Care plan documents are an important and often overlooked aspect of nursing home care. In today’s episode, nursing home abuse attorneys Rob Schenk and Will Smith discuss plan of care documents and how they differ from other medical records with guest Nancy Ridge, a Legal Nurse Consultant with an independent practice.
TRANSCRIPTION OF EPISODE
Schenk: Hello out there and welcome back to the Nursing Home Abuse Podcast. My name is Rob Schenk.
Smith: And I’m Will Smith..
Schenk: We have a very interesting episode for you today. We’re going to be talking – actually last week we talked about care plan meetings, like who attends them, what the purpose of them is for, and this week, we’re going to be talking for a few minutes about the actual documents that a company that the care plan – literally the care plan.
Smith: The care plan documents themselves. The plan.
Schenk: The plan.
Smith: And we’ve got Nancy Ridge, who is a nurse consultant.
Schenk: As a guest.
Smith: As a guest. She’s going to be discussing what an actual care plan is, and she has been practicing nursing since one year before Rob and I were born. She started in 1977 working in a nursing home as a nursing tech. That’s when she decided to enter nursing and pursue a career in a field that she had a true passion for. She completed her license in practical nursing degree, her LPN, while living in Clarksville, Tennessee. After working as an LPN for 20 years, she returned to school and completed her associate’s degree in nursing in Excelsior College of Nursing in New York.
Her husband was an Army officer at the time so she had the opportunity of moving and working in various settings as a clinical nurse and a nurse manager, so she’s been all over the various states working in different capacities as a nurse. Her areas of nursing have include nursing home, community health, ICU, emergency room, medical and surgical, home health and school health.
And one of her greatest pleasures in nursing is being an advocate for patients. As a patient advocate, she assists them through the maze of the healthcare system and provides them with the skills they need to make good healthcare decisions. And like I said, she is a legal nurse consultant and she is extremely qualified to talk with us today about our subject matter, which is the plan of care document itself.
Schenk: And with that, Nancy, welcome to the show.
Nancy: Thank you.
Smith: And it says here you’re from Clarksville, Tennessee.
Nancy: No, that’s where I had my initial training was in Clarksville, Tennessee.
Smith: Oh, okay. I didn’t know you had a Clarksville. Rob is from Mt. Juliet, Tennessee.
Schenk: I’m from Mt. Juliet, so about an hour or so south.
Nancy: Okay, well Clarksville, Tennessee, is right near Fort Campbell.
Smith: Oh, I got you. Okay.
Schenk: Austin Peay and Fort Campbell? What did you say?
Smith: She said Fort Campbell.
Schenk: Fort Campbell, yeah I’m sorry.
Nancy: Fort Campbell, correct.
Schenk: Oh, what I was trying to say was the 101st.
Nancy: Correct, yes.
Smith: So what we want to talk about today are the care plans and the care plan meetings because what our practice deals with is 100 percent long-term care issues. So the vast majority of our clients are either families or actual residents of long-term care facilities who have been injured because of negligence. And so the plan of care documents are big deals for the people who listen to the this podcast.
Nancy: Okay. The plan of care document is a medical document that nurses refer to as a map of nursing care. The purpose of the plan is to provide consistent care and to assist the staff to achieve the patient’s center goals through different nursing interventions.
Smith: Okay. And who’s responsible for these documents?
Nancy: The healthcare plan is developed by a registered nurse, and she does a comprehensive nursing assessment of the patient, which may include other input from other staff members.
Smith: I got you. And does it cover other things like dietary or activities or anything like that or is it all just medicine?
Nancy: No, it covers all activities, the daily living, which is the mobility, elimination, nutrition, and then also it covers medications and all health conditions that that patient may have.
Nancy: It is important to assure that the staff is giving consistent care to that patient.
Smith: I got you. So it’s going to have things in there like, “This is the medicine that they’re taking right now.” This is how – if they have thickened liquids or what their religious preferences are or what activities the family wants them involved in, right?
Nancy: Correct, it covers all social needs and also just input that’s request from the family and from the patient themselves. So everyone has a part of the healthcare plan and provides information to the nurse.
Smith: One of the things that that statement of deficiencies looks at is how they weren’t involving the resident in the care plan and how they weren’t involving the family members in the care plan. So generally speaking, do they invite the family members to be a part of the care plan meeting to look at the care plan documents?
Nancy: Yes, they are required to. They are required to notify the families in writing and with a phone call to make them aware of the time for the meeting.
Smith: Got you. And I would imagine the resident has to be there as well if they’re cognizant, correct?
Nancy: Correct. If they able to attend, they are invited to attend.
Smith: And this care plan document, when does it generally get generated after admission? How long? Is there a specific time?
Nancy: Yeah, you’re required to complete – the nurses are required to complete a comprehensive nursing assessment within 14 days and to initiate the plan of care within 14 days of admission.
Smith: I got you. And is it one care plan for the whole year or do they generate them every month, every quarter? How often does it happen?
Nancy: Care plans are an ongoing process and they’re to change with – you have your initial care plan, which is reviewed at the 30-day mark and then 90 days of the initial admission. And a care plan can be changed at any time if there’s a change in the patient’s health or any need that’s seen. Patients are assessed every eight hours by a nurse.
Schenk: I got you. What kind of change in condition in a resident would warrant a reassessment of the care plan?
Nancy: A change in mental status, change in mobility, eating, loss of weight, anything like that. Any change in their activity, in daily living, are cause for change.
Schenk: I got you.
Smith: And who’s allowed to have access to this, this care plan?
Nancy: All staff that help with care must know, must be able to review the care plan. The patient and the family can request it at any time.
Schenk: So this is a document that the family can come into the nursing home and say, “Hey, can I see the care plan?” and then it has to be offered to them because it’s a part of their record?
Nancy: Correct. Correct. The care plan is in a nursing home setting, the patients are assessed every eight hours by a nurse. And whenever you have a change of a shift, a change of assignment within that facility, the nurse who is signing off must give a report to the nurse who is signing on to take responsibility of that patient. The care plan is gone over at that time with that nurse and most of the time the nurse then sits down with the assistant staff, the nursing assistants and aides, and then lays out their part of what they need to do to follow the plan. All staff members are reviewed with the healthcare plan every shift change.
Smith: And let me ask you this. So we have this care plan meeting that’s got this care plan document, and it’s made available, so I guess staff, if they wanted to, they could go look at it. But are they told at the beginning of the shift, “Hey listen, we’ve had a care plan meeting. We’re to remind you in this care plan document that Ms. Johnson is thickened liquids or that she doesn’t like rice,” or something like that? How is it communicated typically?
Nancy: The nurse meets with the staff that are caring for that patient, and it’s done right at the beginning of the shift, and of course, any changes during that shift, any felt changes that are noted, then automatically the staff is notified – “We need to do this now” or take different types of interventions with the patient.
Smith: Understood. And do the doctors have any involvement with these care plan documents?
Nancy: In nursing home settings healthcare documents, they’re nursing plans of care, and generally the doctors do not look at the healthcare plans, because the nurse develops them with part of the doctor’s input by looking at the doctor’s diagnosis and the medications. And the doctor can make recommendations. He may order than a patient ambulates so many times a day with assistance, and that would be put into the care plan, but normally doctors do not review the nursing healthcare plan.
Smith: Ah, I got you. So this is largely the people that deal with the residents on a day to day basis, help with the ADL, the feed room, the shower room.
Nancy: Yep. That’s correct. The nursing care plan is – the standard process of the plan, the nurse does the comprehensive nursing assessment and then she develops a nursing diagnosis, which is different from the doctor’s diagnosis. That’s how that’s developed into the plan.
Smith: Okay, and if family members have an issue with a care plan, how do they go about – can they challenge it? Can they change it? Who in the nursing home do they go see?
Nancy: Usually they would address it with the nurse who’s in charge at the time, and sometimes there’s not a nurse, but the RN is the only one who can make changes to a healthcare plan. So the family member of course could approach any staff member, which should carry that information back to a registered nurse and make changes. Of course, any changes that might be needed that are critical at that time that may not can wait for a staff meeting, of course that can be changed at any time. The nurse that is assigned to that patient can make immediate changes, like if all of a sudden their gait is unsteady, then they can say, “Okay, this person needs some assistance until we find out what’s going on with them,” so they can make changes like that.
Smith: Okay, excellent. And so you are a legal nurse consultant, right?
Nancy: That’s correct.
Smith: So we use legal nurse consultants as well. How often do these care plans come into play when you’re looking at issues of negligence? Is it generally that somebody’s not following the care plan or that it wasn’t generated properly in the beginning?
Nancy: It could be both. Maybe during the nursing assessment something was not picked up on and then also you’re looking at the care plan itself to make sure that they did receive those interventions like they should have. It could be both areas.
Smith: I got you.
Schenk: How long have you been doing this consulting? Oh sorry, let me ask that again because I was muted. How long have you been doing nurse consulting?
Nancy: I started the consulting in 2001.
Schenk: Okay, so it’s been a while?
Smith: And if individuals want to get a hold of you, what’s the best way to do that? Or if other attorneys, because we have attorneys who listen to this, we have a wide audience actually – anybody involved in long-term care facility management, how would they go about getting a hold of you?
Nancy: Okay, I have a LinkedIn site that I have and I always post my phone number, my office number that they can contact me.
Smith: Okay, and that’s 803-924-5756, right?
Nancy: That’s correct, and my email address is also – I get many calls and emails.
Smith: And what’s your email address?
Nancy: It is
Smith: Okay, and we’ll put both of those up on the screen just in case any attorneys out there are listening to this and they need to reach out to you, because I think that this is a really important area, not only for other attorneys to look into when you’re investigating these cases, but it’s important for the families to get involved too. Do you typically see families involved in these care plan meetings or is that not the case?
Nancy: Usually I do not. I have, on a couple instances, I have covered, I have done cases not just with nursing homes, but with hospital settings and school health settings, which have a different type healthcare plan, so I have met with some of the clients with those, but not typically.
Smith: So hospitals have a type of care plan as well, is that correct?
Nancy: Correct, and also school districts.
Smith: Oh really? And how do the school districts use a care plan?
Nancy: A child or student who may have a condition that requires a nursing intervention, like they may be diabetic and the nurse may need to check their blood sugars during the day, they may play sports – the purpose of the care plan in the school is to notify the staff that this person may have a health condition, to make sure that it does not affect their education process.
Smith: Okay, interesting.
Nancy: And their social, because many of them play sports, so care plan in the school setting is very, very broad and covers a lot of areas, field trips, everything, a lot of details.
Smith: Well that makes sense because the care plan document sounds like it is basically what’s the problem, what are we going to do to fix it? And that’s always a good road map to have for anything.
Nancy: Well you have interventions and you have goals.
Smith: Right. And those goals…
Nancy: For that person that they will improve.
Smith: Okay, and those goals can be things like reduce the number of falls or don’t have a bed sore, right?
Nancy: Correct. That’s correct.
Schenk: Well great. Well Nancy, this has been exceptional for our audience. I think we’ve all learned a lot more about care plan documents in the nursing home setting and we appreciate you coming on the show and maybe we’ll get you on the show sometime in the future.
Nancy: Okay, thank you. Thank you for the opportunity.
Schenk: Thank you, Nancy.
Smith: Thank you.
Schenk: Bye. I can definitely tell by the succinct nature of Nancy’s questions that she definitely has a military background. That was her husband that was in the military?
Smith: Yeah, her husband was an Army officer, and she knows what she’s talking about.
Schenk: She does.
Smith: It’s always good to talk to somebody…
Schenk: …Who has the experience.
Smith: …Who has that breadth of experience. She’s worked in med-surg, she’s worked for school districts. I didn’t realize that school districts have their own care plans. That’s interesting. But we at least, between this episode and the one before it, are starting to get an idea of how important care plans are for your loved one in long-term care settings.
Schenk: Care plans – know them, get them.
Smith: Understand them and be there when they’re generated.
Schenk: Absolutely. Okay Will, I guess this will be the end of the episode. Where can people download other episodes?
Smith: You can go anywhere you download your other podcasts. If you want to watch it, there are two ways – you can go to our YouTube channel, our YouTube channel, Schenk Smith, and you can also go to our website, which is www.nursinghomeabusepodcast.com. If you want to see our faces or if we have screenshots and everything else that you want to see on the screen, I always suggest you go watch the video. But yeah, anywhere that you can get the MP3 for a podcast, we’re there.
Schenk: Excellent. And with that, we will see you next time.
Smith: See you next time.
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