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
Adding the "ECP Note" column to any Emergency Trackboard (ED), Patient List (IP) or Appointments list (OP). This shows whether there are any non-deleted ECPs associated with a patient. Hovering over the "P" icon produces a list of related-encounter ECPs and double-clicking produces a full text display of all patient-associated ECPs.
The "++AHS IP MD ED CONSULTS TEMPLATE++" patient list template, applied to any new or existing patient list, includes the ECP Note column.
Chart Sidebar (rightmost section)
Look to the chart Sidebar (right most column when a chart is opened), then select "Notes" from the index (top of Sidebar), then observe clickable links for opening the ECP Chart Activity, displaying a popup list of related-encounter (ED, IP, OP) ECPs, displaying a popup display of the full text of all non-deleted patient-associated ECPs, performing a Chart Search for ECP-related materials and generating a new ECP note.
Look for an list of related-encounter Exceptional Care Plans within the Notes sidebar.
Chart Storyboard (leftmost section)
Note the ECP alert appearing in the patient Storyboard of an open chart. This is present if there are any patient-associated ECPs. Hover and click behaviours replicate patient list column functions.
Chart ECP Activity
Use Chart Search to "Jump to" the Exceptional Care Plan chart activity, or seek the activity among the tab options for any opened chart.
The ECP activity instructions are at the top of the activity display and have interactive links to a number of ECP tools and functions.
An ECP note generating section follows the instructions (see tip sheet below).
The bottom section oif the ECP Activity lists the full text of all ECPs together with links for more focused display and editing of individual ECPs.
Chart Review Activity
Use the Chart Review activity within any opened chart, then the "Notes" tab and a checkbox for a quick filter for notes of the "Exceptional Care Plan" type.
Note that multiple ECPs are, by default, sorted by the date of the encounter when the plan was first entered ("Service Date" column) but can also be sorted by the most recently edited or updated ECP (click on the "Note Date" column).
Personalization options for this Notes display allow defaulting the ECP quick filter to "always on" and defaulting the sort method to use "Note Date" instead of "Service Date".
Chart Search
Use Chart Search to search for the phrase "Exceptional Care Plan" to produce a list of all ECPs attached to a patient chart.
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 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" 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.
Deleting Exceptional Care Plans
Inactive ECPs can be deleted. This is recommended when a patient has (had) multiple variants of a plan and ECP lists need to be trimmed to ensure that only the most current and relevant plan is listed.
Open or jump to the ECP activity, as described above (chart search on “exceptional” is easiest).
Use the link to display the full text of all ECPs in a popup window.
Select a speific note by using the link that appears just below its title. The note will be opened within the encounter that generated it and editing links will become available.
If the current user is the author of a selected ECP, a “delete” link will appear. If not, use the “Addend” link to open then save the ECP. The “delete” link will then become available.
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 popup 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 popup window.