Are care plans valuable?

[Nurse Beth]

We just had a mock survey, and the surveyor pointed out our (electronic) care plans were not always pertinent to the diagnosis, had not been updated, or closed out when no longer a "problem".

But I think there's a reason that the nurses don't place a high value on care plans, and why they're seen as "busy work" Nurses sometimes feel they don't really add value to their patient care.

What do you think? Thanks!

[Oceanpacific]

Sometimes I despair about this. We have a nursing care plan that is developed upon the patient's admission. Some of our nursing home assessments (upon which care plans are based) are really helpful in describing what the patient values and enjoys. I've seen assessments that say " Mr. Smith likes to be out of bed by 5 am and he always has a shower. He enjoys having coffee with other residents before he has breakfast. After breakfast he likes to read the newspaper and then nap. He enjoys television in the evening and his favorite shows are.......He adores dogs and should be included whenever the therapy dogs are on the unit. He likes to talk with his daughter, Sally, in the afternoon. Her number is ......the patient needs someone to assist him in getting the call started."

The legal trouble begins because of the templates used for nursing notes in which it is very tempting to just check off all the boxes. If your "reposition every 2 hours" patient died at 2 am, it does not go over well if you checked off the boxes saying you turned him at 4 am and 6 am. These types of mistakes happen too often.

If the care plans are just a thoughtless exercise, no good will come from it. Get your clinical informatics person to meet with your team and develop plans you believe in and then develop charting templates which are integrated with the care plan.

[vampiregirl, BSN, RN]

In Hospice, our care plans are beneficial. If I'm seeing a patient that I'm not primary nurse for, the care plan gives me a good idea of what the patient's goals are as well as the major ongoing issues. It helps that our charting program really integrates the care plan component into the charting.

When I worked LTC, I did not find the care plans useful. Often they were not up to date and it was cumbersome to find what I was looking for.

[Aurora77]

I review medical records for legal purposes. I want to tell you that someday, someone will be reviewing the charting and the care plans you have on record. I have reviewed records for LTC, AL, OB/L&D, critical care, home health, and garden-variety med/surg. Do not ever think that your charting, including your documentation of an RN-determined plan of care to be delivered or delegated, is a waste of time. It can save your butt ... or have it in a helluva sling. Your call.

But don't just do it out of fear. Do it because it documents your worth. Yes, it does. When the atty comes a-calling on your risk manager and s/he is at ease when he does because s/he knows your care is awesome, be sure s/he can back that up with good documentation. And if your documentation sucks because the system they make you work with sucks, agitate. If you were a fine finish woodworker, you wouldn't be able to make beautiful furniture with lousy tools.

Could you give some examples? I'm curious about how this works. Like other posters, I see most care plans as busy work and double charting. For example, practically every patient is at risk for falls. My judgement plus policies dictate what I'm going to do for them. That care is not driven by the care plan in the chart. In fact, I will have charted all of those interventions and patient care before I even look at the care plan.

While I do see care plans as very useful to students learning to think through the nursing process, as a practicing nurse, I don't see their value, at least in my acute care setting. I'm sure there must be something I'm missing, can you help?

[SHGR, MSN, RN, CNS]

Care plans are fine when you're in nursing school because they help you learn how to think critically. Once you've actually been working for a while, they become busy work.

If we could ditch the frou-frou verbiage, courtesy of NANDA, and make them more concise, then maybe there could be a place for them.

This was my thought, as well.

[FloridaBeagle]

It can save your butt ... or have it in a helluva sling. Your call.

Care plans are for the lawyers, not the nurses. My last employer was getting on us for not adding new care plans when indicated, but of course did nothing to reduce our patient load or responsibilities so we can spend even MORE of our precious time charting. As it is, I have to wheel my computer into the med room to hide from my hall-roaming patients so I can get charting completed. It's time we have nurse secretaries to chart for us.

[KeepItRealRN, BSN, RN]

In their present itteration, care plans are a colossal waste of time. The main reason for their existance is because they are JAHCO requirements. I'll be the first to admit that during my work day looking at the "care plan" falls to the very bottom of my list of things to do. At my facility the "care plan" is not what we look to to drive patient care, that driver is in the "plan of care" which is the daily nurse to nurse communication area on our EMR.

Since careplans are JACHO requirements and not going away anytime soon, the desgners of EMR software and the nurses who dwell in the carpted areas of the hospital need to come up with a solution that is simple, streamlined, and relevant. Compliance

increases with decreases in the amount of hassle. It's a pretty simple formula really.

Compliance and hassle are inversly proportional. It is really as simple as that.

[TheGooch]

Absolute waste of time IMO

Until someone sues the place that you work at.

[TheGooch]

Could you give some examples? I'm curious about how this works. Like other posters, I see most care plans as busy work and double charting. For example, practically every patient is at risk for falls. My judgement plus policies dictate what I'm going to do for them. That care is not driven by the care plan in the chart. In fact, I will have charted all of those interventions and patient care before I even look at the care plan.

While I do see care plans as very useful to students learning to think through the nursing process, as a practicing nurse, I don't see their value, at least in my acute care setting. I'm sure there must be something I'm missing, can you help?

I can give you an example. They cover your butt when a place is being sued for negligence and wrongful death. If something is documented they can't say you didn't do it. I would think it would be pretty obvious as to why it's a good thing.

[TheGooch]

Care plans are for the lawyers, not the nurses.

yeah and if it's not documented in the care plan it wasn't done even if you did do it but just thought "it was a waste of time" to document it.

[KeepItRealRN, BSN, RN]

yeah and if it's not documented in the care plan it wasn't done even if you did do it but just thought "it was a waste of time" to document it.

I agree that if tasks are not documented in the patient's record are assumed not done. But I believe that most prudent nurses document what they have done throughout the day either by a flow sheet or written note.

As for the poster who said "care plans are for lawyers". No care plans are for JAHCO. Your daily documentation of for lawyers.

My experience with care plans is that they are created as an after thought, never looked at by other members of the health care team, and thus the care plan as a driver of patient care is completely worthless as it exists today.

[nurseprnRN, BSN, RN]

Example: Patient documented as fall risk (yeah, yeah, everybody's a fall risk, but this one had fallen backwards on her butt several times at home before being admitted). She was supposed to use a walker and NEVER be allowed to walk without somebody next to her with contact guard at all times, duly noted in her admitting RN's plan of care. Guess what? You bet. Somebody got floated to her floor and was walking with her, but was walking in front of her WITH HIS BACK TO HER, and she fell backwards, pulling the walker over with her. Died, too, as so many old birds do when they fall, hit their heads and break their pelves. Big settlement, not because an old lady was going to live a long time or miss a lot of work, but to send a message to the facility about following a written plan of care based on an RN assessment, per the state nurse practice act and the ANA Scope and Standards of Nursing Practice.

Her plan of care clearly indicated that someone should be next to her and keeping a hand on her because she tended to fall backwards, but hey ... care plans are a waste of time and we don't read them. Besides, we know how to walk people, we do it all the time. The walker is all she needs for support and balance, everybody knows that.

Uh, huh.

[OCNRN63, RN]

Example: Patient documented as fall risk (yeah, yeah, everybody's a fall risk, but this one had fallen backwards on her butt several times at home before being admitted). She was supposed to use a walker and NEVER be allowed to walk without somebody next to her with contact guard at all times, duly noted in her admitting RN's plan of care. Guess what? You bet. Somebody got floated to her floor and was walking with her, but was walking in front of her WITH HIS BACK TO HER, and she fell backwards, pulling the walker over with her. Died, too, as so many old birds do when they fall, hit their heads and break their pelves. Big settlement, not because an old lady was going to live a long time or miss a lot of work, but to send a message to the facility about following a written plan of care based on an RN assessment, per the state nurse practice act and the ANA Scope and Standards of Nursing Practice.

Her plan of care clearly indicated that someone should be next to her and keeping a hand on her because she tended to fall backwards, but hey ... care plans are a waste of time and we don't read them. Besides, we know how to walk people, we do it all the time. The walker is all she needs for support and balance, everybody knows that.

Uh, huh.

Precisely. It was in the plan of care, but in spite of it being there, the person ambulating her didn't pay attention to it, and the patient fell. All that time spent on that care plan was for naught.

Just because some disagree with you doesn't call for snark. You feel one way, others feel another.