Help with Care Plans!!! What all to care plan???

crissrn27, RN · Jul 16, 2009

ooohhh, where to start, lol. First you have to careplan all the things that you said you would on the RAPs, then things like DM, anemia, etc. Any kind of behaviors, wounds, moods, medications with high risk for side effects.

The RAPs are a good tool to help do the careplan, just don't fall into thinking that the RAP issues are all you need to care plan.

Hope this helps, sorry, in a hurry!

Ruas61, BSN, RN · Jul 17, 2009

I also add in vulnerable adult status, code status, can/can't or do/don't want to self-admnister meds, allergies, health maintance status- ie eyes, teeth, etc..

edhcinc · Jul 18, 2009

Hi. Maybe I'm just not reading this right...but the question and responses seem to say that we write care plans based on what we think the state surveyors will look for, not based on actual resident problems?

Behaviors may be a STAFF, not a RESIDENT problem. A disease is not a resident problem--managing the lifestyle/physical changes may or may not be...Is a "status" a problem? Or a medication?

Am not sure we will ever truly understand, plan, or provide "resident-centered" care if we continue to write "surveyor-centered" care plans. YES--surveyors see a plan--but does the staff know, or carry out, all of the possible approaches?

All that work--but not a plan that actually works for, or helps, anyone...And there just isn't enough time or brain power left to analyze all the pieces--to fit each into a few clearly defined resident problems--actually problematic to the resident...Tis frustrating to professionals--and tis not "quality". Somehow, we need to turn it around again...

achot chavi · Jul 18, 2009

Our careplans are multidisciplinary so we include EVERYTHING done for the patient, from dietary and medicine to PT and SW and of course all the nursing stuff. EVERYONE gets a care plan on risk for falls.

Trishalishus, PhD, CNS · Jul 19, 2009

We have a template that covers everything you can think of as possible areas of relevance. First thing we do is sit down with the new resident and/or family and decide where that person sits in a category and what the implications for care are. The care plans are all 20 pages long (or so) but because they're in categories, and because in ltc you get to know your residents it's not onerous - and it's a terrific way for new staff to quickly learn about a resident. Also it's all phrased in the first person to remind us that they're important - not just objects to be navigated around all day.

So for example. Category "Mobility"

"Sally" has (L) hemiplegia.

This means I can't voluntarily move my left leg or left arm. My goal is to avoid contractures in my (L) hand and to maintain my independence as much as possible. You can help me to achieve these goals by 1) massaging my (L) hand every day and 2) helping me into and out of my wheelchair and bed and with toileting.

Category: Communication skills

Sally is aphasic - both expressively and receptively.

This means I can't speak to you in words to express my needs and sometimes I don't understand what you are saying to me. My goal is to not become socially isolated. You can help me by 1) speaking to me slowly and waiting for a response (please remember I am not an idiot and I'm not deaf); 2) asking me questions with only one option (eg "Do you want to go to bed, Sally?" Not: "When do you want to go to bed Sally?) 3) talking to me while you work with me.

The category would also include what to do if things go wrong. eg I get frustrated and yell when people don't try to listen to me. If I do yell, please slow down or start again and be patient with me. Please don't patronise me.

Other categories include Nutrition (diet, feeding mode etc) - and pretty much anything else you can think of that is regularly found in ltc - and "Other" for anything else.

I love it - it's brilliant - because it's really informative; patients are individuals; staff and patients are empowered; you can change the goals etc if the patient improves/deteriorates.

Good luck

toicole · Jul 25, 2009

Do you guys do a seperate care plan for the podiatrist or do you just add it to the ADL Care plan? Thanks.

Ruas61, BSN, RN · Jul 25, 2009

TrishJK- I heard about this kind of care plan format at a class recently. Until seeing you give an example of it, I thought it seemed a bit 'goofy', now I can see it as a workable idea./ Thanks

achot chavi · Jul 25, 2009

Do you guys do a seperate care plan for the podiatrist or do you just add it to the ADL Care plan? Thanks.

I add it to the ADL care plan

KATTB_RN · Oct 4, 2009

A careplan should be like a book of the resident. It should reflect all the care that that resident should recieve, plus there certain preferences that they request. You should be able to pick up a residents careplan and know exactly how to take care of that resident.=)

rapkeygurl · Oct 6, 2009

Wow I like this site, gals, anyways I went to a great seminar put on by the good ole state of texas about what surveyors look for the told us ok like falls for example ask yourself this question? what risks does the resident have? was physical dx, have they have previous falls? what meds might contribute, etc..

I recently have added a careplan for anyone that does NOT take a flu shot -- YEs they have the right to not have it but we are to offer the risks factors etc.. quarterly. I am careplanning DNR or FULL CODE/Advanced Directives. Wearing briefs at night if they wish. I care plans are super cool.

susanthomas1954 · Oct 10, 2009

As a former winner of the Nobel Prize for Care Plans, (ok, I made that up) I would like to say that If I write a care plan for a patient or resident, the state will not be happy. You have to care plan by the RAPS, which I think we all know insult the intelligence of any nurse. The state will cite you if you don't. AND I have to be careful not to care plan anything that the nurse's won't do, because then nursing gets cited for not following the care plan. It's crazy.