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 Notes" column to any Emergency Trackboard (ED), Patient List (Inpatient), or Appointments List (Outpatient). This shows whether there are any non-deleted ECPs associated with a patient. Hovering over the "P" icon produces a list of ECP actions that can be selected, including opening the chart to the ECP activity, opening Chart Review to a list of ECPs, or opening a pop-up display of all ECPs. Double-clicking within the column opens the patient's chart to an "ECP Notes" tab within the "Notes" section of the Chart Review activity.
The "++AHS IP MD ED CONSULTS TEMPLATE++" patient list template, applied to any new or existing patient list, includes the ECP Notes column.
Chart Sidebar (rightmost section)
Look to the chart Sidebar (rightmost column when a chart is opened), then select "Notes" from the index (top of Sidebar), then observe clickable links for displaying all ECPs in a dedicated tab within the Chart Review activity (Notes), opening the ECP chart activity, displaying a pop-up display of the full text of all non-deleted encounter-associated ECPs, performing a chart search for ECP-related materials and generating a new ECP note.
Look for a list of related-encounter ECPs 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. Hovering over the Storyboard section produces a list of ECP actions that can be selected, including opening the chart to the ECP activity, opening Chart Review to a list of ECPs, or opening a pop-up display of all ECPs. Clicking within the Storyboard ECP section opens the patient's chart to an "ECP Notes" tab within the "Notes" section of the Chart Review activity.
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 of 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 "ECP Notes" tab. This tab will show only notes of the ECP type, with columns and sorting optimized for working with ECPs.
Note that multiple ECPs are, by default, sorted by the date of last edit of any displayed ECPs.
The "Filter" button and functions can be used to limit displayed ECPs to those associated with particular specialties, authors or departments.
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 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.
Editing work is best initiated from within the ECP Chart Review tab.
Position the cursor/pointer/selector over the ECP of interest, right-click to obtain a pop-up menu, then select the "Edit or Append" option.
This option will not show if the current user does not have ECP editing rights.
The ECP will open for editing within the encounter in which it was originally authored. If that encounter differs from the one that the patient chart is currently opened to, a second instance of the chart may open.
Be sure to "Save" the edited ECP to make it available to others for viewing. "Pended" ECPs are locked to the editing user until "Saved".
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.
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 pop-up window.
Select a specific 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.
Deleted ECPs will no longer appear in chart ECP lists or searches, and they will not trigger Patient List column icons or chart Storyboard alerts.
Deleted ECPs can be examined, if needed, by opening the ECP chart activity and then selecting the "Show Deleted" checkbox within the ECP list appearing below the ECP activity instructions.
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.
Inactivated but non-deleted ECPs will appear in chart ECP lists or searches, and they will trigger Patient List column icons or chart Storyboard alerts.
Inactivated ECPs should be deleted, as above, when no longer needed for clinical reference.
Sending 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.
Pull ECPs into a Note or Letter
The full text of all non-deleted ECPs can be pulled into a documentation object (e.g., progress note, letter) with a SmartLink (".ECPNOTES"). The ECPs will be organized in reverse chronological order.
The full text of the latest non-deleted ECP (with a one year look-back period) can be pulled into a documentation object with a related SmartLink (".ECPLASTNOTE").