Everyday charting

The bath that did not happen and the code you picked for it

Refused, not attempted, not offered: each code tells the next reader a different story. Chart the one that actually happened.

7 min read built on 0 cases updated 2026-10-29

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

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The shower was on the schedule. It didn't happen. Now the ADL flowsheet wants a code, and the drop-down gives you refused, not attempted, not offered and activity did not occur. They don't mean the same thing. Each one tells the next person who reads the chart a different story about why this patient went without care. Pick the one that matches what really happened, and back it with a short note.

Key points

  • Before you pick anything, ask who stopped it: the patient, the patient's condition, missing equipment, or your side of the shift (time, staffing, nobody offered).
  • Refused means the patient was offered the activity and said no. Nobody offered? Then nobody refused.
  • If something stopped it, like a medical or safety reason, a missing lift or a broken shower, use a not-attempted code. Name the reason in the note.
  • The shift ran out and you never offered it? Say so, plainly. Then hand it off so the next shift picks it up.
  • The note has to match the code: which activity, when you offered, what the patient said or what stopped you, what you tried, who you told.

What to write

How it often gets charted How it should be charted
Refused shower.Shower offered 0830, pt stated she was too tired and asked to try after lunch. Re-offered 1330, pt declined again, stated she prefers to shower in the evening. Bed bath offered and also declined. Pt alert, oriented x4, aware shower is on schedule. Charge RN notified. Passed to evening shift for evening shower per pt preference.
ADLs refused.Pt accepted oral care and AM hygiene at sink with setup. Declined full shower at 0900, stated he showered at home last night before admission. No skin soiling noted. Will re-offer tomorrow AM.
Bath not done.Shower not attempted. Pt SpO2 88% on 2L with exertion during AM transfer, RN assessed and held shower for safety. Partial bed bath (face, hands, peri) completed. Dr. [NAME] aware of O2 change. Shower to be re-attempted when cleared.
Refused. (shower room out of service)Shower not attempted, shower room on unit out of service since 0700 (maintenance ticket placed). Full bed bath offered and completed 1000. Shower to be rescheduled when room available.
Refused feeding.Lunch tray set up 1215, pt ate approx 25% with cues, then pushed tray away, stated not hungry. Offered alternate (soup, supplement shake), pt drank 120 mL shake. Intake recorded. Third meal this week under 50%, dietitian referral requested, RN aware.
Activity did not occur. (with no note)Shower scheduled for this shift was not offered. Unit census 32, two CNAs on floor after call-out, priority given to toileting and repositioning. Charge RN [NAME] notified 1400. Shower handed off to evening shift and placed on tomorrow AM list.
Pt refused bath. (patient asleep)Bath not offered at 0700 as pt sleeping after poor night (see night shift note). Offered 1030, pt accepted, bed bath completed with assist x1.

Look at the sleeping patient in the last row. A patient who is asleep hasn't refused anything. Someone decided to wait, and if the bath happened later, you code that.

Template

Patient declined (code: refused)

[DATE] [TIME]  [ACTIVITY, e.g. shower] offered by [NAME/ROLE].
Pt declined, stated: [PATIENT'S REASON IN THEIR WORDS, NO QUOTES].
Pt alert and oriented x[NUMBER]; able to state that [ACTIVITY] is scheduled.
Alternative offered: [e.g. bed bath / sink wash / later time] - [ACCEPTED or DECLINED].
Re-offered at [TIME] - [OUTCOME].
Skin/hygiene check: [FINDINGS, e.g. no soiling, skin intact].
[CHARGE RN / PRIMARY RN NAME] notified at [TIME].
Plan: [e.g. re-offer on evening shift per pt preference].

Held for a clinical, safety or equipment reason (code: not attempted)

[DATE] [TIME]  [ACTIVITY] not attempted.
Reason: [MEDICAL/SAFETY REASON, e.g. SpO2 88% with exertion, BP 82/50, new dizziness]
   OR [EQUIPMENT/ENVIRONMENT REASON, e.g. mechanical lift out of service, shower room closed].
Decision made by [NAME/ROLE] at [TIME].
Done instead: [e.g. partial bed bath: face, hands, peri] / [nothing substituted].
[PROVIDER / CHARGE RN / MAINTENANCE] notified at [TIME]: [WHAT WAS REPORTED].
Plan: [ACTIVITY] to be re-attempted [WHEN / WHEN CLEARED].

Never offered this shift (code: not offered / did not occur)

[DATE] [TIME]  [ACTIVITY] scheduled for this shift was not offered.
Reason: [FACTUAL REASON, e.g. 2 CNAs for 32 pts after call-out; rapid response on unit 1300-1430].
Care that was completed: [e.g. toileting q2h, repositioning, oral care, meals].
[CHARGE RN NAME] notified at [TIME].
Handed off to [ONCOMING SHIFT / NAME] at [TIME]; [ACTIVITY] placed on [NEXT SHIFT / DATE] list.

Message to the charge nurse or supervisor

[DATE] [TIME]
To: [CHARGE RN / SUPERVISOR NAME]
From: [YOUR NAME, ROLE]

Room [NUMBER]: scheduled [ACTIVITY] did not happen this shift.
Reason: [PATIENT DECLINED x[NUMBER] / HELD FOR SAFETY: [REASON] / NOT OFFERED: [REASON]].
Charted in flowsheet as [CODE YOU SELECTED] with a note at [TIME].
This is the [NUMBER] missed [ACTIVITY] for this patient since [DATE].
Requested: [e.g. move to evening shift / extra staff for showers / lift repair / care plan review].
Handed off to [NAME] at [TIME].

Words to avoid

Word or phrase Why it hurts What to use instead
refused with no detailReads as a behavior pattern, says nothing about who offered or whenThe offer and the answer: Shower offered 0830, pt declined, stated [REASON]
refused ADLsLumps together activities the patient may have acceptedName each activity: shower, oral care, dressing, meal
noncompliant, uncooperativeA label instead of an observation, and it travels into the care planWhat the patient did or said: pt pulled blanket up and said not now
bath not doneNo reason, so the reader fills in the worst oneThe reason: safety, equipment, time, patient choice
activity did not occur with no noteThe general category without its explanationThe category plus the specific reason in one line
as usual, always refusesTurns today's event into a history you didn't documentToday's facts only. If there's a pattern, count it: third declined shower this week
tolerated well on a skipped taskImplies the care happenedChart only what was actually done

Refused clicked when the real cause was staffing

The usual mistake is grabbing refused because it's first in the list, or because it's the only option that seems to close the task. The Reddit threads are full of this. Nurses say pt refused is often the only option they see, so they click it. Even when the patient asked to wait an hour and nobody came back.

Why that's a problem:

  1. The code turns into data. In long-term care, your shift-by-shift ADL entries feed the MDS. Section GG keeps a refusal (07), a medical or safety reason (88) and an environmental limitation such as no lift (10) as separate codes, because they mean different things for care planning. Ten refused entries in a row and the patient looks like someone who keeps turning down hygiene. That can set off a behavior care plan, a family meeting, a capacity question. If the real cause was that the shower room was down, none of that was needed. And the actual problem never got fixed.
  2. A code without a note can't be defended. Refused with no time, no offer and no reason looks exactly like a box someone clicked at 0645 without seeing the patient.
  3. **People avoid not offered because it feels like admitting a failure.** It's an honest reason. It also sends the problem where it belongs: staffing or workflow. The patient's behavior has nothing to do with it. Click refused to dodge it and you've documented care that didn't happen the way the chart says. Nurses in those threads call that what it is.
  4. ***Activity did not occur* is the general category. It doesn't explain anything.** In Section GG, every not-attempted code sits under activity did not occur, and each one names a reason. If your flowsheet offers a bare did not occur, the reason has to go in the note.

Bottom line

Nobody offered it? Then the patient didn't refuse it. Pick the code that names the real reason, and write one line that proves it.

Official guidance

  • Use a not-attempted code only when the activity really didn't happen: the patient didn't do it, and no staff helper did it for them. If someone helped with part of it, code the level of help. (CMS, CareerStaff)
  • Code 07 means the patient refused. That's the patient saying no. Any other reason the activity got missed needs a different code. (CMS, CareerStaff)
  • Code 88: the activity was held back because of the patient's medical condition or a safety concern. Code 10: environmental limits, such as missing equipment or weather. (CMS, CareerStaff)
  • Code 09 (not applicable) is narrow. It applies only when the activity wasn't attempted and the patient didn't do it before the current illness, injury or stay either. A busy shift doesn't count. (CMS, CareerStaff)
  • Older Section G style flowsheets use code 8 for an activity that didn't happen on your shift at all. If your facility still uses them, 8 means none of it, the whole shift. Partly doesn't qualify. (LeadingAge Oregon, Course Hero tip sheet)

Your facility's drop-down may use different labels from these codes. If you can't tell which option maps to which reason, ask your MDS coordinator or unit educator. Once. Then write it on a card. Labels like not offered vary from system to system.

What this rests on

No published decision turned up for this question. We looked, and the searches are in the record. So this article stands on published guidance and on how the question is asked on the floor, not on a court opinion. That is a weaker footing than the rest of the guide, and you should know it before you rely on it. The decisions behind the other articles are all in one place.

From nurses online

Quoted as written. Opinion, not a source.

  • I appreciate nurses who dont hunt me down to tell me to cover the ptient they were literally just in with a blanket (yes that has unfortunately happened) but I appreciate that nurses have lots of other tasks that we CNAs dont realise. And I have even said that to other CNA‘s who are complaining that

    Why do so many nurses not do ADL? : r/nursing reddit

  • Final year nursing student and nursing assistant (CNA equivalent I believe) and this conversation is really valuable for me, thank you for promoting it. ... I wasn’t allowed to let full adults refuse baths. I would get in trouble for charting refused even if I asked them a billion times so I feel yo

    r/nursing on Reddit: I did not give a bed bath and lied about it on the patient's chart. reddit

  • We just had an inpatient that I had as a resident when I was a CNA (I'm now lab). I chit chat with the med/surg nurses at night, her nurse mentioned "Well apparently we can't give her a shower bc she refuses them, I'm not sure if it's the dementia or the head trauma." (

    r/nursing on Reddit: Management has decided that patients are not allowed to refused baths reddit

  • Was a CNA working agency about 10-15 yrs ago at your standard issue shitty nursing home, evenings, ratio 15:1. Do my standard assembly line shit, fighting the numbers simply to get everyone up for dinner, fed, and back to bed and cleaned up, but I don't sign for anything I didn't actually

    r/nursing on Reddit: When you’re the only CNA on the floor reddit

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Advice, not law.