Epic care plans and goals

[djamies]

I am in the process of becoming a credentialed trainer for Epic, as our hospital is going live with Epic in a few months. I could use some guidance on patient/family long and short term goals. I realize that the goal needs to be what the patient states (per JCAHO guidelines), but I'm thinking patients and families could use some direction in setting appropriate/attainable goals. Is there anyone using Epic who can help with this? Also, in a typical shift, how much time do you spend reviewing and updating your patients' care plans?

[AceOfHearts<3]

At the end of a long shift I just LOVE having to do the dots and POCs for the careplans- I get to chart again everything I've done (said no one ever). That "select all" box and "F7" become your best friend.

Our careplans are all templates and it's kind of a crap shoot at times finding one that fits. Pain, infection, COPD, and heart failure are the biggest ones we use on my unit.

[kskarzin91]

Our epic care plan are hospital templates developed by lovely education department. So you type in COPD and a list pops up with check boxes beside it. Check the ones that apply. Bam done. After that you should chart progressing or complete daily but most nurse click reviewed and are done with it.

[lrobinson5]

I currently use EPIC but there is no such thing as a patient/family goal. We have templates with specific problems, which automatically pops up your goal and intervention. Example: Select template for GI bleeding, it assigns a goal and lists the assessments and interventions (which you can either select or leave blank depending on what you actually did for the patient).

Also, I spend as little time as possible on care plans. I treat it like flare from Office Space. "If you want me to wear 37 pieces of flair, make the minimum 37 pieces of flair."

[djamies]

Thanks - that's really helpful.

[djamies]

When I say "as helpful as they have ever been," I'm being sarcastic. What I'm saying is that they have not been helpful in the past, and I expect them to continue to exist in their state of unhelpfulness. Thanks for wanting to understand.

[adventure_rn, MSN, NP]

I use Epic and I actually like our care plans pretty well (as far as one can like something that's relatively pointless).

Our unit has an admission template that is specific to the unit. When we initially enter the care plan, we check off the boxes for topics that apply (i.e. imbalanced blood glucose, fluid imbalance, altered tissue perfusion, altered oxygenation, central line maintenance, IV therapy, isolation precautions, etc.), and uncheck the topics that don't apply. Some boxes apply to everybody (i.e. medication education, discharge preparation), and others don't. Once checked off, the goals and education points flow automatically into the Care Plan and Education tabs respectively. The patient/family has zero input in the care plan. Patients have no idea that these care plans exist, and nobody ever reads them (except during chart audits).

In my hospital, I've heard that they're actually used pretty extensively in rehab (where patients contribute more actively to their own goals), but are an arbitrary pain in acute care.

If my patient has had a major change in status and I have time to spare, I'll spend about 10-15 mins per patient charting on care plans (I have 2-3 patients per shift). If nothing has changed or I'm busy, I hit the 'Reviewed' button, which is the minimum care plan documentation that my unit requires per shift.

My pet peeve is having mandatory care plans that automatically flow over to the patient and have nothing to do with my nursing care. For instance, in NICU, every baby who is being followed by the opthomologist for Retinopathy of Prematurity has an ROP Care Plan that automatically flows over. The ophtamologist has no idea these care plans exist, and doesn't chart on them. I do not diagnose ROP, I generally don't educate extensively on ROP, and there's really not a lot I can do to prevent ROP, so having it automatically flow into the nursing care plan seems completely ridiculous. I always struggle to chart on it when I'm closing out the care plan in Epic on a baby who is being discharged.

[beckyboo1, BSN, RN]

Hmmm I haven't heard of putting a pt and family goal in there. Managers haven't mentioned it.

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.

OMG please don't tell our managers, we don't need more to put in our care plans. And I agree, I have never once said "oh what should I do next? I know! I'll look in the care plans for guidance!"

[pockunit, ADN, RN]

We are supposed to ask for the pt's shift goal (shower, take a walk, etc), but the care plan itself is still based on nursing assessments and ADPIE. Most people don't ask about the shift goal or just chose an obvious one like pain control for post-op pts.

[sammiesmom]

The place I used to work for and utilizes EPIC has an awesome care plan part. All JCHAO core goals are there premade even the education materials are all linked and I only have to click a few buttons and its done! I don't ask the patient goals. They don't know what they need only what they want! HA!

[NotYourMamasRN]

Our hospital also requires Careplans be updated every shift. I hate it because we are double charting, everything I put in the Careplan template has already been entered into the assessment. It is a waste of my time and usually takes about 5 minutes per each patient. I used Epic at other facilities but at the we use Meditech. The computer automatically populates the Problem, I picked the As Evidenced By and my favorite for this is Disease Process. Then we MUST pick the goals, timeframes, and outcomes from a prepopulated list. Then at the bottom we have to type a Note on how we are meeting each careplan during the shift. Most patients have 3-5 of these templates that must be filled out on each shift. I hate it!

[bgxyrnf, MSN, RN]

Care plans are the biggest waste of electrons that I can think of.

[brillohead, ADN, RN]

Care plans are completely separate from pt/family clinical goal for the shift.

For goals, I tend to "direct" the patient a little with my questioning... "I'm supposed to ask you what your goal for this shift is -- I'm guessing you probably want to , would that be correct, or is there something different you'd like to focus on?"

Some people just say "get better" or "go home" or "get the heck outta here" and if that's what they say, that's what I enter.

But the line to enter the goal is not even on the same screen as the area where I enter care plans (yes, we're on Epic). And I only have to enter a care plan for a new admission (or a change in situation on a current patient) -- the nurse who admits the patient sets up (from templates with adjustments as pertinent) both the care plans and the education sections. Then every nurse after that documents on the existing care plans (progressing/not progressing) and education for each shift.

I'd go bat-guano crazy if I had to create and enter care plans from scratch for every single patient on every single shift!