When you get ready to do a med pass, you don’t go to the med cart and say “I know what medications to give and when so I won’t look at the Medication Administrative Record (MAR).” You know following the exact medication order is important to the patients’ treatment and safety. Yet, your staff may enter the patient’s room without having read your nursing orders in the nursing care plan. Aren’t the nursing interventions you plan for your patients just as important as the medication orders? Here are some reasons why nursing staff may not follow nursing care plans and some ideas about what to do about it.
1. Writing care plans for the state survey, not for others on the nursing team to follow.
Will your CNA know what “Ineffective breathing pattern due to exacerbation of CHF manifested by orthopnea.” means? Simplify the wording of the care plan so everyone on the team knows what you are talking about and what to do. “Shortness of breath when lying flat” would be more easily understood. With this nursing diagnosis, your intervention of keeping the head of the bed elevated would make sense to everyone caring for that patient.
If your care plans apply to all patients without any specifics for each patient, consider creating standards for all patients. Then write the care plan to meet each patient’s unique needs. Make sure your care plans are “patient centered” not “staff or facility centered.”
Don’t make the plans repetitious and longer by stating the obvious. Who would not, “follow physician orders” or “give medication as ordered.” Leave phrases like these out.
2. Writing care plans without input from the rest of the nursing staff.
Whatever your process for writing care plans, make sure you get input from the staff taking care of the patient at the bedside. Not only do you get the most accurate and up to date information, but the staff who contribute to the plan are more likely to follow it. They might even encourage their peers to follow it as well.
3. Not making reading and knowing care plans a priority.
It isn’t unusual to rely only on verbal or taped reports for information about patients. This could be a dangerous practice. You are depending on the shift or two shifts before you to tell you what are the most important issues for the patient during your shift. You may miss something. Reading the nursing care plan could have alerted you to look for problems that could be prevented or detected early.
Recently, a LPN came up to me to ask me to update her on a new patient. I told her a few basics that were not on the care plan and then referred her to the care plan for the most important information she would need. It would take her about the same time to read the plan as it would for me to tell her the information. Also, by referring her to the plan, I stressed its importance.
Don’t let your staff tell us they don’t have time to read the care plans. Let them know it is vital to their jobs to follow the care plans so they can give the patients the best care. Failure to do what is on the care plan can lose them their jobs. Talk frequently about what is on the care plan. Give staff at least five minutes a day to familiarize themselves with the care plans of the patients they care for. Suggest they read one patient’s plan a day. Make the care plans as accessible as possible.
By writing your nursing care plans using understandable terminology, seeking input from your staff and expecting all staff taking care of the patient to know and follow the care plan, you might see some amazing results. Your staff may get excited about contributing to the care plan and being part of a high functioning team. Isn’t that what quality care is all about?