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 typical practice.

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 highlighted to other providers, and that review or expiration dates are explicit.

Reviewing Exceptional Care Plans

Existing and active ECPs are chart documents. These can be found and reviewed by any of the following means:

List Columns

Chart Sidebar (rightmost section)

Chart Storyboard (leftmost section)

Chart ECP Activity

Chart Review Activity

Chart Search

Selecting an ECP found by any of these means will bring forth the plan and associated instructions. Note that these plans may have additional interactive 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, "expiration 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 created 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" link provided in the ECP section of the "Notes" view in a chart (right) sidebar when opened to inpatient, outpatient or emergency encounters.

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 or updating data used in the template.

Editing Exceptional Care Plans

ECPs can be edited by the authoring clinician. Some clinicians (e.g., prescribers, nurses) can also "take over" ECPs authored by a colleague by using an "Addend" workflow.

A similar workflow applies within the ECP chart activity.

If the full-text ECP display pop-up is activated (e.g., from Patient List, Storyboard or Sidebar links), links will appear at the top of each ECP. These can be selected to open the ECP for editing within the originating encounter.

Deleting Exceptional Care Plans

Inactive ECPs can be deleted. This is recommended when a patient has multiple variants of a plan and ECP lists need to be trimmed to ensure that only the most current and relevant plan is listed. 

A similar set of steps also works from within the "ECP Notes" tab of the Chart Review activity.

Inactivating Exceptional Care Plans

There may be use cases where a particular ECP is no longer valid or pertinent to a patient's care, but there is clinical value in continuing to have the ECP listed (e.g., for historical reference). To "expire" or otherwise invalidate an ECP that will continue to display, edit the ECP as described above. The expiration date and validity attributes should be changed before saving, not deleting, the changed ECP.

Copying Exceptional Care Plans to Primary Care and Other Providers

Route ECP to Provider(s)

As illustrated in the ECP 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) with the ECP filter activated, selecting a row corresponding to the ECP of interest, then using the "Route" button to select one or more providers for receipt. Covering comments can be added. 

Link to ECP for Notes

Using the same Notes tab within the Chart Review activity, users can right-click over an ECP of interest, select the "Copy Link" option from the pop-up menu, then paste the copied link into other clinical documentation (e.g., progress note). The embedded link can be selected by a reader to display the full ECP in a pop-up window.

Resources