LTC careplans

nursejanedough · Dec 28, 2000

Why bother? Most floor nurses in LTC don't have time to read those care plans. As far as I know the MDS/PPS nurses are doing the computerized care plans and filing them in a book at each nursing station. When I was a floor nurse, I never knew there were any care plans around. Then I became an MDS/PPS nurse (it became my job to do the care plan , not the actual nurses taking care of the residents, go figure) and I tried to include the floor nurses and CNA's in all the care plan meetings, they came when they could. I tried to let everyone know where the care plans were. They were in huge black books at the nursing stations. No one ever looked at them, except us MDS nurses and the state government people who came to screw us once a year.

Tim-GNP · Jan 7, 2001

Although many computer companies have claimed that they have the 'best' RAP/Care planning programs, caveat emptor! DOH does not want to see 'canned' care plans. When I worked as a consultant, I remember one facility in Kansas who was cited for 'canned' care plans just because they were computerized!!!

Also, remember on thing about those computer programs-- if you feel that something is a problem for a resident, and the RAP does not trigger for that problem, CARE PLAN IT ANYWAY! The RAPs are not fool-proof, and they cannot take the place of sound clinical nursing judgement.

As far as the nursing assistants not reading the care plans, when I was a charge nurse, I used to pick a care plan every few days, and review the content with my CNA's. This takes work! You have to follow behind them as you read---I know they don't have time to stop and listen! I used to get them to listen to what I had to say by taking the care plan into the shower room with me and giving showers with them.

You have to be committed to dissemination of the care plan information. Otherwise, you have goals and INTERVENTIONS that are care planned, but not being carried out. This is the number 1 reason for DOH deficiencies related to POC. You would be shocked if you knew how many times I read the plan of care to my CNA's and they would say: "what? are you crazy... that's not Mary or John..." and then they would tell me things that were relevant to the resident's care.

The moral of my story... write your care plans and be sure that you have the nurses aides imput. Otherwise, you are dead in the water.

Nancy1 · Jan 8, 2001

I understand where you are coming from, and I agree that not everyone reads care plans. However, residents need summaries. We made it part of our weekly summary that the nurse needs to review 2 problems on the POC when doing the summary. We also have the floor nurse update assessments and review the entire POC for the quarterly reviews. I have a form that I use to make sure all the nurses are doing this as it is on the nurse job standards.

We use the American Data Electronic Chart System and I have found it to be good. I admit that I have worked to make it more facility friendly, but they have to make them more generic. I would be happy to enter into a dialogue. E-mail me. nancy1

kewlnurse1 · Jan 18, 2001

Our facility uses a computer program called MDI. It has had it's bugs, but I like it because not only do you have diagnoses and interventions, etc., to choose from, but you have the capability of forming your own diagnoses, etc., that make the careplans much more individualized. I agree with the post where someone said "why bother" - often, caregivers really don't pay much attention, but it is worth every effort (and surveyors love it ).

freddy · Jan 30, 2001

I am Care Plan Coordinator at a 121-bed facility. We use MDI also, and I really like it for the same reasons kewlnurse1 mentioned. It really is easy to make individualized care plans using this system.

As for making care planning practical, we began using a new tool about 3 mo. ago that involves the STNA's directly. The tool is one page and includes every aspect of the resident's care. It is updated as new orders are written, either by myself or the discipline writing the orders or giving the specialized instruction (dietary may change a supplement, Speech Therapy may give specific feeding instructions). It is kept in a plastic sleeve together w/ the STNA's care flow sheet, each resident has an individual plastic sleeve where these papers are kept in binder at the nurse's station. They know they have to look at these and that they are responsible for the information on it if questioned by a surveyor, etc. This has definitely improved communication between disciplines and so far has had a positive effect on continuity of care.

nursejanedough · Jan 31, 2001

Hi, what is MDI? I would like to tell my friend (the person that took over my job - MDS (Minimum Data System) coordinator) about your careplan computer system. What company and what does MDI stand for. She needs all the help she can get. Thanks.

freddy · Feb 4, 2001

Nursejanedough: MDI stands for Management Data, Inc. It is the name of a computer software company based in St. Louis, MO. My facility sent a few of us there to be trained to use it. Your friend, the MDS coordinator, may be interested to know that MDS's are entered into the software, too. It pulls the triggers from the MDS to create a generic care plan, which we then edit to include specific resident problems, goals and interventions. We can also create our own problems using it.

freddy · Feb 4, 2001

This is another reply to nursejanedough regarding integrating care planning with the actual hands-on caregivers {nurses and aides}. Our facility makes the aides know what a resident's problems are and how their care affects it because of the working care plan that is placed with each resident's care flow sheet. When they do their paperwork, they look at it. And I know they do because they come to me if they think something is not right or if they have a question. Also, the nurses must update the care plan as orders are written. Compliance with this is not at 100%, but I'm working on it! Also, I have a care plan meeting aide who comes every week. She also helps with transport of residents to and from the meetings and is a wonderful source of information. Communication is the key!

alisonja18 · Feb 10, 2001

I was happy to read freddy's note re: integrating all carestaff in the capreplanning process. I am a very new web browser, and trying unsuccessfully to find a wab site specifically about careplanning, and more specifically about non-qualified staff involved in the process. This is because I am undertaking a project as part of a course outlining how I involve my care assistants in the capreplanning process. I am manager of an elderly care residential home in England, and there are no qualified staff on site, as we are not classified as a nursing home. This means that unqualified staff have to take responsibility for careplanning. Any comments, help suggestions? P.S. to all aides who have responded to the previous post praising their efforts, believe me, I could not manage my home without you!

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browneyez · Jul 22, 2006

I currently work at a facility where I am the MDS Coordinator the nurses there doesn't want to ever do any of the careplans and I think it is a shame. I learned that everyone has to put something on the careplan and they expect for me to do it all which I don't mind but they are nurses too and work directly with the patients and won't touch the careplan. :nurse:

Daytonite, BSN, RN · Jul 23, 2006

Hi, browneyez!

The last nursing home I worked at had some very specific one page nursing care plans that we were to pull and place in the very front of a patient's nursing notes to help us guide our charting. We had pre-printed ones that several of us had worked on for falls, skin tears, decubitus ulcers, fever (or antibiotic), flu, diarrhea and abnormal lab values. The MDS Coordinator was also the nurse in charge of the permanent care plans and she would incorporate those into the main care plan. I don't think that nursing home care plans for the everyday stuff that the charge nurses encounter is that hard. I've written plans for things like shingles and uncontrolled blood sugars. These are not like the care plans that students are required to write for school, so on them we specifically included facility policies with regard to the frequency the patient needed to be charted on and what needed to be charted. They sat right in front of the nursing notes where they could be noted so there was no excuse for them to ever be missed.

I wish I could share some of these with you, but I lost them all when a computer technician cleared my hard files. I was sick when I discovered what he had done--hours of work lost. A few interested people who are willing to spend a few extra hours developing these one-page plans can make a big difference in the quality of the care and documentation being done. They are also a learning tool for the less experienced charge nurses.

Welcome to allnurses! :welcome: