Re: Careplans

[Debbie Ohl]

Care Planning: What, Where , How   There are several ways to approach care planning. The basic ways to create care plans can come from both structured care plan formats and free form care plans. Structured care plans work best for frequently occurring problems that have fairly standard interventions with just a few tweaks to individualize. You could approach these from a standardized format using: RUGs categories, Quality Indicator Categories, health condition categories, or RAP areas. Personally, RAP care plans are bests done in a structured model (root RAP, reason, impact physically, mentally, psychopsocially) using a free form method due to the nature of how they come together for the individual residents, Altough you could use a standardized plan, it adds volume to the plan, and is not as individualiezed as it  could be for best results.   Functional status and daily care needs.  Compromise will result in some type of care planning dependent on where and how it impacts the person and the type of support needed. ADL�s Directives: for CNA use, describes the type of support residents need; CORE RAP Care plan: identifies root problem RAPs and the impact holistically.   Rehab: therapy writes their care plan; nursing care plan addresses their role in supporting activities from therapy (use a pre-structured plan). Usually this is a short term plan and should be kept  close to unit nurse, consider it an immediate need care plan, so the unit nurses stays aware and on top it.    Restorative Nursing: it is best if they use a free standing care plan, it is easier to audit and provides a laser like guide for the providers. These can be readily standardized for ease of use based on P3 service categories. The intervention for the program would be reflected on the core plan under the appropriate RAP as �refer to restorative nursing plan�.     Health maintenance.  Monitoring stable and unstable conditions and disease processes. For the most part if medical condition requires regular monitoring you would want to have a care plan addressing that medical problem. I would call it an immediate need or day to day care plan. These can usually be pre-structured. They need to be readily accessible and used by the unit nurses. Often the medical condition is stable and has resulted in some sort of functional deficit or compromise. In this case I would address it from the RAP perspective for care planning based on impact to functional status.     Medications. Medications can be an intervention for a problem or can be a problem in and of itself. As example the use of an antipsychotic may be an appropriate intervention to treat a schizophrenic (in this case it would be an intervention on the care plan probably related to mood or behavior RAP) or it may have been inappropriately prescribed and require reduction and elimination and/or producing troubling side effects If this is the case you could address it from the PA drug RAP or as a medical need, user choice. Personally I would could consider this an immediate plan and keep it close to the unit nurse.   Debbie Ohl RN, NHA LTC Consultant & Educator, Ohl & Associates 613 Compton Road, Cincinnati, Ohio 45231 Phone / Fax 513-522-6041 [EMAIL PROTECTED]  www.greatcareplans.com ----- Original Message ----- From: [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Wednesday, March 24, 2004 4:23 PM Subject: Re: Careplans In a message dated 3/24/04 2:56:56 PM Eastern Standard Time, [EMAIL PROTECTED] writes: Hi everyone, I was just wondering how many of you do carepan's by "problems" vs "raps".  Hi.  We have some standard care plans for our building that apply to most residents.  They include Elopement Risk, Resident is a Smoker, Resident is Long term placement, Resident is short term placement, Hot/Cold environmental, Resident has hx of substance abuse, Resident requires activities to meet specific needs, Resident has no LOA, Resident has LOA w/supervision, Resident has LOA without supervision, and that is all I can think of at the moment.  We then do the careplans that trigger per rap, and then any other issues that need to be addressed are summarized in the global summary.  All our individualized as necessary.  Does that help?   Sherri