INTEGRATED PLAN OF CARE (IPOC)
Admit Date: ____/____/____ Initial Ongoing (Skip pg 1)
Date
Initiated /
FOCUSED NEEDS / PROBLEMS
/ OUTCOME OF ASSESSMENT / COMMUNICATIONSCASE MANAGEMENT (CM)
Evidence of domestic violence, abuse, homelessness
Assistance with Power of Attorney/ legal issues
Financial issues Psychosocial needs Placement
Receives Home Health Services Home equipment needs
Safety concerns/falls at home Discharge Planning
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Protective Services notified
Info provided (See Pt. Education)
Pt. to be followed
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
ENTEROSTOMAL/WOUND CARE Incontinence
Non healing/open wound Pressure ulcers-all stagesStoma site / pre op marking New ostomy
Education - Ostomy self care
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Info provided (See Pt. Education)
Pt. to be followed
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
PHYSICAL THERAPY (PT)
New deficits in baseline function with mobility skills.
Recent fall or fall risk New amputation, THR, TKR
Mobility assessment for post hospital placement
New onset neurological impairment decline in mobility
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Info provided (See Pt. Education)
Pt. to be followed – Physician order required
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
OCCUPATIONAL THERAPY (OT) New total joints
Decline in self care skills - New Recent
Dx. benefiting from splinting or upper extremity orthotics
Toilet training
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Info provided (See Pt. Education)
Pt. to be followed – Physician order required
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
SPEECH THERAPY (ST) Swallowing or chewing difficulty
Communication difficulty 2º neurological function / trach
Speech: slurred* rambling* aphasia*
S/P surgery of neck, throat, mouth, brain
Post extubation for patient intubated > 7 days
Recurrent pneumonia – especially RLL
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Info provided (See Pt. Education)
Pt. to be followed – Physician order required
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
NUTRITION SERVICES (NS) Enteral/ parenteral feeds
Special diet DKA Chewing difficulty Poor intake > 3 days
Recent unexplained weight loss/gain (>10 lbs in past month)
Non healing wounds/ pressure ulcers
Education – Therapeutic/Special diet Diabetes
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Info provided (See Pt. Education)
Pt. to be followed
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
PHARMACY (P) Use of herbal preparations
Six (6) scheduled prescription or OTC meds
Falls 2º to meds Possible adverse event 2º to meds
Education needed for: ______
Other: ______/ Services not currently needed See NOTE
Pt. to be followed Info provided (See Pt. Education)
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
RESPIRATORY THERAPY (RT)
Smoker Respiratory problems - acute chronic
Oxygen dependent (home O2)
Equipment issues ______
Other: ______
Currently being followed for: ______/ Services not currently needed See NOTE
Smoking Cessation brochure - Offered Declined
Pt. to be followed Info provided (See Pt. Education)
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
SPIRITUAL CARE
Consult Other: ______
Currently being followed for: ______/ Info provided (See Pt. Education) See NOTE
Pt. to be followed
Signature: ______Date: ____/____/____
Evaluation Completed
Signature: ______Date: ____/____/____
ADVANCE HEALTHCARE DIRECTIVES: Assistance requested* In Medical Record Requested* Brought in* - date: ____/____/____
Comments: ______NCP002A #2 7-6 Page 1
Date Initiated /SYSTEM PROBLEMS
Check all that apply
/ DESIRED OUTCOMECheck all that apply / Time
Frame / NURSING INTERVENTIONS
Check appropriate interventions
1. PSYCHOSOCIAL
Problems coping with:
Disease process
Communication barriers
Psychosocial / spiritual
Other: ______/ 1.1 Able to express thoughts and feelings
1.2 Able to effectively communicate
1.3 Will verbalize reduction or mgmt. of anxiety
1.4 Advance Healthcare Directives
Brought in Assistance provided
1.5 Other: ______/ Provide emotional support
Involve family/ S.O. in care process
Involve patient in care process
Provide spiritual care/support
Advance Directives follow through
Other: ______
Initials
2. NEUROLOGICAL
Altered mental status
Decreased LOC
Seizure precautions
Other: ______/ 2.1 Patient awake, easily aroused
2.2 Oriented to time, place and person
2.3 Speech clear. Mood, affect, behavior
appropriate to situation
2.4 Other: ______/ Assess for orientation, LOC
Assess neurological deficits
Maintain seizure precautions & monitor for seizure
activity
Other: ______
Initials
3. MUSCULOSKELETAL
Alteration in ability to ambulate,
turn from side to side or actively
move extremities.
Other: ______/ 3.1 Will maintain or improve pre hospital mobility
status
3.2 Involvement of family/ significant others whenever
possible
3.3 Other: ______/ Assist with ADL’s Perform ROM
Assist with toileting Log roll as indicated
Encourage ambulation as tolerated /ordered
Maintain proper body alignment
Involve family in care
Initials
4. GI / GU
Alteration in bowel or bladder
function
Other: ______/ 4.1 Voiding and bowel movements as per pt. norm
4.2 No signs or symptoms of distress
4.3 Other: ______
4.4 Other: ______/ Place NG tube/ monitor output
Assess bowel sounds
Assess for gastric / urinary distention
Monitor I and O, record BM’s
Provide daily foley care
Initials
5. NUTRITION
Alteration in nutrition status
Alteration in fluid and electrolyte
balance
Other: ______/ 5.1 Provide adequate nutrition
5.2 No significant weight loss
5.3 Control of nausea and vomiting
5.4 Other: ______/ Up to chair for meals
Encourage adequate diet fluid intake
Advance diet as tolerated
Offer nutritional supplements
HOB 30º for enteral tube feeding
Initials
6. ENDOCRINE
Diabetes - Serial CBG’s
Thyroid disturbance
Other: ______/ 6.1 Maintain optimal blood glucose levels
6.2 Other: ______
6.3 Other: ______/ Monitor CBG’s as ordered
Assess for S & S of hypo / hyper glycemia
Other: ______
Initials
7. RESPIRATORY
Difficulty breathing
Shortness of breath
Airway obstruction
Inadeq. oxygenation / ischemia
Other: ______/ 7.1 Will report in respiratory symptoms
7.2 Will experience ease of respirations and signs of
adequate oxygenation and circulation.
7.3 Other: ______
7.4 Other: ______/ Assess breath sounds
Monitor SpO2 O2 as ordered & wean as tol.
Nebulizer as ordered HOB at 30º - 45º
TCDB Encourage use of IS
Position for optimal gas exchange
Other: ______
Initials
8.CARDIOVASCULAR
Alteration related to diagnosis
or disease process
CHF Chest pain
Other: ______/ 8.1 Feel free of chest pain
8.2 BP within acceptable parameters
8.3 Reduced peripheral edema
8.4 Pre hospital CV status maintained or improved
8.5 Other: ______/ Monitor BP, HR, pulses, cap refill
Assess heart sounds
Monitor daily weights
Monitor cardiac rhythm
Antiembolic hose / SCD as ordered
Initials
9. PAIN AND COMFORT
Pain related to:
Diagnoses / Disease process
Surgery/ Procedure
Chronic condition
Other: ______/ 9.1 Verbalize acceptable level of comfort/ pain
9.2 Exhibit reduction of indicators of pain
9.3 Other: ______
9.4 Other: ______/ Assess pain with every encounter
Provide appropriate interventions (meds,
alternative modalities) based upon pain
assessment & response to interventions
Reassess pain after every intervention
Initials
10. SKIN INTEGRITY
Impairment:
Actual Potential
Braden Score: ______
Other: ______/ 10.1 Skin integrity will be maintained / protected /
improved
10.2 Free from infection
10.3 Other: ______
10.4 Other: ______/ Turn q 2 hrs.
Protect bony prominences
Assess skin for breakdown – Braden Scale
Check for incontinence, change linens prn
Assess need for specialty bed / mattress
Initials
11. PATIENT SAFETY
Potential for injury
FALL RISK
RESTRAINTS
Other: ______
______/ 11.1 No injury during stay
11.2 Patient receives appropriate care
11.3 Restraint free / Restraints removed ASAP
11.4 Other: ______
11.5 Other: ______/ ID, Allergy, Resuscitation Status bands on pt.
Check at every encounter.
Critical alarms on
Fall Risk Caution / Alert Level interventions
implemented per protocol.
Bed Monitor / Alarms on
Initials
Documentation by- (Signature/Title): ______Date: ____/____/____ Time: ______
______Date: ____/____/____ Time: ______
Completed/ Reviewed by: ______RN Date: ____/____/____ Time: ______
NCP002A #2 7-6 Page 2
PROBLEM PROGRESS EVALUATION
KEY: R = Resolved P = Progressing U = Unresolved
Date: ____/____/____
/ Date: ____/____/____ / Date: ____/____/____ / Date: ____/____/____DAY / NIGHT / DAY / NIGHT / DAY / NIGHT / DAY / NIGHT
OUTCOME #
GOAL PROGRESS: /R P U
/ R P U / R P U / R P U / R P U / R P U / R P U / R P UComments if not resolved
OUTCOME #
GOAL PROGRESS: / R P U / R P U / R P U / R P U / R P U / R P U / R P U / R P UComments if not resolved
OUTCOME #
GOAL PROGRESS: / R P U / R P U / R P U / R P U / R P U / R P U / R P U / R P UComments if not resolved
OUTCOME #
GOAL PROGRESS: / R P U / R P U / R P U / R P U / R P U / R P U / R P U / R P UComments if not resolved
OUTCOME #
GOAL PROGRESS: / R P U / R P U / R P U / R P U / R P U / R P U / R P U / R P UComments if not resolved
CAREGIVER
Initials
CAREGIVER ID
Signature / Title / Initials / Signature / Title / Initials / Signature / Title / InitialsNCP002A #2 7-6 Page 3
PATIENT AND FAMILY EDUCATION *Any changes are to be documented in the MULTIDISCIPLINARY NOTES below
LEARNING SUMMARY – date: ____/____/___ Initials: ______Must be completed within 24 hours of admission.Readiness to Learn: Willing/able to learn Barriers to learning present: ______
Learners: Patient Family / significant other Caretaker
Learning Preference/ method (LM): None stated VD = Verbal/discussion W = Written materials
Learning Evaluation (LE): S = Satisfactory knowledge, learning and/or competence NR = Needs reinforcement
Document as applicable to diagnosis, learning needs and patient availability
TOPIC / Date: ____/____/____ / Date: ____/____/____ / Date: ____/____/____ / Date: ____/____/____
DAY / NIGHT / DAY / NIGHT / DAY / NIGHT / DAY / NIGHT
LM / LE / LM / LE / LM / LE / LM / LE / LM / LE / LM / LE / LE / LE / LM / LE
Diagnosis, signs and symptoms
Treatment Plan
Prevention / Risk factors
Medication Safety
Pain Management
Activity / Safety
Fall Prevention
Self Care
Diet
Hydration
Habilitation/Rehabilitation
Medical Equipment Use & Safety
Smoking Cessation
EDUCATOR Initials
MULTIDISCIPLINARY NOTES
Date/ Time / DISCIPLINE / NOTESNCP002A #2 7-6 Page 4