Nurseweek/Healthweek|Good Question:New methods of patient assessment

	November 6, 1998 Q: My hospital is going to implement a new method of charting. I’m used to writing narrative, and we are switching to PIE method charting. I think I need to improve my writing plus my assessment skills. A: It is always stressful to know that you will need to change one of the basic components of nursing practice, the way to document the care you give. However, I think you’ll find the PIE (problem, intervention, evaluation) method simple, efficient, and easy to learn. The PIE method is used in conjunction with a care planning system that is based on identifying patient problems or making nursing diagnoses. The nurse assesses the patient’s needs, identifies these needs as problems, and develops interventions and a plan of appropriate care. This is the nursing process in action. The PIE documentation system provides a concise and organized way of addressing patient progress. In charting, the problem statement (P) can be similar to the problem noted in the care plan, or it can be a more specific explanation of a problem occurring at a particular time. The documentation of the interventions (I) should reflect the care you actually provided. The care plan might list several interventions that can be provided to help the patient with pain management, such as types of medication, diversionary techniques, alternative therapies, and activities. But your documentation on this problem would include only those interventions you provided at the time. The evaluation statement (E) is your analysis of how the interventions worked. Use your assessment skills to determine the outcomes of the interventions. An example of the documentation of this type of problem using the PIE format is: 1 p.m. P#1: Patient complains of increasing pain when trying to cough and deep breathe. I: Gave po medication, repositioned with pillows to support abdomen, and gave instructions re waiting a half hour to allow pain medication to be effective. E: Pt stated pain was better after 1 hour, C&DB was completed, using pillow splint, x2 after medication. This organized documentation method allows care providers to track the patient’s progress more easily—you can just look for all the entries on P#1—and determine whether revisions to the care plan are needed. If you have concerns about your assessment skills or documentation system, bring them to the attention of your manager and educator. You may also want to take a home study course to brush up on these areas of practice. Q: I’d like to work in managed care, utilization review, auditing, or anyplace that deals with insurance. What do you suggest I do about entering this field? A: One of the nice things about being a nurse is the variety of opportunities we have available to us. Even though we seem to hear a lot of complaints about the managed care system, it has opened many new doors for our profession. One of the best preparations for your goal to transition into managed care is to work as a case manager or in the case management/outcomes department in an acute care hospital. In these roles you learn the ins and outs of the insurance business, the federal and state regulations related to healthcare coverage, billing and coding information, and all you ever wanted to know about mandatory paperwork relating to these areas. You also learn about billing and accounting systems in hospitals and the correlation between documentation in the medical record and the services covered by various insurance plans. If working in this capacity is not possible for you, then I suggest looking for educational offerings. Many hospitals, colleges, and CE providers offer certificate programs in case management. Or look for classes or home study courses in case management, utilization review, medical records coding, and other related topics. You could call the education department at your local hospital or check with some of the larger managed care companies in your community to see if they offer classes.


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Submit your questions Ericka Waidley, MSN, RN, has more than 20 years of healthcare experience as a clinician, a front-line manager, and an executive. She welcomes your questions. Send them to editor@nurseweek.com and title them Good Question. Or fax your question to (408) 249-3756. You must include your name and phone number, but they won’t be published.