care plans: time management

[freddy]

I write care plans and would like to ask all you other care planners out there: How long does it usually take you to write one, start to finish? How long to update a quarterly? Do you just care plan the triggered RAPs, or do you add problems, goals and approaches to include problems like respiratory, cardiac, etc.? If you don't add these other problems, how have your surveys been in the past?

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[mondk]

Freddy: I used to be an MDS/CPC in a 60 bed facility with 12 Medicare beds as well. Our computer was ancient (Windows 3.1) so I handwrote all of our CP's. I only had 3 days to do all this plus have the meetings with the families etc. Needless to say, I worked like a dog!!! I not only careplanned RAPS but also addressed any other problems they might have exhibited, like threatening to hit wandering res. that came into their room, any unusual behaviors or habits they exhibited stuff like that. We even cp'ed one guy who only wanted coffee and toast for brkfst. I didn't get any deficiencies during that time but I was really overworked and overwhelmed sometimes. I had the complete cp on their charts within 14 days of admission for the non-Medicare residents and the 5 day MDS on the chart for the Medicare residents like on day 6 after collecting team signatures. I also had the complete cp by day 14 on the Medicare residents too. Hope this helps...mondk

[LeslieJBRN]

Hi Freddy, I am a manager in a LTC facility

& in answer to your question, for a brand new

care plan it only takes me an hour or 2 (uninterupted!)& that is including all the

triggered problems plus I care plan for all their currant diagnosis. Right now I am in

charge of setting up our Master Library for

our computer systems care plans (copies of which will be on all the units) so that for a new admit or a new problem, all we will have to do is pull & personalize which will cut the time significantly down. As for my quarterly updates, I don't spend that much time (for example the other day I did 5 quarterlies in between doing other stuff that came up). Hope this helps......Leslie

[freddy]

I think part of our problem is that we're being too thorough. Our interventions may be too specific, causing us to have to go back in and make too many changes. We use the facility's software to write them; each discipline care plans their RAPs. The floor nurses fill out the admission care plan form, then the coordinators write and update the comprehensive CPs.

[nursejanedough]

Hi, freddy. Just read your question. I assume you are computerized on your care plans. Our computer system had standardized care plans and then I would go in and individualize each problem. At least, I tried to. I really did. After I quit the MDS/PPS job, I found out that state came in and thought the care plans were not specific enough. But some problems are just basic, e.g. Incontinence - assist to toilet/check and change their dadgum diapers every two hours, etc. Good luck with all your paperwork/computer work. I hope the residents in your facility are not getting neglected with all the new government regulations.

[freddy]

Thanks for your reply, NJD. Yes, our CPs are on computer. Our system is as you describe, it creates generic problem, goals, approaches from the triggered RAPs that you have to edit. I wonder if it isn't faster to hand-write them sometimes. But I think that once we get caught up w/ updates, it will be easier to edit the CPs as needed. We print each problem on a seperate pg., so if there is a change, we edit in computer, print the edited problem & replace that page in the CP.

I really don't feel our residents are being neglected d/t new regs. I guess I'm not real sure what you meant by that. If you're referring to the shortage of nurses & aides, we've had our share of problems but we always get thru the crunches. The CP/MDS/QI/Restorative, etc. nurses & aides help out when needed. Overall I'd say the quality of care we provide is pretty good.