I had a student at the University of Virginia School of Nursing come up to me following a presentation and confess that she found the common medical practice of “charting by exception” unduly constraining. Meant to streamline medical record keeping and make it easier to quickly review trends, charting by exception instructs personnel to document only unusual findings or exceptions to the norm. As a result, doctors and nurses are tempted to limit what they look for, especially if the chart is already filled with WDLs (“within defined limits”) from previous shift workers.
