TREATMENT PLANNING TUTORIAL
Commonly Used Items
ü Opening and developing a new preliminary plan
ü Adding, removing problems, medical concerns, short and long term goals
ü If the desktop icons are not available
ü Using plans from previous admissions or other patients
ü Known errors (and workarounds)
Preliminary plan begun within 24 hours of admission; however the practice is to complete the preliminary plan as soon as possible
Master plan within 72 hours of admission
Medical concerns are conditions that are currently being treated by the inpatient psychiatrist
Danger to self or others or gravely disabled due to a mental illness. Therefore a typical plan will have two psychiatric problems (1) reason for hospitalization – DTS, DTO, or GD, and (2) underlying cause based in an ‘approved’ mental illness
This format fosters and encourages charting that meets medical necessity
Dates, names, times entered one time…
In change to master plan, unchanged information does not have to be re-entered (included social work interventions)
Number of problems, goals, interventions
Predetermined and customizable problems
Update from preliminary to master, update plan for extended hospitalization, previous to later admit
Ability (later) to incorporate special treatment concerns for treatment refractory individuals developed from prior hospitalizations / experience with client type
Printed hardcopy; most recent electronic version saved; no archival; may continue to use handwritten forms
Repeated and predetermined data; in some cases there are both automatic and manual options
Medical necessity; policies
Update types: (1) Preliminary ® master (2) Previous ® new (3) Adaptation of other plans (4) Later: special purpose concerns and interventions: high profile problems, patient types, diagnoses
Why Windows? Searching patient plans (files) uses Windows and not a dedicated application
· Working with windows – opening, closing, sizing a window, maximizing a window, alternating among open windows, scrolling up or down with either scrollbars or mouse wheel. Ctrl + Home, Ctrl + End moves the focus to the beginning or end of the file list
· Maximizing useful information in a window – using the ‘Views’ tab in Windows Explorer
· Treatment planning implemented in Microsoft Word forms – only those elements of the form that are different for different plans can be edited. There are a number of ways to move the insertion point from field (the elements such as patient name, date, problem statements that must be edited) to field: using the Tab key, using the ¬ ¯ ® arrows, scrolling – with either scroll bars or mouse wheel, moving the ‘cursor’ with the mouse. Ctrl + Home, Ctrl+ End moves the selection point to the beginning or end of the document
· The standard Word ‘menus’ are available but it is strongly recommend that you use only the Treatment Planning toolbar and the standard automation tools provided. The purposes to this are (1) to standardize the planning elements and file names (encourages reuse) and (2) the user’s convenience in entering data
· Use the ‘split’ view to view and cross refer to two parts of a plan at one time
The system is designed to have only one editable plan open at one time. However many read-only plans can be open simultaneously
1. Click the Tx ‘New’ icon on the desktop. Alternate. Click the Tx ‘Folder’ desktop icon. When the folder opens, click the icon labeled Tx ‘New - preliminary’ or ‘New’
2. If asked for a ‘Password to modify,’ click ‘Read Only.’ If given the option, click ‘Enable Macros’
3. A new plan opens, dates are set and a dialog box ‘Pt. Name, Dates, and Type of Plan’ opens
(1) Enter the patient’s name. Note that dates, times, and type of plan are set while loading and will not normally need to be changed at admission. (2) Set the number of psychiatric problems (normally two) and medical concerns. (3) Click Save; if a plan with exactly the same patient name already exists, you will be asked whether you want to overwrite, to change the name or to open the old plan. When asked to ‘Save As’ click ‘Yes.’ If asked, enter the password. (4) Check that dates, names, etc. are what you want them to be. If not change them, Click Save again… (5) Click Exit
4. The focus is set at the plan type. Press the Tab key to move sequentially from field to field (Tab moves forward, Shift + Tab moves back; the mouse pointer can be used to move to another field.) Click ‘Edit’ on the ‘Treatment Planning’ toolbar to highlight the fields that are fillable. The following fields normally need to be filled in
5. Preliminary diagnosis, strengths, elos, prognosis
Problem statement. Click the down arrow and select an appropriate problem. If none of the choices is appropriate, select individualize. Press the Tab key. Enter a problem where it says ‘Enter a custom problem statement here’ and click ‘OK.’ Enter signs and symptoms (AMB) and etiology (R/T)
Goals. You will need to fill the goals; the time frames and target dates should not normally need to be changed. I am hoping that the social workers and activities therapists will fill in their parts of page 3 of the plan
Interventions. There is flexibility here to individualize or combine interventions (for different problems.) Optimal use of planning occurs when page 3 interventions are entered electronically by sw and at. The names of the nurse, md, sw, at normally need to be entered only once
Medications. There is space for upto 14 medications plus a space to enter non-standard orders. At the present time, a separate page will need to be handwritten or typed if this capability is exceeded
6. Click ‘Initialize and Save…’ on the ‘Treatment Planning’ bar if you want to change the number of problems / medical concerns or dates or patient name at any time
7. Click ‘Final Save…’ Click ‘Save’ when you are given an option to Save or Cancel
8. Printing. When ready, click ‘Print…’ on the ‘Treatment Planning’ toolbar. You have the option of printing all pages or any combination of pages. Click ‘Exit’ on the ‘Treatment Planning’ bar. SW/AT may print their part of the plan separately. There is a problem with signatures that may be resolved by having a separate signature page
9. Changes. Changes e.g. errors or actual changes such as medications can be changed either by hand or re-opening the plan (see developing the master plan for how to do this) and typing in the changes
1. Click the Tx ‘Folder’ desktop icon. When the folder opens, click the icon labeled Tx ‘plans.’ Maximize the folder. Click Views, select Details, and then click the Name bar to arrange the plans by patient name
2. Click on the desired plan (file) to open it. If asked for a ‘Password to modify,’ click ‘Read Only.’ If given the option, click ‘Enable Macros.’ When asked, enter your User Name and Password
3. The ‘Pt. Name, Dates, and Type of Plan’ dialog does not automatically open. Open it by clicking ‘Initialize and Save…’ on the ‘Treatment Planning’ toolbar. Changes required:
Treatment plan date and time: click the right arrows to increase, left arrows to decrease. Clicking the button labeled ‘c’ sets the date / time as the current value
Click the ‘Master’ option. Set the number of problems and medical concerns
Click Save, Click ‘Yes’ when asked to ‘Save As’ then click exit
4. Enter the five axis diagnoses and any data items such as elos, prognosis that have not been entered
5. Problems, goals, interventions, medications… may be changed as described under ‘Opening and developing a new preliminary plan’ above
The following items are a repetition from ‘Opening and developing a new plan’ above
6. Click ‘Initialize and Save…’ on the ‘Treatment Planning’ bar if you want to change the number of problems / medical concerns or dates or patient name at any time
7. Click ‘Final Save…’ Click ‘Save’ when you are given an option to Save or Cancel
8. Printing. When ready, click Print on the ‘Treatment Planning’ toolbar. You have the option of printing all pages or any combination of pages. Click ‘Exit’ on the ‘Treatment Planning’ bar. SW/AT may print their part of the plan separately
The easiest way to do this is by clicking ‘Initialize and Save’ and setting the number of problems and medical concerns to what is needed. This is all that should be necessary
Alternative
There is an alternative way to do this that adds or removes only one problem at a time or only one medical concern at a time or only one goal at a time. You can use this if you do not want the number of goals to be determined by the number of problems
To add a short or long term goal:
1. Place the insertion point anywhere in the last goal (short or long depending on what you want to add.)
2. Click the Tab key until the insertion point is on the next line
3. Click the down arrow
4. Select ‘100’
5. Click the tab key
To remove a short or long term goal:
1. Place the insertion point anywhere in the last goal (short or long depending on what you want to remove.)
2. Hold Shift key down and click the Tab key until the insertion point is at the goal number (if you placed the insertion point at the goal number, omit this step)
3. Click the down arrow if necessary to show the options that are a set of numbers and the symbols ‘up’ and ‘dn’
4. Select ‘0’
5. Click the tab key
Comments
Problems and medical concerns may be added or removed in a similar way but this should not be necessary
Selecting ‘up’ instead of a number will interchange the problem or goal with the previous one; select ‘dn’ to interchange with the next problem or goal
Click ‘My Computer’ on the desktop
Click the ‘Folders’ icon
Click the + icon next to ‘F:’
Click SHARED, AM, dir
Select ‘Folder’. With the Ctrl key pressed, select ‘New - Preliminary’ or ‘New.’ With both these icons selected, right click any one of them. Select ‘Send To’ then select ‘Desktop’ from the options. The desktop icons should now be available
The process is as for ‘Developing the master plan’ except that there are additional changes to make
1. The additional changes required include the following
Change the admit date. Clicking the button ‘c’ sets the date to its current value. Right and left arrows increase / decrease the date. Clicking the button labeled ‘d’ changes the label to ‘m’ then to ‘y’ then back to ‘d’ again… When the button is set at ‘d’ the day changes; when it is set at ‘m’ or ‘y’ it is the month or year that changes. Note that when the admit date is changed, the date of the plan also changes
Change the date and time of the plan
Select either ‘Master’ or ‘Preliminary’ option
If you want to read but not modify a plan, use the ‘read only’ version
1. Click the Tx ‘Folder’ icon on the desktop. When the folder opens, click the icon labeled Tx ‘view’ or Tx ‘read only.’ You may now want to maximize the folder and to click Views, select Details, and then click the Name bar to arrange the plans alphabetically
2. Click on the desired plan (file) to open it
1. You may occasionally be asked to save a file of the kind that ends ‘.dot’ and if this happens click ‘No.’ (If you click yes, you may be asked to ‘Save’ and if so, click ‘Cancel.’)
2. If you get an error message, click ‘End’ and try again. Don’t click ‘Debug’.