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.

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.

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? ------------------

I would have done what you did. Since you had previously discussed advanced directives w/ this patient before, I also would have thought the patient's wishes would be the same. This is the first I've heard of advanced directives on a "by diagnosis" basis. Not sure about the legalities of that, I'm sure it varies by state. ------------------

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!

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.

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.