P R O F. K I S H O R E K U M A R .

COLLEGE OF NURSING

EMS MEMORIAL CO OPERATIVE HOSPITAL AND RESEACH CENTRE

PERINTHALMANNA

NURSING DOCUMENTATION
F-DAR
A DAR
 This Session is to simplify F-DAR
and to answer the following:

• What F-DAR charting is?

• Why F-DAR charting is used?
• How F-DAR charting looks like?
• Explain sections of F-DAR charting?
• Exemplify different F-DAR charting scenarios?
• Catalog the Dos & Don'ts of F-DAR charting?
• When to use FDAR charting?
 F-DAR CHARTING
A handy way to chart and save time
• A great charting method for nurses who have a lot of
patients, along with other disciplines.
• Geared to save time and decreases duplicate
charting.
• It is easier to read by other professionals like
nutritionists, occupational therapist, Physiotherapist,
Physician Assistants etc and gives them a snapshot of
what went on during a nurses’ shift in a concise
manner.
• Most health care settings are requiring disciplines
now to document in the F-Dar format.
 PURPOSE OF F-DAR CHARTING
To
1. Ensure Holistic emphasis on patient and Patient
priorities.
All APPROPRIATE, RELEVANT & AVAILABLE information
should be included to ensure complete documentation.
2. Easily identify critical patient issues / concerns in the
Progress Notes.
3. Facilitate communication among all disciplines.
4. Improve time efficiency with documentation
- Ease in documentation.
5. Provide concise entries that would not duplicate patient
information .
-already provided on flow-sheet / checklist.
 F-DAR CHARTING
Focus on a specific patient problem, concern, or event
A systematic approach to documentation.
Method of organizing health information in an individual's
record.
Brings the focus of care back to the client, client concerns
and Patient strengths.
Describes the patient's perspectives and focuses on
documenting the patient's current status, progress
towards goals, and response to interventions.
Instead of a problem list or list of nursing and medical
diagnosis, a focus column is used that incorporates many
aspects of patient and patient care.
 ELEMENTS of FOCUS CHARTING
Three columns are used in Focus Charting for documentation
Date and Hour: (FIRST COLUMN) eg: 22/2/2018, 8:00pm
Focus (SECOND COLUMN)
Progress Notes (THIRD COLUMN) organized into DAR
Contain information only related to the focus
F-DAR stands for Focus Data Action Response
F - Focus
D - Data
A - Action
R - Response
F-DEAR
F - DA R E
F - DA RT
 FORMAT of FOCUS CHARTING
Date &
Time
Focus Progress Notes
Date D: -----------------------------------------------------
Time ----------- --------------------------------------------------
--------------------------
Name (initials) / Designation / Signature
Date A:------------------------------------------------------
Time --------------------------------------------------
------------------------------.
Name (initials) / Designation / Signature

Date
Time R: -----------------------------------------------------
------------------------------------------------.

Name (initials) / Designation / Signature

 FORMAT of FOCUS CHARTING

Date &
Focus Data Action Respone
Time

Teaching /
Evaluation
etc

Name (initials) / Designation / Signature

 F-DAR CHARTING
Focus

Identifies the Subject / content or

purpose of the narrative entry.
Focus is separated from the body of the
notes in order to promote easy data
retrieval and communication.
 F-DAR CHARTING
Focus
eg: Pain
Chest Discomfort
Hyperthermia
Nausea Vomiting
Fatigue
Skeletal Traction
Discharge plan
Ineffective breathing pattern
Impaired Skin Integrity
‘Patient's Condition Unchanged,
No Improvement, No Declination’
 F-DAR CHARTING - Focus
The common topics of focus can be:
Nursing diagnosis / NOT A Medical diagnosis
Patients’ concerns and behaviors
Patient strength, problem, or need
code blue, vomiting, coughing
Therapies and responses
Significant events such as
admission, transfer, discharge, teaching,
consultation, monitoring,
Management of activities of daily living
Assessment of functional health patterns. etc.
 F-DAR CHARTING
Data
Supporting evidence for writing the progress note.
Like the assessment phase of the nursing process.
Statements contain objective/ subjective information
and assessment cues written in narratives.
Subjective:
What the patient says
Things that are not measurable
Observations noticed from patients’ behaviors.
Objective:
What you assess / findings, vital signs
Things that are measurable
Letting the reader know
“this is what the patient is saying and what I’m seeing”.
 F-DAR CHARTING
A c t i o n - the “verb” area
Reflects planning and implementation phase
of Nursing Process.
Statements include Past, Present, immediate and future
nursing actions and changes to the plan of care.
Write here what you did about the findings
in the data part of the progress note.
This includes
Nursing interventions
Basic, Perspective & Independent Nursing Interventions
- Administering Medications - Routine care / Bedside care
- Repositioning - Serving diet / Feeding - Monitoring
- Health teaching - Applying traction - Calling Doctor
Collaborative orders etc
 F-DAR CHARTING
Response
Reflects evaluation phase of nursing process
Describes how the care plan goals have been attained
Describes Evident patient outcomes or response
to any nursing and medical care
Write how the patient responded to your action.
eg: Temperature decreased from 38.9 to 37.1 OC (axilla)
Patient Denies Pain Rating of pain at a score of 2 out of 5
Patient states feels less nauseated, no vomiting.
Patient condition stable, HR 84/Min, B/P 110/56 mm of Hg, RR18 /Min
Patient states “I can understand the plan now”
Documented each time after administering PRN medications
Sometimes, you won’t chart the response
for several minutes or may chart hours later
FOCUS CHARTING - GENERAL GUIDE LINES
Must be Evident at least once in every shift.
Must be patient- oriented not nursing task- oriented.
Sign / Name / Designation or Code for every time entry.
e.g. s/d, PK Kumar, Staff Nurse, 2259).
Document only the relevant and hence no general notes.
eg: patient’s concerns, plan of care, health status etc
Document patient’s status on admission, for every transfer
to / from another unit or discharge.
Begin with comprehensive assessment of the patient using
inspection, palpation, percussion, and auscultation.
Collect information from the patient, family, existing health
records (such as checklist/flow sheets, laboratory results
and other health care providers.
 FOCUS CHARTING - DO’S
1. DO time and date in all entries.
2. Use flow sheet / checklist to keep current information
3. Chart as you make observations.
4. Be factual and complete. Record exactly what happens to patient,
care given and response to care.
5. Describe patient's current status, patient's behavior and use
direct patient quotes.
6. Write your own observations and sign your own name and initials
for every entry.
7. Draw a single line thru an error. Mark this entry as “error and-sign
your name.”
8. Use only approved abbreviations and accepted chart forms.
9. Use next available line to chart.
10. Write legibly.
11. Use ink.
8Hrs shift: Morning: Blue, Afternoon: Black, Night: Red.
12 Hrs shift: Morning: Blue or Black, Night: Red
 FOCUS CHARTING - DONT’S
DON'T begin charting until you check the name and MRD No/IP No
on the patient's chart on each page.
DON'T chart procedures or cares in advance.
DON'T clutter notes with repetitive or frequently changing data
already charted on the flow-sheet /checklist.
DON'T make or sign an entry for someone else.
DON'T change and entry because someone tells you.
DON'T cover up a mistake or incident by inaccuracy or Omission
DON'T “white out” or erase an error.
DON'T throw away notes with an error on them.
DON'T squeeze in a missed entry or “leave space” for someone
else who forgot to chart.
DON'T write in the margin.
DON'T use meaningless words/phrases “good day”, “no complaints”
DON'T use notebook, paper or pencil for documentation.
 Focus Charting (F-DAR) Samples
PAIN
Date &
Time
Focus Progress Notes
28/02/18 D: Patient requested pain medication for incisional pain
08.00 PM PAIN in right groin. Patient is on first post operative day
after right heart catheterisation. Rated a pain scale
score of 8 out of 10.
A: Administered Lortab 5/325 mg PO. Repositioned
patient for comfort to supine position.
Name (initials) / Designation/ Signature
09.00 PM
R: Rated a pain scale score of 2 out of 10.
Name (initials) / Designation/ Signature

Note how the note was first written at 08.00 PM.

and the response was written later at 09.00 PM.
 Focus Charting (F-DAR)
PAIN
Date &
Time
Focus Progress Notes
20/02/18 D: Reports of continuous sharp pain in mid abdominal
5.00 PM incision area Crying – “ I need something for pain now”.
PAIN Facial grimacing, Guarding behavior, Restless and
irritable. Rated a pain scale score of 9 out of 10.
Name (initials) / Designation/ Signature
5.15 PM
A: Administered Celecoxib 200mg IV . Encouraged deep
breathing exercises and relaxation techniques.
Repositioned on right side . Placed pillow to abdomen
to help splint the wound. Kept patient comfortable and
safe.
Name (initials) / Designation/ Signature
5.30 PM
R: Patient reports pain relief and stated “Much better
now”.
Name (initials) / Designation/ Signature
6.00 PM
R: Rated a pain scale score of 2 out of 10.
Name (initials) / Designation/ Signature
 Focus Charting (F-DAR) Samples
CHEST DISCOMFORT
Date &
Time
Focus Progress Notes
20/02/18 D: Mid-clavicular line pain rated 4 out of 5 on a
9.55 AM
Chest pain scale.
Name (initials) / Designation/ Signature
Dis -
10.00 AM A: Medicated with Isordil 5mg.
comfort Name (initials) / Designation/ Signature

10.30 AM A: Assessed chest pain, Rated 2 out of 5 on a pain

scale.
Name (initials) / Designation/ Signature

10.45 AM
R: Resting in bed. Patient stated “I am feeling
better now”. Rating of pain at a score of 2 out of
5 on a pain scale.
Name (initials) / Designation/ Signature
 Focus Charting (F-DAR) Samples
HYPERTHERMIA
Date &
Time
Focus P ro g re s s N o te s
25/02/18 Hyper- D: Temperature of 38.9OC (axilla). Skin is flushed and
8.00 AM
thermia warm to touch.
Name (initials) / Designation/ Signature

8.10AM A: Tepid Sponge Bath done. Let patient wear loose

clothing. Educated regarding soft food rich in
Vitamine.C such as oranges. Encouraged adequate oral
fluid intake.
Name (initials) / Designation/ Signature
8.30 AM
A: Administered 250mg IV Paracetamol as per order.
Encouraged adequate rest.
Name (initials) / Designation/ Signature
9.00 AM
R: Patient able to rest. Temperature decreased from
38.90C to 37.1OC (axilla)
Name (initials) / Designation/ Signature
 Focus Charting (F-DAR) Samples
Shortness of Breath
Date &
Time
Focus P ro g re s s N o te s
25/02/18 Shortness
8.00 PM D: Increase respiratory rate of 24 / Min.
of Breath
Use of accessory muscles to breath.
Presence of nonproductive cough.
SaO2: 90%, BP:100/60
Name (initials) / Designation/ Signature
8.00 PM
A: Elevated Head end of Bed to high fowlers position
Name (initials) / Designation/ Signature

8.05 PM A: Applied 2L O2 nasal cannula

Name (initials) / Designation/ Signature

8.45 PM R: SaO2 : 95%, RR : 20/Min,

Patient denies Shortness of breath,
Resting comfortably
Name (initials) / Designation/ Signature
 Focus Charting (F-DAR) Samples
FATIGUE
Date &
Time
Focus P ro g re s s N o te s
25/02/18 FATIGUE D: Less movement noted with verbalization “__________”
8.00 AM Name (initials) / Designation/ Signature

A: Morning care done. Monitored vital signs and charted.

8.00 AM Regulated IVF and charted. Assessed patient needs and
morning care done. Advised SN to always stay on patient
bedside. Promote proper ventilation and a therapeutic
environment. Elevated the head of the bed (moderate high
back rest). Provided comfort measures for patient to rest.
9.45 AM Due medications given. Name(initials) /Designation/ Signature
A: Tepid sponge bath done, Let patient wear loose
clothing and provided a blanket.
Name (initials) / Designation/ Signature
12.30 PM
R: Patient demonstrted independence in selceted ADL
dressing and feeding. Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
POINT OF CARE FOR PNEUMONIA
Date &
Time
Focus P ro g re s s N o te s
25/02/18 POINT
8.00 PM
D: Diagnosis of pneumonia, History of COPD, Sinus
OF CARE rhythm on monitor. BP 134/85 mm of Hg, RR : 19/
FOR min, Oral temp 97.60F.
8.10 PM PNEUM Name (initials) / Designation/ Signature

ONIA A: Patient on 1L O2 via Nasal canula. Saturation

between 92-94% throughout shift.
Name (initials) / Designation/ Signature

11.45 PM R: Unchange in baseline status, appears in no

distress.
Name (initials) / Designation/ Signature
26/02/18
12.30 AM E: Continue with Point of Care.
Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
DISCHARGE PLAN
Date &
Time
Focus P ro g re s s N o te s
25/02/18 DIS-
12.00NOON CHARGE
D: Discharged order given by Dr.Name/Time
Name (initials) / Designation/ Signature
PLAN
A: M – advised SN to give the due medications.
03.45 PM E – encouraged to maintain house & surroundings clean.
T – advised on follow-up consultations
H – encouraged to do chest tapping to facilitate mobilization
of secretion.
O – observed for signs of super infections such as fever,
black fury tongue and foul odor discharges.
D – encouraged to eat fresh vegetables and fish
S – advised to continue spirituality
Name (initials) / Designation/ Signature
4.00 PM
R: Patient out of the room per wheelchair with
improved condition.
Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
DISCHARGE PLAN
Date &
Time
Focus P ro g re s s N o te s
25/02/18 DIS-
12.00NOON CHARGE
D: Discharged order given by Dr.Name/Time
Name (initials) / Designation/ Signature
PLAN
A: H – Health Teaching
03.45 PM
A– Anticipatory Guidance
S- Spirituality
M- Medications
I– Incisonal care
N- Nutrition
E- Environment
Name (initials) / Designation/ Signature

4.00 PM R: Patient out of the room per wheelchair with

improved condition.
Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
Impared Skin Integrity – Plaster Cast
Date &
Time
Focus P ro g re s s N o te s
25/02/18 Impared
12.00NOON
D: "I broke my wrist when I fell down from
Skin stairs”. Hair: loss of pigment, oily. No Blanching,
Integrity wrinkles around oral cavity, eyes, Dry skin,
– Plaster petichiae on right/left ankles, reduced tugor,
edema 2, casted wrist dry, warm.
Cast Name (initials) / Designation/ Signature
01.45 PM
A: Educate client about using emolient for dry
skin, hydration, hair care for oiliness, sunscreen.
Name (initials) / Designation/ Signature

3.00 PM R: Continue to monitor casted wrist, monitor

input/output, continue to monitor vital signs.
Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
VOMITING
Date &
Time
Focus P ro g re s s N o te s
25/02/18 VOMITI D: Patient states is unable to keep anything
12.00NOON
NG down for 24 hours and is just throwing up
"yellow stuff". Color pale, skin warm and dry,
mucous membranes dry, tugor fair.
Name (initials) / Designation/ Signature

A: Vital signs Monitored, Due medications

01.45 PM
given.
Name (initials) / Designation/ Signature

R: Patient states feels less nauseated, no

3.00 PM Vomiting. urine obtained. continue to monitor
vital signs. HR 84/min, B/P 110/56mm of Hg,
RR18 / min.
Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
Nausea
Date &
Time
Focus P ro g re s s N o te s
25/02/18 D: “I feel like my stomach is filling up with pressure again
12.00NOON
Nausea and I’m nauseated.” Abdomen round and soft, gastrostomy
bag at body level. Rare bowel sounds.
Name (initials) / Designation/ Signature

012.15 PM A: Gastrostomy bag lowered.

Name (initials) / Designation/ Signature

R: “I feel like better now.” Approximately 200 cc golden

12.30 PM fluid returned along with flatus.
Name (initials) / Designation/ Signature
A: Kept gastrostomy bag at body level. Bag is
tolerated at body level. Monitored abdominal status. No
4.00 PM discomfort noticed. Patient instructed to call the staff-nurse
when he is uncomfortable.
Name (initials) / Designation/ Signature
R: Patient said “I can understand the plan now.”
4.30 PM Name (initials) / Designation/ Signature
 Focus Charting (F-DARE) Samples
PATIENT'S CONDITION UNCHANGED,
NO IMPROVEMENT, NO DECLINATION
Date &
Time
Focus P ro g re s s N o te s
25/02/18
6.00AM
D: saO2 90%, RR 28, BP 100/60, T 98.6,
PATIENT'S HR 98
CONDITION Name (initials) / Designation / Signature
UNCHANGED,
06.15 AM A: no changes, continue to follow care
NO
plan
IMPROVEMEN
Name (initials) / Designation / Signature
T, NO
8.30 AM DECLINATION R: patient condition stable, resting
comfortably.
Name (initials) / Designation / Signature
 Focus Charting (F-DAR) Samples
SKELETAL TRACTION
Date/Hour 03/08/08 :00PM
Focus: Skeletal Traction
Progress Notes
D: 8:00PM : Received lying on her bed conscious and coherent
with skeletal traction @ left leg
with long arm posterior mold @ right arm
vital signs taken and recorded
A: 8:00PM Bedside care done, back kept dry.
Placed in a comfortable position
` Maintained alignment of extremities
Served diet as tolereted and consumed with fair appetite
kept traction weights hanging freely
Endorsed with latest Vital signs
T: Health teachings imparted with emphasis on importance of :
proper positioning to promote lung expansion
proper hygiene to promote sense of well being
eating nutritious foods
R: 09:00PM Patient Kept well rested
Name (initials) / Desiganation / Signature
 Focus Charting (F-DAR) Samples
Post Procedural Assessment of Patient
CHART JUST DATA, WHEN PURPOSE OF NOTE IS TO DOCUMENT
ASSESSMENT FINDINGS & THERE IS NO FLOW SHEET/CHECKLIST FOR THAT.
Date &
Time
Focus Progress Notes
Post D: Received from the RR via
03/01/08
Procedural stretcher. Awake and alert, vital
2.00 PM
Assessment
transfer signs stable, IV right
of Patient
forearm, foley catheter in place
with clear yellow urine. Dressing on
RLQ is clean and dry moving all
extremities voluntarily “Minimal
incisional pain” Pain rating of 3 out
of 10.
Name (initials) / Desiganation / Signature
 Focus Charting (F-DAR) Samples
POST PROCEDURAL TRANSFER
A patient back from a thoracentesis back from the procedure
 Begin the note with ACTION
when the patient’s interaction begins with intervention
or when including date would be unnecessary repetition.
Date &
Time
Focus Progress Notes
Patient A: Patient instructed on actions and side
03/01/08
Teaching – effects of Digoxin. Given information
2.00 PM
Drugs leaflets. Discussed when to report on side
effects / complications.
(Digoxine) Name (initials) / Desiganation / Signature

2.30PM
R: Return demonstration of radial pulse
palpation seen. Patient stated: “I can
understand the purpose of medication.”
Name (initials) / Desiganation / Signature
 F-DART CHARTING - Teaching
Medication Education
Chart by with Action (A) and Response (R ), if it is unnecessary to
repeat the data or interaction with patient.
eg: discharge teaching or patient education
Response was written later when patient actually redemonstrated.
 F-DART CHARTING - Teaching
HOW TO CHART A RESPONSE ALONE:
Charting the D and A would be redundant and pointless,
document just the R
eg: When patient has met a goal on care plan on demonstrating how
to properly use the incentive spirometer.
 F-DART CHARTING - Teaching
HOW TO CHART A RESPONSE ALONE:

Date &
Time
Focus Progress Notes
03/01/08 Patient R: Patient
demonstrates he is able
2.00 PM Teaching to change his own abdominal
– dressing using aseptic
Dressing technique.
Name (initials) / Desiganation / Signature
Change
F-DARE / F-DEAR CHARTING
Evaluation
When the purpose of the progress notes
is to evaluate progress toward the
defined patient outcome
 When is FDAR necessary
1. To describe a patient problem/ focus/ concern as per plan of care.
2. To document an unusual episode or significant event in patient
care.
(a) responsibility for patient care changes from one Dept to
another
eg: Admission, admission status,
Pre-transfer assessment
Discharge planning, Discharge status etc.
(b) a significant treatment / Intervention took place.
eg: Pre procedure assessment, Post procedure assessment,
Transfusion of RBC , Beginning of thrombolytic therapy,
PRN medications etc
3. To document an acute change in patient's condition or new event
in patients’ condition.
eg: Respiratory distress, Seizure ,Code blue etc
 When is FDAR necessary
4. To document new findings, new sign or symptom or a new
behavior which is the current focus of care.
A “temporary foci” that are uncertain whether important or can
be quickly be resolved without incorporating in plan of care.
These are also valuable information to be communicated
to the health care team.
5. To identify an exception to the expected outcome
when the significant finding or an outcome is not expected.
6. To document an activity or treatment that was not carried out
when a treatment or activity in the flow sheet was not provided
to the patient or was different from the standard of care.
7. To describe all specific patient /family teaching.
8. To identify the discipline making the entry as well as topic of the
note, especially when all team members use same case record.
eg: Dietitian: Instruct low fat diet , Physiotherapist: Crutch walking
 CONCLUSION
F-DAR is a concise and easy way of charting.

It takes some practice to the get use to and I

highly encourage that during clinical and
orientation time you take ample time to
practice charting.
 THANK YOU
FOR YOUR PATIENT
LISTENING
KISHORE