A Quick Summary on Care Plans

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One of the most important parts of being an emergency nurse is understanding that the nurse manages the patient’s care much more independently than in some other areas.  Often it is the nurse who is driving the patient’s visit forward, checking results and communicating them to the team.  Although all of those roles are found in other hospital areas, the “timing cycle” in the emergency department of minutes (not hours or days) often means that the nurse is having to gather information and results and communicate them much faster and more frequently than in other areas.

The EPICC framework separates planning into two phases — the next 30 minutes and the next 60 minutes.

The purpose of the 30 minute plan is to be clear about what the “POP” for the patient is – Problems, Objectives and Plan.

Problems

Clear communication and documentation of the current patient’s issues and what is being done to resolve them.

Objectives

This is what expectations the team has for the patient’s vital signs for the next 30 and 60 minutes.  Some examples:

• Heart rate below 100
• Resolving Fever
• Urine Output of 30cc/hr

It is important that the team attempt to be as objective as possible when defining these end points so that it is clear whether the objectives are being achieved.

Plan

Clear direction as to what the planned priorities are and what the next steps to the patient’s stay are.  As an example:

• In the next 60 minutes we need to (in order) get a chest x-ray, get an ECG and bloodwork, go to CT Scan and have the neurologist come to see the patient.