to the manipulative use of confidentiality laws by the residential director here.