I am questioning what needs to be documented when nurses perform in house POC testing, such as a venipuncture or fingerstick for a PT/INR, hg A1c, etc. We use a system where the test is ordered and marked acquired once completed, the nurses are questioning our process of requiring them to document "venipuncture was performed" or fingerstick was performed and pt tolerated well. They feel they are documenting twice, since the system marks the tests acquired when they perform them and it's a given that they have to do a venipuncture for a blood draw, so why do they need to document that they are doing a venipuncture. Any ideas where I can find something in writing that states they must do this documentation? Thanks!