Hospital Accreditation: Nursing Plans of Care
on 1/9/2018 10:00:00 AM
Nursing care plans continue to be frequently cited by CMS and accrediting organizations (AO’) during surveys. Knowing what surveyors are focusing on can help your hospital assure that nursing care plans pass regulatory muster. The interpretive guidelines under Appendix A of the State Operations Manual at §482.23(b)(4) forms the basis for this discussion.
What is the requirement?
CMS and AO’ expect that nursing staff develop and keep current, a nursing care plan for each patient. The nursing care plan may be part of an interdisciplinary care plan or it can be a stand-alone document. Currently, the expectation for a nursing care plan applies to inpatients, although there are proposed rules by CMS that would expand this requirement to outpatient settings as well.
When should care planning begin?
Care planning starts upon admission. It includes planning the patient’s care while in the hospital as well as planning for discharge to meet post-hospital needs. Surveyors will often review initial nursing assessment documentation and then review the plan of care to determine if identified care needs had a plan of care developed in a timely manner.
What is the scope of a nursing plan of care?
Per CMS: “A nursing care plan is based on assessing the patient’s nursing care needs (not solely those needs related to the admitting diagnosis). The assessment considers the patient’s treatment goals and, as appropriate, physiological and psychosocial factors and patient discharge planning. The plan develops appropriate nursing interventions in response to the identified nursing care needs. The nursing care plan is kept current by ongoing assessments of the patient’s needs and of the patient’s response to interventions, and updating or revising the patient’s nursing care plan in response to assessments.”
What gets cited?
The most frequent findings surrounding nursing care plans are as follows:
- Care plans are not individualized to reflect a patient’s specific care needs. With the advent of electronic medical records (EMR), nursing care plans have become highly templated and driven by canned text in drop down menus. This works when care needs and interventions are standardized among patient populations, however, it does not work when a patient has a unique care need that is not part of the menu choices, or that require interventions that are not pre-populated in the EMR.
- Care plans are not updated to reflect the patient’s current care needs. Care plans are often looked upon by staff as static documents that are developed mostly to meet regulatory requirements rather than working tools to assist them in providing care. Because of this, care plans often do not get updated to reflect changes in a patient’s condition and current care needs.
- Resolution of care issues are not documented at the time of discharge. When a patient is discharged, the nursing care plan needs to be closed out. Either care needs were met, or they remain active. If the latter, then there should be some documentation in the patient’s record as to what actions were taken at the time of discharge. Were the care needs communicated to the next provider of care? Was the patient provided with information such as care instructions or access to community resources to assist with care issues? That type of thing.
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About the Author
Richard Curtis RN, MS, HACP
RN, MS, HACP
Richard (Rick) Curtis is the Chief Executive Officer for CIHQ. Rick is nationally recognized as an expert on the Medicare Conditions of Participation and the CMS Certification & Survey Process. As CEO, he successfully guided CIHQ in becoming the nation's 4th CMS approved deeming authority for acute care hospitals.
Rick's clinical background is in critical care nursing with a focus in cardiovascular and trauma service lines. He has held both clinical and executive management level positions in Quality, Risk, Education, Infection Control, and Regulatory Compliance.
Rick is a regular speaker at numerous state and national conferences on the federal regulations and accreditation standards, and is host of CIHQ's popular monthly webinars addressing key compliance challenges in today's environment.
Rick is nationally certified in healthcare accreditation, and serves as Chair of the Board of Examiners for the Healthcare Accreditation Certification Program (HACP). Rick has a degree in Nursing with a Master's Degree in Health Services Administration.