Evaluating a plan of care: continue, change or escalate
Four questions that tell a practical nurse when to continue, change or escalate a plan of care. With a worked example of three clients.
- A plan names a result and a time for it.
- Every check ends in continue, change or escalate.
- A result that does not come on time needs a report.
A plan of care is right until the client changes. To evaluate a plan, ask if the client is moving toward the goal, and then decide to continue, change or escalate. This guide gives the four questions and one worked example.
What a plan of care says
A plan says what the client needs, what you will do, and what result you expect, by when. You set your priorities at 07:30, and by 10:30 your clients have changed, so you check each plan against what is happening now.
Four questions for each plan
- Is the client moving toward the goal?
- Is the plan still safe for this client?
- Is anything overdue, or no longer needed?
- Who needs to know?
Every answer ends in one of three decisions.
| Decision | When |
|---|---|
| Continue | The plan is working. |
| Change | The goal is right, and the approach or the pace is wrong. |
| Escalate | The expected result did not come, and the plan itself has to change. |
When to check your plans
Look across all your clients at four moments: after report, after your first assessments, after any change, and before you hand over.
A worked example: three clients at 10:30
It is 10:30, and you have three clients.
- Client J had abdominal surgery yesterday. The goal is pain at 3 or less. The analgesic was given an hour ago, and the pain is still 7. Client J will not walk.
- Client K is three days after a hip replacement, and walked to the hallway this morning with a steady gait.
- Client L was admitted with dehydration. The goal is 1500 mL by mouth today. So far, client L has had 150 mL.
Client K's plan is working, so you continue.
Client L has the right goal and the wrong pace, so you change the approach. Offer preferred fluids at set times, record the intake, and report if it stays low.
Client J's result was due within the hour, and it did not come. Now the pain is blocking the next goal, which is walking. Reassess, and then report it, so the plan can change. That is escalating.
The check can change your first priority
Client J is also your first priority now. Nobody here has a threat to life, and client J has a real problem that gets worse with waiting.
This guide follows the Medibara lesson “Is the plan still right”.