[Verified Answer]: Documentation Best Practices Review one…

Documentation Best Practices Review one client’s chart entries below. Which entry does not follow documentation best practices? Correct Practice Incorrect Practice 10/22/20XX 17:15 New prescription for oral pain medication received without further orders; pain medicine administered (see MAR). ———- J. Samuels, RN 10/22/20XX 17:55 In bed with upper side rails in place; assessment unchanged; rates pain 3/10 and denies any needs at this time. ———- H. Simpson, RN 10/22/20XX 18:00 At 16:50, client in chair rubbing back of left lower extremity (LLE); rates pain 8/10 and requested oral pain medication; posterior LLE cool to touch, no swelling or redness noted; when asked, client says they backed into an open drawer approximately 20 minutes ago. ———- J. Samuels, RN 10/22/20XX 18:45 Client reports pain is gone; posterior LLE assessment unchanged; client freely moves LLE at ankle and knee joints; walking in room without discomfort. ———- H. Simpson, RN