Center for Improvement in Healthcare Quality Newsletter
February 2022

CIHQ-ARS Blog

Issues with Care Plans

By: Laura Velasco
The goal of any medical professional is to heal, but it's possible to become too focused on the medicine, forgetting the individual patient's unique needs. Nursing care plans help put the focus back on the patient and on how the medical diagnosis impacts the patient. Care plans also make communication and coordination between all members of the patient’s healthcare team much easier. This article will discuss the common pitfalls that can happen when implementing and developing the care plan.
One issue arises when the nursing plan of care contains no reference or evidence as to when it was created, updated, or modified. Care plans should be implemented upon admission and adjusted as needed.
Here are some examples of issues that are commonly cited:
  • A patient is being treated for pain, yet no plan of care was initiated
  • A patient is not being treated for pain, yet the plan of care was initiated
  • A patient is being treated for anxiety, yet no plan of care was initiated
  • No nursing plan of care initiated at all
  • A patient identified as having nutritional needs requiring supplements, yet no plan of care was initiated
  • A patient identified as a high risk for fall, yet no plan of care was initiated addressing this need
Here are some other examples of how the care plan must be adjusted during care:
  • A patient has tested positive for a multidrug resistant organism and placed on contact precautions, but no plan of care addressing isolation or infection was initiated
  • A patient was identified as having nutritional needs with ongoing G-Tube feedings. During the hospitalization, the patient had a seven-pound weight loss in two weeks. No plan of care was implemented addressing the nutritional or fluid and electrolyte status
  • A patient was placed on hemodialysis during the hospitalization. No plan of care regarding fluid and electrolyte imbalance was initiated
The care plan must indicate whether every goal that was identified during hospitalization was met or not met. As such, each goal must also be addressed upon discharge.
The key to solid nursing care plans is to make sure you have all the information necessary to formulate a complete plan and then adjust throughout the course of care as appropriate.
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