Exceptional Care Plan Documentation
Some patients suffer from chronic or recurring conditions that may present with exacerbations in settings where staff are unfamiliar with a patient's specific treatment requirements. Examples include rare bleeding disorders, complement deficiencies, and complex metabolic disorders, as well as multi-emergency department users requiring a consistent approach to management that may differ from prevailing standards.
Clinicians managing such patients may have devised individualized treatment plans that work best for a particular patient with a particular health condition. These "Exceptional Care Plans" (ECP; also referred to as "Emergency Treatment Plans" or "Exceptional Treatment Plans") are documented in Connect Care using a workflow that ensures that the existence of the plan is prominently flagged for other providers, and that relevant review or expiration dates are highlighted.
Reviewing Exceptional Care Plans
Existing and active ECPs are chart documents. These can be found and reviewed by any of the following means:
Look to the chart Sidebar (right most column when a chart is opened), then select "Notes & Sidebars" from the top index, then note the clickable links provided for displaying a list of ECPs, opening the ECP activity, opening the FYI activity or immediately generating a new ECP note.
Use Chart Search to "Jump to" the Exceptional Care Plan chart activity, or seek the activity among the tab options for any opened chart.
Use Chart Search to search for the phrase "Exceptional Care Plan" to produce a list of all ECPs attached to a patient chart.
Use the Chart Review activity within any opened chart, then the "notes" tab and filter for notes of the "Exceptional Care Plan" type.
Look for an Exceptional Care Plans section within the Problem Oriented Charting sidebar, then click on the hyperlink to open the ECP activity.
Selecting an ECP found by any of these means will bring forth the plan and associated instructions. Note that these plans may have additional hyperlinks within them.
Clinical Validity of Plans
Pay particular attention to the ECP properties (at the top of individual plans). These specify a "last reviewed" date, "next full review" date and current plan status (Active or No longer needed). This information can determine whether a plan is still clinically applicable.
Authoring Exceptional Care Plans
A new ECP can be documented by using the Exceptional Care Plan activity (found by any of the methods listed above). Instructions are provided within the activity. A simple way to start a new plan is to use the New Note link provided in the ECP section of the "Notes & Sidebars" view in an inpatient chart (right) sidebar.
All new ECP notes are created using a standard template which ensures that all ECPs have similar layout and content. Use the F2 key to find wildcards for entering the ECP name/title, the relevant health condition and the specifics of the actual treatment plan. Also be sure to select the "ECP Properties" button at the top and enter review date and status details.
Clickable (link) areas within the ECP documentation template facilitate rapid access to tools for entering structured data used in the template.
Exceptional Care Plan Flags
That a patient has an active ECP is highlighted at the top of the patient StoryBoard (left-most column of all opened patient charts in Connect Care) with a "FYI" (flag icon) that can be selected to open the "FYI" activity within a chart. The same activity can be used to add a new ECP flag or to remove an ECP FYI flag if the care plan has expired or is otherwise no longer needed.
A "new flag" button at the top left can be used to add a new ECP flag (select "Exceptional Care Plan" from the list of FYI types)
Use the ".EXCEPTIONALFYI" SmartPhrase in the new flag comments to generate standardized prompts about where to find the actual care plan
Copying Plans to Primary Care and other Providers
As illustrated in the linked tip sheet, the best way to copy existing ECPs to other providers involves accessing the ECP via the notes tab in the Chart Review activity (Hyperspace), then using the "Route" button to select one or more providers for receipt. Covering comments can be added.