Epic care plans and goals

Pangea Reunited, ASN, RN · Jun 22, 2016

I'm confused ....are you a nurse? I've never made a care plan according to what a patient states. Do you have to actually write care plans for epic or are there existing templets? As for how much time I spend on them (care plans)- none if I can get away with it, and that's still too much. Hate those things with a passion.

SC_RNDude · Jun 22, 2016

My spidey senses tell me you are not a nurse.

From my experience, nurses (including myself) despise epic care plans. I would say most don't bother with "what the patient wants", and don't put too much thought into them as far as what they put in the computer. They click on what would make sense for the patient in order to get this senseless charting task done and to move on to more important things. The next nurse probably clicks and copies 90% of what the nurse before them entered.

Care plans are a Joint Commission (haven't been called jcaho in many years)requirement (so I've been told), and it's easier to do in Epic then in other systems I've used. But what is in the computer really has nothing to do with the real nursing care that is taking place. It's just another PIA charting task that takes time away from things that really matter.

djamies · Jun 22, 2016

Actually, I am a nurse - for 18 years. I hate care plans, too, and generally believe they are as helpful as they have ever been. However, we are being told that the "pt/family long/short term goal" is going to be automatically added on every patient, and my principal trainer told us that there is not a list of goals because TJC requires it to be the patient's/family's statement. The thing is I need to train the RN's the way we should do things, not the real world way, you know what I mean?

emtb2rn, BSN, RN, EMT-B · Jun 22, 2016

Dj, you going to be a superuser? If so, ask the epic folks for examples from other facilities. If they push back with the individualistic crap, just tell them you need a template to guide your build and don't want to reinvent the wheel. Use those words verbatim.

allnurses Guide · Jun 22, 2016

I hate those care plans so much. So, we're supposed to create a care plan on the patient's goal, and this gets to be ridiculous in Psych.

"So, Bob, what's your goal?"

"To get the hell out of here, you dumbass!"

"Mary, I'd like to ask you what your goal is."

"I know you're in cahoots with the KGB. I'm not giving anything up."

Here's a special one for Geropsych:

"Ok, Joe. What's your goal?"

"Have you seen Mother?"

"Ok then, Junior. Can you tell me what your goals are for Joe?"

"To get better."

"Yes. Of course."

"I want him back to the way he was before all this happened."

"I see he has dementia..."

"Yeah, I'd like him to get his memory back."

So, now I put these patient/family goals into the care plan and we are supposed to chart under these. Thanks to Whoever-Started-This-Mess that decided to hyper-focus on using "the patient's own words" [insert unicorns and rainbows here], we are now charting under these bizarre "goals". Yes, I'm charting about suicidal ideation on the care plan for "Risk for Suicide" under the patient's stated goal of "To get the hell out of here."

On my more ornery shifts, I almost hope for the most ludicrous response to this question. I think the best answer I ever got was "none of your business, sweetheart", which was given to me by the world's crankiest, crispiest old lady:up:

On some patients, yes, I can work with them and pull out a reasonable goal... most of them? Not really and I don't really try anymore.

The only time I look at the care plan is when I have to set it up with a new admission or when I have to chart through the care plan. No, I do not update it. I do not care. It is a sham. The only people who care are the people who are paid to make things look good on paper for Joint Commission.

This is how I really feel.

allnurses Guide · Jun 22, 2016

Actually, I am a nurse - for 18 years. I hate care plans, too, and generally believe they are as helpful as they have ever been. However, we are being told that the "pt/family long/short term goal" is going to be automatically added on every patient, and my principal trainer told us that there is not a list of goals because TJC requires it to be the patient's/family's statement. The thing is I need to train the RN's the way we should do things, not the real world way, you know what I mean?

This is the frustrating part. Everyone knows it's bogus!

Here.I.Stand, BSN, RN · Jun 22, 2016

Hmmm I haven't heard of putting a pt and family goal in there. Managers haven't mentioned it. I can see it now...we bring in a pt with nonsurvivable TBI and family is trying to decide whether they want to wait for brain death or go to OR for a DCD (donation after cardiac death.)

Clearly, pt is not going to give me a goal.

To the family, "What is your goal for your 18 yr old daughter's care?" Mother dissolves in sobs, father stares at me and asks "Are you ******* kidding??"

We typically apply a few applicable templates with admission. I was taught that opening the care plan to enter my narrative note counts as a review, so that's what I do. Once a shift, I open the care plan and enter my note under "multiple trauma, Adult/OB" if note primarily about injuries, or "mechanical vent" if they were having respiratory issues, or "significant events" if it doesn't really fit into any other area.

When they are extubated, I'll resolve the mechanical vent goal and physical restraint goal if the restraints came off.

My favorite is when the pt is still sedated and paralyzed, and it gives you that prompt: "the following goal(s) were expected to be met prior to today" 'improve physical strength.'" To which I think, "you're ******* kidding me. PT probably made that goal."

If I have spare time and feeling all correct, I might do some browsing through that behemoth list o' templates and stick one on the care plan.

But as far as looking at it to direct my care? It's redundant. My assessment tells me what I need to do, and I document what I do.

SC_RNDude · Jun 22, 2016

Actually, I am a nurse - for 18 years. I hate care plans, too, and generally believe they are as helpful as they have ever been. However, we are being told that the "pt/family long/short term goal" is going to be automatically added on every patient, and my principal trainer told us that there is not a list of goals because TJC requires it to be the patient's/family's statement. The thing is I need to train the RN's the way we should do things, not the real world way, you know what I mean?

Fair enough. I understand you have a job to do.

However, I am perplexed. You hate care plans (I agree), but you think they are as helpful as they have ever been (I disagree)?

I know you didn't get on here for a debate. So, I understand if you don't want to take time to explain. But, if you do explain (I'm interested in your perspective) I promise not to continue to sidetrack you from what you came here for.

whichone'spink, BSN, RN · Jun 22, 2016

When I worked the floor I would enter a goal, what I wanted to see. Patients don't know what the hell they want. For example, if a patient gave me a nonsense goal, I would instead type "Walk 5 times around the nurses station". It has to be something measurable. Nurses should have the ability to use discretion when completing these care plans.

mmc51264, BSN, MSN, RN · Jun 23, 2016

I am a super user and an Informatics student.

We present care plans to our CPC to approve or not. We do not have long term goals.

We have goals that need an end date (that is JCO). It can be as simple as "pt will remain free of falls" or "pain level will decrease" We also have a lot of "teach back____ by discharge" (insulin administration, dressing change, s/s of infection, etc).

Care plans are actually very difficult to write and we have a hard time getting them approved. Our Peds dept has done a fabulous job of writing theirs, we have good ortho ones and the transplant teams have them. We are lacking in many areas however. We have been live for 3 years and it is still a work in progress.

Epic should have a lot of templates that you should be able to use. It is not reinventing the wheel.

I don't know the policies at your hospital-we took many of the paper copy care plans and used them to get started.

Patients should be part of the team, but I am not so sure about a patient LED goal. For example, I am an ortho nurse. My patients are not going to be able to have enough knowledge about what a realistic goal might be. a patient that expects zero pain after a knee replacement is not realistic. It is our job to help them figure that out. Some the goal might be to use the walker to get to the bathroom, others might be to be able to stand and pivot to the BSC.

The only cases that I could see family goals might be dressing changes, administering Lovenox if pt is unable or unwilling.

It seems to me that you should be getting some help from the EPIC people.

BittyBabyGrower, MSN, RN · Jun 23, 2016

You can't add a free hand goal, most of ours we adapted from

our paper ones.

You should be working with EPIC and the builders on this. We have templates we go into and pick which care plan set we want such as Newborn/Transition to Extrauterine Life. Then there are headers such as Neonatal Abstinence/Drug withdrawl, Nutrition, Breastfeeeding and then each had a goal such as Infant will not exhibit withdrawl symptoms and then interventions like medication management, etc. The builders should be looking at your stuff with you and helping you.