Plan of Care

[Zee_RN, BSN, RN]

My organization uses an electronic health record system with a very confusing Plan of Care option, more suited for home care than hospice.

My question is .... who updates your NURSING plan of care? I'm seeing nursing problems identified by an MSW on a few care plans and this makes me nervous. Of course the MSW/LSW can and does update the Social Work portion of the plan of care. But an MSW identifying "Need for Decubitus Wound Care" or "Altered Genintourinary" seems wrong to me.

Thoughts, please? And any links to documentation that specifies who can/can't would be appreciated! (I'm heading to the Conditions of Participation now but not sure how specific they will be in this regard.)

[toomuchbaloney]

MSW and Spiritual care should also be updating the POC as pertinent to their work, as you have indicated. They should not be "updating" the POC relative to nursing or medical duties and if this is occuring it should be addressed in a team meeting. It is not, however, problematic for them to document something that they observed, witnessed, or heard about a decubitus ulcer or similar during the course of their visit.

The MSW should NOT be creating a nursing problem for the POC, that is outside of scope. More correctly, they may identify what they believe to be a problem and call the attention of the RN or MD to that area of concern. They may develope an appropriate Social Work problem for the POC without consulting another discipline.

Many or perhaps even most hospices don't encourage narrative type documenation within the POC and prefer that the Hospice professionals confine those comments to the body of the EMR. I am not in that group. I prefer that the POC reflect the dynamic and ongoing attention to the components and goals of the care.. I prefer that the professional staff utilize the drop down boxes, check boxes, and concise features of the EMR to document the more mundane elements of their visit and utilize the POC to narrate detail within the appropriate "problem". This practice reveals to CMS or JC or CHaP or whomever is auditing that the POC is indeed relevant, ongoing, and personalized rather than cookie cutter.

[Nashvillejeanne]

You are right to be concerned from the point of view that the RN Case Manager is the one who oversees the POC. The other disciplines can add to the POC but they should show that they are discussing the issues with the "team". The COP is pretty clear on it. Look under plan of care, and duties for each discipline. It is best for the MSW to contact the RN Case Manager directly if she sees a nursing issue that needs to be addressed before team meeting.