Care Plans an Exercise in FUTILITY??????

[Destinystar]

:uhoh21: I would like to know how many of you out there sit down and read each and every care plan on each and everyone of your residents each and every day before you start work? I am not talking about getting report, or reading the assignment board.

Yes the RN nursing practice act mandates that we formulate one, and the state and federal regulations mandate that we develop one as well. Most of the care plans just duplicate what is already built into the standards of care, & the MD orders.

Do you think that the care plans in the residents medical records have a significant impact on the way you deliver nursing care?:uhoh21:

[Destinystar]

i could not agree with you more. when we identify a problem if we could just formulate a nursing diagnoses, write a goal, and write the interventions write there in the nurses note it would be so relevent & in a logical time frame. all this duplication of effort is a joke. the problem with fill in the blanks is you have to read the whole form including things that are irrelevant to the patient. yes this stuff is required but it does not contribute to the care we provide. now we have to assess and fill out all of those pain scales. i swear if you dont know how to look at a resident and know if they are uncomfortable or know if the pain med you gave was effective should you really be a nurse?? if you are not sure of something you need to look in a nursing manual not some handwritten care plan written off the top of someones head or copied from some book or generated by a computer. i dont think i have heard one nurse who has been out of school for more than 5 minutes state that they just couldnt function if it wasnt for those care plans and depended on them to provide care. :uhoh3:

care plans can be useful, so long as they are designed to serve a purpose (rather than just creating more paperwork). where i work however, they are the biggest waste of paper since the national enquirer went to print. we have a "checklist" system, and every shift come hell or high water we go through each patients plan and *tick* things like "frequency of obs" and so on (despite the fact the patient may just be a social admission - oh no sister smith, qid obs regardless...). the best system i have ever seen was where the care plans were incorporated into the clinical notes in much the same way the attending mo writes their notes (ie: patient history and assessment followed by plan of care). this way they are actually useful, relevant, and are a form of documentation for the care provided. i've also seen some of those kardex systems in use, but found they can be fiddly and also they do not form part of the patients record.

i think as nurses, we have a love affair with forms and paperwork with little check boxes and arrows and multiple choice questions and graphs and charts and so on... when it can all be achieved with minimal fuss by scribbling in the notes.

[missmercy]

[the problem with fill in the blanks is you have to read the whole form including things that are irrelevant to the patient.

and doesn't that just clog up the reporting system, the time management idea, the concise, usefull picture!!!?

yes this stuff is required but it does not contribute to the care we provide. now we have to assess and fill out all of those pain scales. i swear if you dont know how to look at a resident and know if they are uncomfortable or know if the pain med you gave was effective should you really be a nurse??

very, very good point!!! nursing should be based on learned skill -- not a cookbook -- however, as in cooking, it isn't bad to be able to glance at a recepie -- just to make sure you have all the necessary ingredients. care olans should be guides -- not clinical pathways that are etched in stone or useless computer print-outs with no specifics to the individuals-- unfortunately, that's how they usually end up.:uhoh21:

and in response to the comment that we nurses like check boxes and fill in the blanks -- isn't that sad? we could be so creative and such if we had not been trained to check the box and fill in the blank!! i think some physycian, in some cave -- while examining neanderthal -- decided that forms and careplans would tie nurses hands and give them less time to practice true nursing -- and "poof!" dreamed them up.

[AMICRW]

Nope, I think they were thought up by someone with entirely too much time on their hands and NO bedside experience.

The reason that the MDS and Care Plans became such a focus was because MANY facilities were not doing or documenting findings of the assessments and rounds. Residents were found to have advanced stage pressure ulcers not previously documented. There were patients who were undernourished and dehydrated with no documentation of any decline.

All the current documentation requirement may be overkill, but it wouldnt be THIS bad if it hadn't been THAT bad.

[Destinystar]

the last time i looked the mds was a tool to determine if residents qualified for snf level of care so that a facility could be reimbursed by medical and medicare (too many 0's meant they could be discharged to a lower level of care). hcfa stands for the health care fianancing act. you can write all the assessments, care plans and recommendations until christmas the only correlation there has been to a positive outcome is the nurse to patient ratio. the obra guidelines is what the federal government has established as a tool to site facilities that have residents with sentinel events, etc. the responsiblity that we have for assesssing and developing a plan of care for the residents has always been built into the rn nurse practice act. the only thing the feds did was to make the facility accountable in the form of regulations, fines, and sanctions for ltc that did not comply. i agree with the majority of the nurses that responded that the care plans have no impact on their delivery of nursing care. the fact that the facilities have started facing economic sanctions has. :)

the reason that the mds and care plans became such a focus was because many facilities were not doing or documenting findings of the assessments and rounds. residents were found to have advanced stage pressure ulcers not previously documented. there were patients who were undernourished and dehydrated with no documentation of any decline.

all the current documentation requirement may be overkill, but it wouldnt be this bad if it hadn't been that bad.

[rEAL nUT]

what I think it is that care plan is very important for the patient as well as for us. by care plan we will be able to give the right care for the patients as you know each patients need different care according to thier case, age...ect.

so, we have to write it daily.

To me it seems that care plans take more time away from pt care. I think it is a waste of my time to write down what a nurse should do if a pt has a fever or a foley catheter ect. We do write them at the hospital I work at, but noone ever reads them, we just go through the motions.

[Destinystar]

Maybe there could be a more effecient and effective way for nurses to document the nursing process:)

To me it seems that care plans take more time away from pt care. I think it is a waste of my time to write down what a nurse should do if a pt has a fever or a foley catheter ect. We do write them at the hospital I work at, but noone ever reads them, we just go through the motions.