By Francis Fagjot John

“Today, a major challenge for nursing today is incorporating the best available evidence into the aides workflow and care processes. HOPe Africa is working with folks in developing countries andNigeriato reinvent this very important approach in the healthcare industries, which is an essential and feel considerate to educate the community and society. However, we are looking at simple and affordable healthcare approach, sometimes, this based on the available resources. To effectively leverage evidence to improve practice, increase patient safety, and meet regularly and credentialing standards.”

Plan of Care is an essential part of healthcare, but is often misunderstood or regarded as a waste of time. Without a specific document delineating the plan of care, important issues are likely to be neglected. Plan of Care provides a “road map” of sorts, to guide all who are involved with a patient/resident’s care. The care plan has long been associated with nursing, and many people believe (inaccurately, in my opinion) that is the sole domain of nurses. This view is damaging to all members of the team, as it shortchanges the non-nursing contributors while overloading the nursing staff. To be effective and comprehensive, Plan of Care must involve all disciplines that are involved in the care of this patient/resident.

The first step in Plan of Care is accurate and comprehensive assessment. In the acute care setting, a thorough admission nursing assessment should be followed by regular reassessments as often as the patient’s status demands.


Remember that the ultimate purpose of the care plan is to guide all who are involved in the care of this person to provide the appropriate treatment in order to ensure the optimal outcome during his/her stay in their residence. A caregiver unfamiliar with the patient/resident should be able to find all the information needed to care for this person in the care plan.


Observation: Observation care spans the gap between outpatient and inpatient care. Observation care is appropriate as indicated by care requirements when it is beyond the scope of a usual outpatient care episode, but is expected to be short term (less than 24 hours). Observation care is unscheduled and unanticipated. Observation care may be appropriate for diagnostic evaluation that is needed or for acute treatment and response evaluation needed (e.g., drug interaction) or monitoring of an event (e.g., arrhythmia) or recovery (e.g., for drug ingestion). During the observation period, the Member must be under the care of a physician, as documented by admission, discharge, and other appropriate progress notes that are timed, written and signed by the physician. Usually, at the end of observation care, the patient is either discharged to non acute care follow up or is admitted for acute inpatient care.


Observation may be appropriate for a patient with ALL of the following:

  • Observation care is appropriate as indicated by care requirements that are ALL of the following:
    • Beyond the scope of a usual outpatient care episode
    • Expected to be short term (less than 24 hours)
    • Appropriate for observation care as indicated by ANY ONE of the following:
      • Diagnostic evaluation needed
      • Acute treatment and response evaluation needed (e.g., drug reaction)
      • Monitoring for event (e.g., arrhythmia) or recovery (e.g., from drug ingestion)
  • Observation care is needed for ANY ONE of the following:
    • Signs, symptoms, or other findings appropriate for further evaluation or treatment; examples include:
      • Significant adverse reaction to treatment or procedure
      • Unstable condition
      • Cardiovascular abnormalities (e.g., hypertensive urgency)
      • Respiratory abnormalities (e.g., croup, bronchiolitis)
      • Neurologic abnormalities (e.g., unexplained abnormal mental status)
      • Electrolyte or metabolic derangements (e.g., sodium greater than 150 mEq/L)
      • Injuries (e.g., snake bite, head trauma)
      • Control of severe vomiting or temperature abnormalities needed
      • Severe pain requiring acute management as indicated by ALL of the following:
        • Continuous or frequent (e.g., every 2 to 4 hours) parenteral narcotics required
        • Rapid improvement expected from treatment or acute intervention (e.g., anesthesia procedure)

Observation time begins at the clock time, documented in the patient’s record, which coincides with the time the patient is placed in a bed for the purpose of initiating observation care in accordance with the physician’s order. Observation time ends when the patient is actually discharged from the hospital, or admitted as an inpatient. The medical record must include documentation that the physician explicitly assessed patient risk to determine that the patient would benefit from observation care.


It would appropriate that policy makers and the government, including stakeholders meet regularly to review, compare notes and update existing laws for the benefit of the people they serve, and possibly setup regulatory bodies with commensurate powers to keep set standards. Observing these methods and measures would uphold Plan of Care; A Healthcare Essential and gain people’s confidence in quality service provision.



Francis Fagjot John

HOPe Africa

International Representative

P O Box46254

Kansas CityMO64134

United States of America