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Care planning: the neglected key to excellent patient care

Care planning is central to good clinical care and is as essential to mental health professionals as sheet music is to the symphony conductor or architectural drawings to the home builder. Excellent patient care is about identifying and managing problems effectively and efficiently. Health professionals cannot consistently achieve this without a well thought out care plan that provides a "road map" to guide all those involved with a patient's care. The care plan must be thorough, yet brief enough to be useful. It must be comprehensive and individualized for each patient. It must be dynamic, constantly updated as circumstances change and must also comply with current standards of practice, state and federal regulations. Patient care plans must always be customized for each patient. In a perfect world, staffing ratios would allow health professionals unlimited time to sit at a desk and utilize their expertise. In this perfect world, there would be plenty of time to construct a complete and comprehensive plan from admission through to discharge. This would include a detailed, postdischarge home care plan based on patient history, medical records, physical assessment, and applicable diagnosis.

However, in a complex, imperfect system, there is constant pressure to achieve greater patient outcomes with ever-shrinking resources. The system forces health professionals to do more with less. Hectic nursing shifts do not allow adequate time to research each patient's history and write a comprehensive care plan from scratch. Trying to do it using a paper-based system makes it almost impossible. It’s no wonder that the care planning process is often frustrating and time consuming.

Worst of all, it is often neglected, done as an afterthought, or in a careless manner just to fulfill requirements. Most of the time understaffed professionals are under time constraint, which can lead to mistakes with potentially devastating human and financial costs. The pressure of keeping up with multiple daily admissions and federally mandated deadlines can lead to care plans that fall short from the ideal. The importance of the care plan is often underestimated. There is no doubt that it needs to be given higher priority if organisations are to achieve the greatest outcomes with the most efficient use of resources.

Using the home building analogy, the extra time invested in making architectural drawing with specific measurements of where the walls should go and details for plumbing, electricity, air-conditioning etc. will make the process of building a home efficient, cheaper and better. Anyone who has ever built or refurbished a home knows how expensive mistakes can be. The same is true for the patient care plan. Similarly, one can imagine the chaos if the various professionals building the home --construction workers, electricians, plumbers, welders, etc.did not have one common plan to guide them. The same is true for professionals taking care of patients. Keep in mind that patients are often treated by an interdisciplinary team of nurses, doctors and other allied health professionals. When so many different professionals have access to a patient, it makes one, coordinated patient care plan crucial. Any good, worthwhile goal will be achieved more easily if a clear plan is followed. The care plan has long been associated with nursing, and many people believe that it is the sole domain of nurses. This view shortchanges the non-nursing contributors while overloading the nursing staff. To be effective and comprehensive, the care planning process must involve all disciplines involved in the care of the patient.

A well thought out care plan provides a win-win solution in a health care system burdened by lack of resources. Patients certainly want and need this. They enter the system with a problem and want a quick and effective resolution. Health professionals need it--in the long run it makes their job easier and they get better results. Administration desires it. A more efficient use of staff time and fewer mistakes make for smoother processes and a better bottom line. And finally, health funding sources who pay the bills certainly want this. They prefer working with providers who get good results and do so efficiently. Health professionals have gotten used to working with substandard care plans. This is not to say that health care providers do not do good assessments, or do not know how to provide good care. They do, but that can vary from one day to the next and from one nurse to the next, depending on abilities, experience and circumstances. The care plan can vastly improve both the consistency and quality of care. Care planning is not only underutilized, it's also misunderstood. A good care plan should be dynamic, constantly updated whenever circumstances change. It might need updating due to the problem’s resolution, or perhaps changed as interventions are implemented, or new assessment data is obtained. The plan should be comprehensive enough to cover all aspects of care and also when, and under what circumstances, the care plan should be reviewed. The care plan needs to be goal-oriented and aligned with the actual patient problems. It also needs to be action oriented clearly stating WHO, needs to do WHAT and WHEN. The first step is a good assessment. Once that is done, there is no need to reinvent the wheel. Those working in this field have the benefit of following in the footsteps of health care professionals who have shown the way. Most heath problems have already been treated and solved in the past. As long as the patient’s problem is identified correctly, clinicians should be able to retrieve interventions that have worked well in the past and apply them to the current situation.

With a good and thorough assessment, the next step is to create a quality, evidence-based best practice plan of care that has been proven to work in the past. In order to be useful, the care plan needs to be action oriented and written in practical terms. It must be set in an appropriate context and be genuinely appropriate not only to the problem but also to the situation and the individual. This is another point that most care plans don’t take into account. Not everything that clinicians judge to be problem will be seen as such by the patient. In the same way, not all goals that clinicians set will be congruent with the patient’s wishes. This is why it is essential to have the patient’s input. The care plan should be so clear that any clinician picking it up on any given day without prior experience with the particular patient should know exactly what care is needed and how it should be provided. Another thing that should be clear to any health care professional reading the care plan is the reasoning behind the treatment plan. This is an important point. If clinicians understand the reasoning they will not end up secondguessing or repeat unnecessary assessments. The “why” part of the care plan should be in the form of stating the problem with a brief patient history and providing relevant information on why these particular interventions have been selected. The final part of the care planning process should be action. It should be comprehensive enough to cover all aspects of care, including action items that cover the fine details of day-to-day care. There may be action items which apply to just to one day but not the next. An example might be an appointment the patient needs to get to, or an assessment that needs to be repeated. To sum up, there will be broad level components, daily repeating components and once only action items. The good mental health care plan should also cover risk management components. Finally, there needs to be a review process. As stated earlier, the care plan should be modified as needed. If the goal has been achieved it should be marked off as “completed” and any interventions related to that goal will no longer apply. In the acute setting, the review period may be as short as

next shift, next day or next week. In the long-term or home health setting, the review period will likely be longer. In any case, the goal for treatment should always be specific, measurable and attainable Everything mentioned above might seem daunting at first to busy, overburdened health care professionals. How can so much be accomplished when there is so little time? The answer is a care plan software tool created by Australia’s Clinical Excellence Technology. PsychPlan is a clinician-friendly web based tool that empowers mental health professionals to generate comprehensive care plans and assessments with just a few clicks of the mouse. PsychPlan can cut down the time it takes to create a care plan consistent with clinical best practice by as much as 97%. But PsychPlan is not just about making the process easy and quick; it’s about making a superior care plan that can actually improve the quality of care.

Some software solves many of the problems inherent in paper-based care management, but can generate new ones. For example, software is often designed for sophisticated computer users and can come with a steep learning curve. This can burden organisations with expensive training. Also, clinical software created for hospitals is often designed solely to meet compliance, accreditation or administrative needs with little understanding of the real clinical needs.

Because our team consists of clinical practitioners with hands on experience we understand how a valuable care plan should be constructed. We believe technology should facilitate work processes – not get in the way.

PsychPlan allows mental health professionals to generate comprehensive patient

care plans and assessments consistent with clinical best practice within minutes. Field testing shows that care plans that normally take up to 60 minutes to create, can be generated with our software in as little as two minutes, savings dozens of hours in unnecessary labor costs. By using this tool, all care providers with the proper authorization now share the same set of patient information. In addition, our software is designed to involve and empower patients, an aspect receiving greater emphasis in guidelines and standards.

Since mental healthcare is by nature a human capital intensive industry with chronic labor shortages, efficiency translates to superior clinical outcomes and a better bottom line.

Once the care plan is saved on a computer where it is accessible to authorized personnel, anyone treating the patient can be sure that he or she is looking at the most up-to date version. The care plans can be saved to a patient profile and exported to Word, Excel or Adobe formats for printing, faxing or e mailing. This is difficult almost impossible when using paper versions. Care plan should be reviewed and edited according to a schedule, deleting anything that no longer applies or adding new interventions as needed. All this can be easily done on computer. Unlike the traditional method of soft ware programming where new versions are released every one to two years, Clinical Excellence Technologies’ web-based applications enable the company to release fixes, improvements, and new features within weeks. The care plan process can be customized to fit your organisation’s needs.

All Clinical Health Technologies applications have built-in capabilities for importing and exporting data. In addition, they can communicate with other patient care applications, such as patient administration systems, using industry standards protocols. There is no need to replace existing system since our applications will integrate seamlessly with yours.

All Clinical Excellence Technologies products are geared for the Australian mental health care industry.

Care planning: the neglected key to excellent patient care  

Care planning is central to good clinical care and is as essential to mental health professionals as sheet music is to the symphony conducto...

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