ENSURING QUALITY CARE CARE PLANNING PROCESS September 2019 Safety, - - PowerPoint PPT Presentation

ENSURING QUALITY CARE

CARE PLANNING PROCESS

September 2019 Safety, Oversight and Quality Unit 1

PURPOSE AND KEY TERMS

The purpose is to assist the learner in understanding how to develop an appropriate care plan and incorporate resident choice (person-centered planning) into the resident’s individualized care plan.

• Activities of daily living (ADL)
• Care plan
• Narrative
• Hands-on assist/ Stand-by assist
• Verbal cueing
• Reminiscence
• Resident choice (person-

centered planning)

September 2019 Safety, Oversight and Quality Unit 2

OBJECTIVES

The learner will be able to:

Describe the components of a care plan Develop a care plan. Evaluate and implement resident choice in developing a care plan Demonstrate how to maximize resident independence Write a narrative

September 2019 Safety, Oversight and Quality Unit 3

INTRODUCTION

Narratives are time-consuming but offer a more complete record of your findings. There is no special form for narrating. Notebook paper is the most economical choice. All narratives must be dated and signed by the individual who wrote them. Writing narratives during the first 14 days of a residents admission helps to track what worked and what did not. Narratives also give you and the other caregivers a clear idea of what the resident can or cannot do and a record of how the individual is adjusting to the move.

September 2019 Safety, Oversight and Quality Unit 4

INTRODUCTION CONTINUED

Use this time to work with the resident to discuss choices, preferences and approaches in meeting their full range of physical, emotional, social and spiritual needs:

• You must accurately identify areas where your services are needed and how

you will provide them

Once you are sure of what the resident can do and what others need to do to help them, note that information in the care plan. You are required to develop and maintain an accurate care plan for each resident. The AFH rules give specific requirements about care

• plans. See OAR 411-051-0115.

September 2019 Safety, Oversight and Quality Unit 5

BASICS OF A CARE PLAN

A care plan describes:

• The resident’s needs and preferences
• The resident’s capabilities and strengths
• The assistance the resident requires for various tasks; and
• By whom, when and how often the care will be provided

The purpose of a care plan is to:

• Encourage the resident to remain as independent as possible
• Ensure consistency in care
• Document the care needed and describe how the individual responds to that

care

• Provide evidence of the resident’s changing needs

September 2019 Safety, Oversight and Quality Unit 6

BASICS OF A CARE PLAN CONTINUED

The care plan must be kept in the individual’s resident records and must be available to:

• All caregivers in the home
• The resident
• Division representatives
• The state long-term care ombudsman
• Other persons (such as the volunteer ombudsman, RNs, family,, etc.) with the

permission of the resident or legal guardian

September 2019 Safety, Oversight and Quality Unit 7

WRITING THE CARE PLAN

The care plan describes how the resident’s needs are to be met:

• Most of the information is already known to you or the resident
• The care plan is a care agreement between you and the resident to ensure

appropriate care is provided

Important elements of care plan writing:

• DO write the care plan within 14 days of a new resident’s admission
• DO involve the resident as much as possible
• DO make certain it is updated every six months or as the resident’s care needs

change

• DO make certain all caregivers are oriented to the resident’s needs

September 2019 Safety, Oversight and Quality Unit 8

WRITING THE CARE PLAN CONTINUED

Team members, such as the resident’s healthcare practitioner, home health, physical therapist and family members should be consulted if they are involved in the resident’s care. Make sure to note any specific tasks performed by these individuals. Detail the type of assistance needed and if any special equipment is used:

• “Take to the bathroom every two hours during the day, once during the night

(approximately 1:30am), provide stand-by assistance to adjust clothing. With verbal cueing the resident can perform other parts of the task independently.”

September 2019 Safety, Oversight and Quality Unit 9

WRITING THE CARE PLAN CONTINUED

Be specific about what needs to be done and who will perform the task, when they will do it, and how often it needs to be done. Regularly review and update care plans:

• Plans must be reviewed, and appropriate changes noted, every six months or

sooner if the resident’s needs change. The reviewer must date and sign the care plan. The document must be rewritten if the change makes the plan difficult to read or follow.

September 2019 Safety, Oversight and Quality Unit 10

USE COMMON ACCEPTABLE TERMS

Set-up: Getting things ready so the resident can perform an activity.

• “Put toothpaste on the toothbrush so the resident can brush teeth; lay out

clothes so the resident can get dressed; draw water in a basin and lay out a washcloth, soap and towel for the resident to give self a daily sponge bath.”

Hands-on assistance: The caregiver physically performs all or parts of an activity because the resident is unable to do so.

• “To help the resident get out of bed, verbally explain each step before
• proceeding. Lift behind head and, when holding under both knees, pivot the

resident to a sitting position. Hold the elbow, count to three and say ‘stand.’ Guide to a standing position.”

September 2019 Safety, Oversight and Quality Unit 11

USE COMMON ACCEPTABLE TERMS CONTINUED

Stand-by assistance: A caregiver must be at the side of the resident and be ready to step in and take over the task should the resident be unable to complete the task independently.

• “The resident is unsteady in his gait. A caregiver must stand-by the resident to

steady him with a gait belt if it becomes necessary.”

Verbal cueing: This term refers to giving reminders or directions to help the resident complete activities without hands-on assistance.

• “The resident needs verbal cueing to get dressed in the morning. A caregiver

must tell her what order to put her clothing on, and to remember to button, zip, tie, etc. to ensure it is properly fastened and in place.”

September 2019 Safety, Oversight and Quality Unit 12

PARTS OF THE CARE PLAN

The care plan provides important information about a resident’s:

• Activities of daily living
• Night needs
• Medical needs
• Social needs
• Ability to exit in an emergency
• Nursing delegations

Entries on the care plan should be written to show the parts of the task the resident can perform independently as well as those the provider or caregivers need to help with. Some cognitive and/or emotional needs that result in challenging behaviors need to be addressed separately in the “Behavioral interventions” section of the care plan.

September 2019 Safety, Oversight and Quality Unit 13

ACTIVITIES OF DAILY LIVING

Bathing

• Preferences for method of bathing (shower, bed bath, tub bath) and/or

equipment needed such as bath bench, hand-held shower and grab bars

• The day and time of the bath are important
• Be sure to note any techniques used to make the bath easier for the caregiver

and the resident

• Note any behavioral support needs or special methods used to maintain

dignity and privacy

September 2019 Safety, Oversight and Quality Unit 14

ACTIVITIES OF DAILY LIVING CONTINUED

Dressing

• Explain the types of clothes the resident likes to wear and who chooses the

clothes

• List any methods that are used to encourage the resident to do as much as

possible on their own

• For example: “Lay out underwear, slacks and blouse on bed. Verbally cue

her to get dressed. Put on her shoes and socks for her.”

September 2019 Safety, Oversight and Quality Unit 15

ACTIVITIES OF DAILY LIVING CONTINUED

Toileting

• Note the frequency and pattern of bathroom use, the type of help needed,

any incontinency needs, preventative measures, and sanitary supplies used

• Include equipment helpful in toileting including elevated toilet seats, versa

frame (grab bars on a frame on the toilet), and grab bars

• Adding helpful pieces of equipment may help the resident to remain

independent with toileting

September 2019 Safety, Oversight and Quality Unit 16

ACTIVITIES OF DAILY LIVING CONTINUED

Mobility and transfer

• Describe the resident’s ability to get around with or without assistive devices
• If they use a wheelchair or walker and do not need verbal cues or assistance

the resident is considered independent in mobility

• Any time the caregiver provides verbal cueing, stand-by assistance or hands-
• n assistance their role needs to be clearly explained
• Any equipment used should be documented along with any pain, spasms,

balance problems and the resident’s exercise and activity level

September 2019 Safety, Oversight and Quality Unit 17

ACTIVITIES OF DAILY LIVING CONTINUED

A resident may need help getting in and out of bed or up and down from a chair but be independent in overall mobility. Explain if the resident needs transfer assistance and consider whether the resident can bear weight, needs adaptive equipment or requires the help of others.

• For example, it may only take one person to transfer the resident from the

chair to their bed but it may be necessary for two people to assist the resident from a chair onto a shower chair.

September 2019 Safety, Oversight and Quality Unit 18

ACTIVITIES OF DAILY LIVING CONTINUED

Personal hygiene and grooming

• Describe any cues for assisting with tasks such as shaving, mouth

care, hand washing, etc.

• For example: “Remind him to wash his hands with soap and water before
• meals. He responds well if we wash our hands together.”
• Grooming can often be combined with personal hygiene but

means things such as brushing hair, putting on make-up, filing nails, etc.

September 2019 Safety, Oversight and Quality Unit 19

OTHER ACTIVITIES

Feeding and nutrition

• Note special diets, appetite, help with cutting food, feeding ability and any

feeding appliances needed (dentures or special utensils and plates)

• Note likes and dislikes as well as allergies
• Consider residents’ individual cultural or ethnic background when preparing

food, and what their preferences are regarding foods/meals from their culture

September 2019 Safety, Oversight and Quality Unit 20

OTHER ACTIVITIES CONTINUED

Communication needs

• Indicate any needs the resident has with vision, hearing or speaking
• Do the needs interfere with the resident’s independence and with your being

able to provide care?

• Does the resident use sign language or a language board? Is English their

second language?

• Does the resident wear eyeglasses, hearing aids or any other adaptive device?
• Does the resident need to use a special clock or alarm system?

September 2019 Safety, Oversight and Quality Unit 21

OTHER ACTIVITIES CONTINUED

Night time needs

• Any assistance or supervision required at night, during normal sleeping hours
• If a resident experiences incontinence, times for changing and/or toileting

during the night

• Any night wandering or special instructions for night time needs should also

be indicated in this area

• Use of night restraints and referral to the RN assessment and consultation, as

discussed in “RN Consultation”, must be noted on the care plan

September 2019 Safety, Oversight and Quality Unit 22

OTHER ACTIVITIES CONTINUED

Medical concerns

• Document in the resident’s care plan any medical concerns, treatments,

therapies, procedures or RN consultation or delegation

• You do not need to repeat the specific details found elsewhere in the

resident’s records, but you do need to note that other instructions exist and refer to them

• For example: Weekly blood pressure - see “RN consultation” for specific

instructions.

September 2019 Safety, Oversight and Quality Unit 23

Remember: All caregivers must have the knowledge and/or instructions for every procedure for every resident. Be sure all of your caregivers are properly trained.

September 2019 Safety, Oversight and Quality Unit 24

BEHAVIORAL INTERVENTIONS

Describe any interventions that soothe a resident’s distress and describe interventions or actions that can upset a resident:

• Critical information to include on the care plan includes what behaviors are of

concern, what causes them to get worse (triggers), what helps prevent the behaviors and how to support the behaviors when they occur.

• If physical restraints or psychotropic medications are used, document when

and how they are used

• Use of physical restraints or psychotropic medications should be described in

the medical section

• Refer the reader to the medical orders, documented alternatives that

were tried, and the consultation with the appropriate professionals

September 2019 Safety, Oversight and Quality Unit 25

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS

Include the resident’s lifestyle preferences, activities and the individuals that are important to the resident. Church affiliation, support groups, community involvement or other relevant parts of the resident’s history need to be documented in the care plan.

September 2019 Safety, Oversight and Quality Unit 26

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS CONTINUED

You must offer each resident at least six hours of meaningful activities each

• week. To do this you must know what is meaningful for each individual.
• What was the resident interested in before they came to the AFH?
• Is there any way to modify activities to the resident’s current ability and skill level?
• Are there activities offered in your home that this resident does not want to do?
• Does the resident want to learn new skills?
• Some residents are able to maintain their preferred activities alone or with the help
• f friends. For others, you will need to play an active role in creating activities.
• Are there social or service groups such as the Lions Club, Elks, Moose, Daughters
• f the American Revolution that can help to keep the resident involved?

September 2019 Safety, Oversight and Quality Unit 27

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS CONTINUED

Do not assume that physical or psychological needs have to limit a resident’s activities. Exercise creativity in learning about adaptive devices and specialized opportunities in your community. Often, residents feel depressed because they are no longer involved in life in a way that feels meaningful and engaging. You can help foster residents’ dignity, enhance independence, and promote self-worth by planning activities that meet physical, mental, social and spiritual needs.

September 2019 Safety, Oversight and Quality Unit 28

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS CONTINUED

Documenting the resident’s interests helps caregivers better know the resident and offers topics for discussion.

• Know each resident’s interests, abilities, skills, strengths, values and what is

important to them

• Gather information by talking with the resident, the resident’s family, friends

and care team members

• Observe how the resident interacts with others
• Use the information you collect, together with the care plan, to identify types
• f activities that would benefit the resident

September 2019 Safety, Oversight and Quality Unit 29

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS CONTINUED

Reminiscing can be an activity in itself and it is a key in helping you find

• ther meaningful activities for the residents in your home.
• Acknowledging a resident’s past reinforces self-worth. The past is real and

secure and memories are a source of pride, delight and comfort.

• Reminiscing can be a solitary or shared activity. It means more than recalling

people, places and events in the past. Reminiscing also means making sense

• f the pain and the joy experienced in one’s lifetime.
• Reminiscing can mean forgiving one’s self for misdeeds, making peace with
• thers, and celebrating the accomplishments and victories of life.

September 2019 Safety, Oversight and Quality Unit 30

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS CONTINUED

• Reminiscing helps people find strength at a time when they may be

experiencing loss of health or capabilities. It can help residents to establish friendships with others. It can also be an effective way to communicate with the older adult who only remembers the distant past.

• Encourage residents to share stories with others as well as you. Life review

can be a very rewarding group experience as people talk about their similar events and circumstances from their individual perspectives. It could be an informal conversation over meals or a more formal discussion that takes place weekly in the AFH.

• You can encourage residents to tell you about their grade school years, their

fondest childhood memories, first cars and how they met their spouse.

September 2019 Safety, Oversight and Quality Unit 31

SOCIAL, SPIRITUAL, EMOTIONAL NEEDS CONTINUED

• Suggest residents tape or write their life stories. In doing this, they create a

permanent record of the past to share with their families and others. The resident’s family member can create memory books for them.

• Provide opportunities to experience the past. Photographs, music,

mementoes, costumes and pictorial history books may stimulate memories and rewarding conversation.

September 2019 Safety, Oversight and Quality Unit 32

ASSESS THE ACTIVITY COMPONENTS

Despite physical and cognitive changes, residents can enjoy activities that match their current abilities. Look at the physical and cognitive requirements of an activity. Does it require:

• Sitting, standing or moving around?
• High, moderate or low levels of

energy?

• Ability to see, hear or speak well?
• Balance, coordination, flexibility or

strength?

• A long attention span?
• Ability to retain information?
• Prior knowledge or training?
• Time to learn or practice?

September 2019 Safety, Oversight and Quality Unit 33

ASSESS THE ACTIVITY COMPONENTS CONTINUED

Other factors to consider include:

• Accessibility of materials needed – are the supplies and equipment on-hand
• r easy to obtain?
• Conditions needed for the activity – do you need clear weather, or a certain

setting?

• Availability of community resources – are there volunteers that can help with

activities and resources?

• Involvement of family and friends – can you invite families to a Sunday

afternoon ice cream social?

September 2019 Safety, Oversight and Quality Unit 34

ENCOURAGE RESIDENT PARTICIPATION

Planning ahead based on interests, abilities, skills and values does not guarantee that a resident will want to participate. Motivation is a key element in getting residents to participate in an activity. To help with motivation:

• Keep activities meaningful. Involve residents in day-to-day tasks around the
• home. Be sure to involve them in planning and choosing activities.
• Keep activities simple, if necessary. Some residents may become tired or

frustrated when activities are “too busy” or involve too much instruction. Select activities that are appropriate for adults.

September 2019 Safety, Oversight and Quality Unit 35

ENCOURAGE RESIDENT PARTICIPATION CONTINUED

• Plan activities that promote self-esteem. Activities should be geared to the

residents’ ability to participate. Activities should be stimulating but not

• verwhelming. Scale down activities if necessary.
• Break the activity into smaller tasks. The resident may be able to put napkins
• r glasses at each place setting.
• Respect individual preferences. Some activities may seem isolating or anti-

social to you but some individuals may prefer reading or spending time alone in their room.

September 2019 Safety, Oversight and Quality Unit 36

ENCOURAGE RESIDENT PARTICIPATION CONTINUED

• Encourage social interaction but respect residents’ rights to pursue activities

they prefer doing on their own.

• Provide positive feedback. Show interest in the residents’ activities and offer

positive reinforcement for their efforts, not just their achievements. For example: “I really appreciate you carrying dishes into the kitchen after meals,”

• r “Your room always looks so neat and tidy.” Make sure your enthusiasm is

genuine and reinforcement is given in a sincere manner.

September 2019 Safety, Oversight and Quality Unit 37

EXITING IN AN EMERGENCY

Describe in the evacuation plan as well as help and/or equipment the resident requires when needing to evacuate during an emergency. When the resident first enters your home, you observe and assess their needs and determine if the screening information was accurate. As needs and plans are developed or changed, the information must be transferred to the care plan.

September 2019 Safety, Oversight and Quality Unit 38

INCIDENT REPORT

A written report is required for all significant incidents relating to the health or safety of a resident. You must include how and when the incident occurred, who was involved, what action the staff took and the

• utcome.
• Use of a particular form is not required
• Document the resident’s full name on each page of the narrative, care plan

and resident record

• Do not forget to date each entry and identify who made the entry
• If a signature is used to sign the document, include the printed name next to

the signature at least once in the resident’s record

September 2019 Safety, Oversight and Quality Unit 39

INCIDENT REPORT CONTINUED

September 2019 Safety, Oversight and Quality Unit 40

DISCUSSION/QUESTIONS

September 2019 Safety, Oversight and Quality Unit