How Long are Your Care Plans?

Nascar nurse, ASN, RN · Jan 15, 2008

I believe in the philosophy that "less is more" and too detailed will get you killed.... but apparently my local state surveyors are of a different mind set this year.

Typically my careplans would average 8-12 problems long. I work on a medicare unit, w/ lots of post ortho surgeries, so I end up w/ the RAPS that need careplanned, plus usually also have one for pain, anticoagulant medication, surgical wound/risk for infection, oxygen use.

This past survey tho, now has me careplanning every single resident with a B/P med. Which I think is absolutely stupid.. some of these folks have been on medication for years and stable for years. BUT, state picked up on the one person w/ 3 different drugs and even tho they are stable, they felt this presented big risk factors and therefore should be careplanned. Well then came in coorporate consultants and has now turned into careplanning every resident! Jeez, it's the overkill in this business that wears me out!:barf01: We get so much CRAP in these C.P. that no one is ever gonna take the time to read it (except for surveyors of course)

cadburypam · Jan 16, 2008

Depends on the problem. It also depends on the resident. If they have specific approaches I need to add then it can get a little long. You have to be careful though, you can paint yourself into a corner with the state survey team with care plans because they are going to look at all of the approaches to see if the staff are following each and everyone of them, so make sure they are!

Rexie68 · Jan 17, 2008

I'd say for a new resident, I average about 8 care plans for nursing, 2-3 for social services, 1 for activities and 1-2 for dietary. Each discipline does their own (though I sometimes have to remind them.) I CP the RAPS and pain (can't believe that's not a RAP!) I don't CP every med....just antipsychotic/antidepressant/antianxiety meds and coumadin. I don't CP every BP med....only a resident with unstable hypertension....so far no problems with the state, but they change their mind as often as I change my.....socks. If someone is on insulin, I don't write a specific CP for the insulin, but a general "potential for hypo/hyper-glycemia CP that includes meds, CS, etc. Hope this helps...good luck!!

KristenLPN · Dec 18, 2008

To start off with you have 6-8 problems: Cognition, ADL functions, Risk for Dehydration (if recent IV therapy, use of diuretics, recent infections particularly UTI, and/or staff assistance for adequate fluid consumption), Risk for constipation (which is nearly a given risk in all LTC facilities), Activities, Nutrition, Pain risk, and Risk for impaired skin integrity, and Fall risks. Then of course, if they are on anticoagulants, antihypertensives, psychotropics, etc. I also, do not care plan all medications, but I will add the meds under perspective care plans. For example: Diabetes can be under the nutrition care plan, just have multiple goals. Unless the resident has multiple complications with blood sugars, then I will make a separate care plan. Will also place most vitamin deficiencies under nutrition. If someone is stable with their Coumadin dose, with no abnormal labs, then I may add that under the skin integrity care plan r/t bruising possibilities. Psychotropics I will usually add under any mood/behavior care plan with a goal such as: Will have psychotropic meds at lowest therapeutic range and be free from adverse side effects thru next review. I live in Southern Illinois and work for a company that has 6 homes from one state line to another. We all pretty much have the same State surveyors who all seem to like my plans and I have never (knock on wood) received a care plan tag. As a result, I am the lucky one that gets to travel to all homes to train new hires doing my job. A little late on the punch, but hope this helps someone. :up:

mlolsonny · Feb 7, 2009

At our SNF, our care plans are in the same order:

Hospice (if applicable):

Dressing/ Grooming/ Bathing:

Nutrition/ Hydration:

Mobility:

Toileting:

Skin:

Oral/ Dental:

Activities:

Social Services:

Sensory/ Cognition/ Communication:

Mood/ Behavior: (if needed)

Diagnoses:

Vulnerability:

Discharge Plan:

This certainly makes our care plans easy to navigate. Certainly Sensory/ Cognition/ Communication can be split into more than one section PRN. We keep a paper copy in the patient chart and it's also available in our EMR. Changes to the paper copy are made, and a new copy printed with each MDS. Care plan in the EMR is updated with any changes as well.

Our medical records consultant recommends using either med name or classification, but not current dosages d/t possibility of being missed with changes.

For med or condition changes, we use short-term care plans with a goal date for evaluation.

achot chavi · Feb 8, 2009

I have to care plan every problem but I keep the goals within reason- I don't write goals that are unattainable. I keep interventions to within the reasonable world as well- you can get credit for things you do automatically.

Every Patient gets a diagnosis of Potential For Falls.

Goal for Chronic Dementia?: Maintain highest level of orientation possible.

Interventions for Chronic Dementia?: consistent day schedule, consistent staff/caregivers, and consistent seating and room, Calender and wall clock or watch, participation in recreational activities dealing with orientation. Give explanations, Answer questions, Minimental assessment. Follow up in 3 months

DON'T write things in the careplan that you lack sufficient staffing or equipment for,

keep things simple.

There is no limit to the number of diagnoses.Better to write it and get credit.

You can Google NANDA (North America Nursing Diagnosis Association) for recommended diagnoses and interventions.

I know this is a lot of work, it gets easier. Good Luck!

freddiebear · Feb 16, 2009

First you need to check with the nurse practice act in your state to see what it says about your scope of practice and responsibility towards care planning is. Then, you need to review the Federal guidelines F279-F282 to find out what these guidelines mandate.

Basically RN's are responsible for formulating a nursing diagnoes for any resident problem that is actual, risk, possible, syndrome or wellness. This is the NANDA structure.

F281 states "Services must meet professional standards of quality."

First you assess the resident then based on your assessment you identify the residents actual, risk, etc. problems. Then you prioritize them. Meaning even though the federal guidelines give you 7 days after the completion of the comprehensive assessment the federal guidelines also state that the facility must identify priority problems these can occur the day the resident gets admitted. For example if a resident gets admitted with decubitus ulcers, malnutrition, on O2 for SOB you must provide a care plan to take care of these problems during the first 24 hours of admission you cant wait for 7 days after the completion of a comprensive assessment.

Care plans are individualized so you make as many or as little as each resident requires. Coming up with a certain number is not something that meets professional standards.

Remember the Federal guidelines state that the faciliity is responsible for the care planning process not just the MDS coordinator.

Residents aquire problems around the clock and legally it is the responsibility of the RN who is assigned to take care of the resident to document the problems and care plan them as they arise.

Ruas61, BSN, RN · Feb 17, 2009

Oh, that is a great tickler. Making note of it now.