Where do you keep your care plans?

[BEDPAN76]

Just curious..... Right now we have them in big binder type notebooks on each unit. Administrator has decided to place them in the chart in the MDS section. Any thoughts?

[pielęgniarka, RN]

I think it's better to keep them in a specific binder at the nurses desk where activity staff, CNA's, chaplin, social work, and nurses can all reference to them easily and not have to flip through a confusing chart.

[mdsdebbie]

We keep ours in the MDS section of the chart. I like it that way, to have everything all together is very convient, and everyone knows right where to look.

freezing in NY

Debbie

[gonenutz]

We keep our care plans in a binder along with the quarterly assessments and MDS. Each resident has their own binder. It works out well everything r/t the MDS is in the binder and are kept at the nurses station in a cabinet designed just for these binders. It also keeps the residents charts from being over loaded.

[PsychNurseWannaBe, BSN, RN]

We keep them in a seperate binder. I think it is easier to "work" the careplan if it is in a careplan binder. I can thumb through one binder and not have to open up 25 charts.

[KingDom]

We keep ours under a "care plan" tab in the resident's chart. Kind of a hassle when you need to update the care plan and someone else has the chart, but we've done that for 100 years and sometimes it's hard to change things! :icon_roll

[catnip3]

We keep them in 2 places. It may sound confusing, but it has worked for us. We keep "critical focus" care plans in separate binders on the unit. These care plans address current, acute, individual problems that are to be documented on more frequently. This is helpful for Medicare A residents that we document on at least daily. In the chart in the MDS section, we keep the long-term care plans- the chronic problems in which a resident doesn't show much change.

[achot chavi]

We used to keep them in a separate 3 ring binder all together and they were untouched. I insisted on putting them in the chart with the report so that when a nurse charts she can peruse the care plan as well. It works and got the nurses more involved and informed. Some nurses started to write better careplans as a result

I am constantly reiteration: NO Charting, No Money- get credit for ALL that we do by charting it!!!!!

[dmdscoor]

I have worked in a facility that kept their MDS' in binders on the unit. The beauty of this was that the Assessments tended to stay together. When in charts they sometimes got seperated. The other hidden assest we found was when the state came in they went right to the binder, when the states sifted through the charts they would inadvertantly come across something that caught their eye, this usually lead to nothing but kept us on our toes until they completed their research.

[edhcinc]

somehow, the content of parts of this thread seem inconsistent with the professional nurses' role in care planning.

the first responder stated--"i think it's better to keep them [care plans] in a specific binder at the nurses desk where activity staff, cna's, chaplin, social work, and nurses can all reference to them easily and not have to flip through a confusing chart." this seems to allow multidisciplinary access for all; actions to implement known to all.

subsequent comments also indicate value in--

• separating plans, thereby making it easier for the mds coordinator to find, "work" or update plans, or
  
• keeping all information used by mds coordinator (and unimportant to, or unused by, other staff) neatly together in a cabinet, or
  
• keeping all information neatly distant from surveyors' review; and
  
• the remote possibility that nurses (and presumably other staff) may actually peruse, read, implement, document findings related to, evaluate, or change a plan.
  

the first three bullets above don't seem to recognize value in carrying out the responsibilies of a professional nurse--to gather and analyze information; then use this analysis as the basis for a realistic plan and guide for daily resident/patient care, known and understood by any/all persons providing care.

the professional nurse just cannot neatly file away care plans which are

• separate from, and unrelated to, the primary patient/medical medical record containing all other pertinent multidisciplinary orders and notes, or
  
• only accessed/reviewed/used by specified staff, or
  
• produced by the coordinator as a specialized by-product of intensive and complicated "rap"--unsung, unread, unimportant, mostly declared stupid paperwork, and
  
• thereby considered a separate, highly protected, and totally irrelevant entity.
  

cynical? probably!!

stand-alone or separately maintained mostly declared stupid care plans will never be important to, or integrated with, actual resident issues or care.

professional nurses must demonstrate the value of nursing process in ltc--

• use mds findings and "triggers" as an integral part of available information,
  
• use other assessments as supportive or primary data,
  
• work with resident/patient and other professionals to gather and analyze available data,
  
• define issues/concerns--acute, chronic, or intermittent--from this analysis,
  
• clarify issues/concerns important/unimportant to resident/patient
  
• reach agreement and understanding of his/her goals,
  
• develop, reach agreement on, and communicate specific resident/patient and staff actions necessary to reach goal/s,
  
• develop and communicate specific staff documentation--objective and subjective--used to measure resident/patient progress,
  
• continually analyze and re-evaluate plan--is it "working" toward reaching resident/patient goals?
  
• continually modify and communicate specific agreed-upon resident/staff actions necessary to reach goal, etc, etc.
  

soapbox now kicked away...time to go to work....