shift is wild

What you chart every shift

Write down the drip before you touch it

Once you take report, the drip is yours. Chart what you found before you touch it, or the last shift's numbers become yours too.

7 min read built on 2 full opinions updated 2026-09-26

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

Denise reacting to this topic

It's 1900 and you've just taken report on a patient on a fentanyl drip, a hydromorphone PCA or a midazolam infusion. Until you document otherwise, everything in that line is now yours. Your first note should record what you found when you arrived (the label, the concentration, what's left, how the pump is set, and who checked it with you) before you change anything.

The short version

  • Read the bag or syringe label and chart it as written: drug, total amount, total volume, concentration and patient. Don't rely on what the pump screen says the drug is.
  • Look at the actual bag or syringe to see how much is left. Chart that number, with the time. The pump's volume counter is a second reading, not a replacement.
  • Chart every pump setting as it was running: rate or dose, VTBI, and for a PCA the demand dose, lockout, basal and the 1-hour or 4-hour limit.
  • Do the check at the bedside with a second RN. Chart their full name, their credential, the time and what the two of you actually compared.
  • Keep your first titration, bolus or bag change out of the handoff note. It gets its own timestamped entry after the handoff entry.

What goes wrong

The usual mistake is a one-liner like Fentanyl gtt infusing per order, verified with oncoming RN. It reads fine, but it leaves out every number that matters.

This is how that causes trouble. Say the count or the drawer reconciliation comes up short at 0300. Someone then tries to work backward: how much was hung, how much ran, how much was left at each handoff. If the first volume in the chart is the one you wrote at 2300 after a rate change, there's no record of what you actually received at 1900. Your shift and the one before it merge into a single stretch of time that nobody can account for, and both nurses end up explaining numbers that were never written down.

The same thing happens with concentration. Fentanyl comes in more than one standard strength, so a dose in mcg/hr only makes sense if you know how many mcg are in each mL. If the pump library was set to one concentration and the bag holds another, a note that just says per order can't show which one was running when you walked in.

A co-sign has the same weakness. Verified with RN doesn't say what was verified: the rate, the label, the volume, or only the fact that a pump was there.

It is not hypothetical

No case in our set speaks to this directly.

What to write instead

All of the examples assume a normal handoff at 1900. Check the math in your own notes: rate × concentration has to equal the dose you chart.

How it usually gets charted How it's better charted
Fentanyl gtt infusing. Pump verified.1905 Received fentanyl infusion at handoff. Bag label read at bedside: fentanyl 1,000 mcg/100 mL (10 mcg/mL), [PATIENT NAME], MRN matches ID band. Volume in bag by visual check approx. 62 mL. Pump: 5 mL/hr = 50 mcg/hr, VTBI 60 mL, library concentration 10 mcg/mL matches label. Checked together at bedside with J. Ortiz, RN. No changes made at time of check.
PCA in use, settings unchanged.1910 Hydromorphone PCA received at handoff. Syringe label: hydromorphone 6 mg/30 mL (0.2 mg/mL). Syringe volume by visual check 18 mL. Pump settings: demand 0.2 mg, lockout 10 min, basal 0, 1-hr limit 1.2 mg. Pump history since last clear: 14 attempts, 11 injections, 2.2 mg total. Checked with M. Chen, RN at bedside. Pt sedation score and RR charted in flowsheet at 1910.
Versed drip continued per MAR.1915 Midazolam infusion received at handoff. Bag label: midazolam 100 mg/100 mL (1 mg/mL). Volume remaining by visual check approx. 40 mL. Pump: 2 mL/hr = 2 mg/hr. Checked with A. Patel, RN. Label and pump concentration match. No titration at time of handoff.
Titrated fentanyl, pt comfortable. (in the same note as the handoff)Separate entry: 1945 Fentanyl increased from 50 mcg/hr (5 mL/hr) to 75 mcg/hr (7.5 mL/hr) per titration order for CPOT 5. Reassess at 2015.
Bag almost empty, new bag hung.1920 Bag at handoff contained approx. 8 mL. New bag hung 1920: fentanyl 1,000 mcg/100 mL, label checked with J. Ortiz, RN. Old bag with remaining approx. 6 mL wasted with J. Ortiz, RN per unit waste process; waste documented in [DISPENSING SYSTEM].

What the better versions have in common is that each one shows what the label said, what you saw, how the pump was set and who looked at it with you, all tied to one time and all charted before anything changed.

Words that do the damage

Word or phrase Why it hurts Replace with
infusing per orderThere's no number anyone can check laterThe rate and dose actually running, e.g. 5 mL/hr = 50 mcg/hr
verified with RNDoesn't say who, when or what was checkedChecked with [NAME], RN at bedside: label, concentration, rate, volume
settings unchangedUnchanged compared with what?List each setting
per pharmacy labelRefers to the label without saying what it readsCopy the label: drug, total amount, total volume, concentration
bag almost empty / half a bagCan't be reconciledapprox. [X] mL by visual check
gtt on its ownDoesn't name which drip, if there's more than oneName the drug every time
pt comfortable in the handoff noteMixes your assessment into the custody recordPut the assessment in its own entry or the flowsheet

What the guidance says

Your unit's policy on co-signing and PCA checks takes priority over anything here. Follow it and chart the way it asks.

Copy this

Continuous infusion received at handoff (chart entry)

`` [TIME] Received [DRUG] continuous infusion at shift handoff from [OFFGOING RN NAME], RN. Label read at bedside: [DRUG] [TOTAL AMOUNT] [UNITS] in [TOTAL VOLUME] mL ([CONCENTRATION] [UNITS]/mL), patient [PATIENT NAME], MRN matches ID band. Volume remaining in bag by visual check: approx. [X] mL. Pump settings as found: rate [X] mL/hr = [DOSE] [UNITS]/hr; VTBI [X] mL; pump library concentration [CONCENTRATION] - [MATCHES / DOES NOT MATCH] label. Line traced from bag to [SITE]; channel labeled [YES / NO]. Checked together at bedside with [SECOND RN NAME], RN at [TIME]. No changes made to infusion at time of check. ``

PCA received at handoff (chart entry)

`` [TIME] Received [DRUG] PCA at shift handoff from [OFFGOING RN NAME], RN. Syringe/bag label: [DRUG] [TOTAL AMOUNT] [UNITS] in [TOTAL VOLUME] mL ([CONCENTRATION] [UNITS]/mL), patient [PATIENT NAME], MRN matches ID band. Volume remaining by visual check of syringe/bag: [X] mL. Pump settings as found: demand dose [X] [UNITS]; lockout [X] min; basal [X] [UNITS]/hr; [1-HR / 4-HR] limit [X] [UNITS]. Pump history since [LAST CLEAR TIME]: [X] attempts, [X] injections, total delivered [X] [UNITS]. Pump key/lock secured: [YES / NO]. Checked together at bedside with [SECOND RN NAME], RN at [TIME]. No changes made to PCA at time of check. ``

When the volume doesn't match what you expected (chart entry + message)

Chart entry:

`` [TIME] At handoff check, volume remaining in [DRUG] [BAG / SYRINGE] observed as approx. [OBSERVED] mL. Based on hang time [HANG TIME], starting volume [START VOLUME] mL and documented rate history, expected volume approx. [EXPECTED] mL. Difference approx. [DIFFERENCE] mL. Label, pump settings and line checked with [SECOND RN NAME], RN; findings as documented above. Infusion [CONTINUED UNCHANGED / HELD PER ORDER]. Charge nurse [CHARGE RN NAME] notified at [TIME]. Pharmacy notified at [TIME]. Patient assessment at [TIME]: sedation score [X], RR [X], SpO2 [X]%, [OTHER FINDINGS]. ``

Message to charge nurse and pharmacy:

`` Handoff volume discrepancy - [UNIT], room [ROOM], [DATE]. Drug: [DRUG] [CONCENTRATION]. Hung [HANG TIME] with [START VOLUME] mL. Observed at [TIME] handoff check: approx. [OBSERVED] mL. Expected from documented rates: approx. [EXPECTED] mL. Checked with [SECOND RN NAME], RN. Pump settings as found: [SETTINGS]. Bag/syringe and tubing kept at bedside, not discarded. Patient currently [STABLE / SEE CHART], assessment charted at [TIME]. Requesting guidance on next steps per unit process. - [YOUR NAME], RN, ext. [EXTENSION] ``

If you remember one thing

Before you press a button on the pump, chart the label, the concentration, the volume you can see, the pump settings and the second nurse's name.

Read the decisions yourself

Every case below is a published decision on CourtListener. Open them. Nothing on this page asks you to take our word for what a court said — and where we only had the search result rather than the full opinion, it says so.

All the decisions behind this guide, in one page — searchable by court, year, or what happened.

What people say on the floor

Nurses talking to each other about this, quoted as they wrote it. This is opinion, not a source. It is here because it shows what the argument actually is — the rules above come from the decisions and the published guidance, not from these threads.

What everyone else says

Guidance from professional bodies, insurers and other people who write about this. Useful, but it is advice, not law — that part is above.

How would you chart it?

This is the part we cannot research. If you have a way of writing this that has held up — put it here. No account, no name needed. Nothing that could identify a patient: no room numbers, no dates of birth, no MRNs. Use placeholders, the example still works.

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