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Punch clocks keep physician orders on target, raise  hospital’s compliance to 100% 

The Joint Commission

Punch clocks keep physician orders on target, raise hospital’s compliance to 100%

After reading this article, you will be able to:

  • Identify which department became 100% compliant after the use of punch clocks was instituted
  • Identify areas in the hospital where the use of a punch clock can improve the dating and timing of orders
  • Discuss possible issues surveyors might raise regarding the use of punch clocks for dating and timing orders

Being open to change is a must at a hospital. Cecile Broussard, RN, MS, quality manager at Our Lady of Lourdes Regional Medical Center in Lafayette, LA, knows this firsthand: When she implemented the use of a punch clock for dating and timing physician orders at Our Lady of Lourdes, some departments responded well, but others did not.

Facilities struggle to stay in compliance with dating and timing physician orders for several reasons, and it can be easy for busy physicians to overlook. Regardless, The Joint Commission (formerly JCAHO) wants it done consistently, clearly, and accurately.

“We decided we needed to find a place to date and time orders” after the facility had identified a consistent problem with compliance, says Broussard, adding that the hospital adopted a “let’s try it” attitude when installing a punch clock, which returned great results.

“We weren’t compliant before at all, and now we’re 100% compliant in the gastroenterology lab,” she says.

How it works

Our Lady of Lourdes started small and piloted the punch clocks on a 37-bed medical unit.

The punch clocks are located in each department (typically by the nurses’ station) where a physician is able to easily access them before filling the documentation or orders. After the physician writes an order, checks a chart, or signs off, he or she slips the paper in the punch clock, which dates and times the sheet before it’s placed in the chart.

Struggles and successes

Broussard notes that physicians are the most challenging group of caregivers to get to date and time orders.

“They are busy doing other things and often feel there are more important things to focus on,” she says. “We just need to keep educating.”

Now that they are 100% compliant, staff members in the gastroenterology department love that punch clocks have been implemented, she says.

“Everything works well. I was really surprised how easy it was to implement into our process,” says Sonia Venable, BSN, RN, clinical manager of gastroenterology at Our Lady of Lourdes.

The department has punch clocks in various areas, such as the recovery room, because physicians use printed postoperative orders. Venable says the clocks helped physicians and staff members work together to improve departments’ compliance rates.

During The Joint Commission review, surveyors raised some concerns about the use of punch clocks. They said there was a chance the papers could be filed before they’re punched.

Broussard says they’re still working with staff members to get them to remember to use the punch clocks since the process is new.

“We realize we have a ways to go, and there will always be some form of handwritten orders and notes, so we have to see how we can make this more effective and not so much a nursing function, but a physician and hospitalwide campaign,” Broussard says.


Briefings on The Joint Commission, August 2008, HCPro, Inc.