FOCUS CHARTING

Leizyl Joy C. Rosete, R.N., M.A.N.

Chief Nursing Officer
September 5, 2018
PRAYER
IT’S FUN TIME!
UNDER A CLEAR BLUE
SKY
 Imagine a clear blue sky without a
cloud in sight. Just thinking about
it should give your spirits a little
lift. Now turn your mind’s eye
down to survey the landscape.
Which of these scenes feels most
calm and relaxing to you?
1. A WHITE SNOWY PLAIN
2. A BLUE SEASCAPE.
3. A GREEN MOUNTAIN.
4. A FIELD OF YELLOW FLOWERS.
 The color blue has power to soothe
the soul. Even a blue image in the
mind can slow the pulse and make
you take a deep breath. Other
colors have significance too. The
scene you pictured contrasted
against that clear blue sky reveals
a hidden talent that resides in the
depths of your untroubled mind.
 1. A white snowy plain.
 You are blessed with a special
sensitivity that allows you to
comprehend situations at a
glance and decipher complex
problems without needing
any proof or explanation. You
have what it takes to be a
clear-sighted decision maker
and even something of a
visionary. Always trust your
first intuitions; they will guide
you well.
 2. A blue seascape.
 You have a natural talent for
interpersonal relations. People
respect your ability to
communicate with others and
the way you help bring
diverse groups together. Just
by being around, you help
others work more smoothly
and efficiently, making you an
invaluable member of any
project or team. When you
say “Nice job, keep up the
good work” people know you
mean it. So it means much
more to them.
 3. A green mountain.
 Your gift is for expressive
communications. You always
seem to be able to find the
words to express the way you
feel, and people soon realize
it’s exactly how they were
feeling too. They say that joy
shared is multiplied while
shared grief is divided. You
always seem to help others
find the right side of the
equation.
 4. A field of yellow
flowers.
 You are a storehouse of
knowledge and
creativity, bursting with
ideas and almost infinite
potential. Keep attuned
to the feeling of others
and never stop working
on building your
dreams, and there is
nothing you cannot
OBJECTIVES:
At the end of the presentation,
the participants will be able to:
1. Explain what focus charting is;
2. Enumerate the Do’s and Don’t’s
in focus charting and
3. Do focus charting.
 PAPER CUT GAME
 This exercise illustrates the
importance of giving meaningful
instructions to others and
expecting feedback for correct
execution of those instructions. It is
fun and quickly makes a point.
 You must follow these quietly
and are not allowed to ask any
questions. You should not get
help from others around you or
even look at other people’s
work.
 Hold up the papers please.
 Fold the paper in half.
 Cut (or neatly tear) off the top right corner
of the folded paper.
 Fold in half again.
 Cut off the top left corner of the paper.
 Fold in half again.
 Cut off the bottom right corner of the paper.
 Fold in half.
 Cut off the bottom left corner of the paper.
 Unfold the paper.
 Now, show off your unfolded
papers to each other and examine
similarities or differences.
 Did you end up with similar
patterns or everyone’s pattern was
different? Why is that? Were the
instructions clear enough? What
was missing? What lessons do we
take from this?
 DID YOU KNOW THAT IMPROPER
CHARTING IS NEGLIGENCE?

 YES!!! IT IS!
WHAT IS FOCUS CHARTING?

- describes the patient’s

perspective
- focused on documenting
the patient’s current status
- progress towards goals
- response to intervention
FOCUS CHARTING PARTS

 Threecolumns are usually used

in Focus Charting for
documentation:

Date and Hour/Shift

Focus
Progress Notes
THE PROGRESS NOTES
Organized into:
(D) data,
(A) action, and
(R) response

referred to as DAR (third column).

FORMAT OF FOCUS CHARTING OR F-
DAR
Date/Hour Focus Progress Notes
9/5/2018 Focus of care, •Data
8:00am this may be: •Action
a nursing •Response
diagnosis,
a sign or a
symptom,
an acute
change in the
condition
behavior
Focus – the problem presented/observed at a
given time.
It could be your Nursing Diagnosis.
Focus of care
a sign or a symptom,
an acute change in the condition
behavior
PROGRESS NOTES

It Makes use of D – A - R
WHAT IS D-A-R?
D is Data
A is Action
R is Response

 Data- the subjective/objective information

supporting the focus at the time of a
significant event.
 Action – the nursing intervention

 Response – the outcome/response to the

nursing intervention.
PURPOSES OF FOCUS CHARTING:
1. It brings the focus of care back to the patient and
the patient’s concerns.

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.

2. The focus might be patient’s strength, problem or

need. Topics that may appear in the focus column
include patient’s concerns and behavior; therapies and
responses; significant events such as teaching,
consultation, monitoring, management of activities of
daily living or assessment of functional health patterns.
 3. The principal advantage of focus charting is in
the holistic emphasis on the patient and his/her
priorities including ease in charting.
GENERAL GUIDELINES:
 1. Focus charting must be evident at least once
every shift.
 2. It must be patient oriented and NOT nursing

task oriented.
 Indicate the date and time of entry on the first

column.
 3. You must sign your name every shift.
GENERAL GUIDELINES
 4. Separate the topic words from the body of the
notes: - Date and time on the first
column
- Focus note written on the second
column
- Data, Action and Response on the
third column
- Document only patient’s concern
and/or plan of care, e.g., health
per shift, hence general notes are
allowed.
- Document patient’s status on
admission, for evwry transfer to/
another unit or discharge.
GENERAL GUIDELINES
 5. Follow the DO’s of documentation
SPECIFIC GUIDELINES
 Begin with comprehensive assessment of
the patient using IPPA: Inspection, Palpation,
Percussion and Auscultation.

 Include in the assessment, collection of

information from the patient, family, existing
health records ( such as checklist/flowsheets,
laboratory results and other health care
providers notes.
SPECIFIC GUIDELINES
 Establish a focus of care to be addressed in
the Progress Notes.

 Document the four elements of Focus

charting as necessary, wherein:
1. Focus- identifies the content or purpose
of the narrative entry and is separated from
the body of the notes in order to promote
easy data retrieval or communication.
SPECIFIC GUIDELINES
2) Data- is the subjective and/or
objective information supporting the
stated focus describing the
observation at the time of significant
event.
3) Action- describes the nursing
interventions (independent, basic and
perspective) past, present and future.
4) Response- describes the patient
outcome/response to interventions or
describes how the care plan goals
have been attained.
 - To document an acute change in patient’s
condition - when there has been an event of
new patient condition.
Example:- Admission
- Pre -(special procedure)
assessment
- Post-(special procedure)assessment
- Pre transfer assessment
- Discharge planning
- Transfusion
- Begin thrombolytic therapy
- PRN medication required
 To identify the discipline making the
entry as well as the topic of the note-
when all members of the patient care
team use one patient program of record.
Example:
- Social Service/financial assistance
- Dietician/instruct low fat diet
- Physical therapist/exercises
 Data statement contain objective
and/or subjective informations.
 Action statement contains only
nursing interventions ( basic,
perspective, independent) past,
present, future.
 Patient outcomes are evident in the

Response statements.
 DAR contain only information related

to the focus, none of the information is

extraneous.
 Example of extraneous:
asleep
watching TV
visited by family
 Information from all these categories(D-A-
R)
should be used only as they are relevant
and available. However, all appropriate
information should be included to ensure
complete documentation.

- Data and Action are responded at one

hour.

Response is not added until later, when

the patient outcome is evident.
DOCUMENTATION DO’S AND DON’T’S
DO’S
- Do read what other providers have written before providing care and
before charting.
- Do time and date all entries.
- Do use flowsheet/checklist. Keep information in flowsheet/checklist
current.
- Do chart as you make observation.
- Do write your own observations and sign over printed name.
- Do describe patient’s behavior.
- Do use direct patient quotes when appropriate.
- Do be factual and complete. Record exactly what happens to the
patient.
- Do draw a single line thru an error, mark it as “ERROR” and sign your
name.
- Do use next available line to chart.
- Do document patient’s current status and response to medical care and
treatment.
- Do write legibly. Do use standard chart forms.
- Do use only approved abbreviations.
 DONT’s
- Don’t begin charting until you check the name and
identification number on the patient’s chart each page.
- Don’t chart procedures or chart in advance.
- Don’t clutter notes with repetitive or frequently changing
data already charted on the flowsheet/checklist.
- Don/t make or sign entry for someone else.
- Don’t change an entry because someone tells you to.
- Don’t label a patient or show bias.
- Don’t try to cover up mistake or accident by inaccuracy
or omission.
- Don’t ”white out” or erase an error.
- Don’t squeeze in a missed entry or “ leave space” for
someone who forgot to chart. Don’t write on the margin.
- Don’t use meaningless words and phrases such as “no
complaints”, “good day”, watching TV.
SAMPLE FOCUS CHARTING
 LET’S HAVE A DRILL
 Patient Information:

Patient Name: Sophia Lorraine Pama Dela Cruz

Age: 52 years old
Sex: Female
Status: Married
Address: Prk. 3, Libertad, Surallah So. Cot
 Patient Sophia’s watcher went to your station
at 10am on September 5,2018 and asked to
see the patient’s condition. The nurse came
and noticed that the patient is having chills.
He immediately took patient’s temperature
and it reads, 38.9 degrees celsius. Drop light
and hot water bag was applied to the patient.
Paracetamol 300mg/amp 1 amp was given as
standing order for high grade fever.
At 1pm, the patient complains LBM and abdominal pain.
The nurse interviews the patient and was able to know
that she has been defecating with non-fouly watery stool
for 5 times already. Upon assessment, the nurse noticed
the patient has dry mouth and sunken eyeballs. Pain
scale of 8/10 was verbalized by the patient. Facial
grimacing was also observed.
Assessment was referred to the AP and ordered the
following:
 Fast drip 200cc of present IVF

 For stool exam stat. refer asap once result is in

 For I and O

 Hyoscine N-Butylbromide (Buscopan) 1 amp IVVT now

 Give Paracetamol 500mg/tab 1 tab q4 RTC

Result has been released and referred to AP. It reveals

that the patient is positive for E. hystolica cyst. She
suffers from amebiasis. The AP ordered, Metronidazole
 GLASS OF WATER
THEORY

A lecturer, when explaining stress

management to an audience, raised a glass
of water and asked, “How heavy is this glass
of water?”
 Answers called out ranged from 8
ounces to 20 ounces.
 The lecturer replied, “The
absolute weight doesn’t matter. It
depends on how long you try to
hold it. If I hold it for a minute,
that’s not a problem. If I hold it
for an hour, I’ll have an ache in
my right arm. If I hold it for a day,
you’ll have to call an ambulance.”
 “Ineach case, it’s the same weight,
but the longer I hold it, the heavier it
becomes.” He continued, “And that’s
the way it is with stress
management. If we carry our
burdens all the time, sooner or later,
as the burden becomes increasingly
heavy, we won’t be able to carry on.”

 “Aswith the glass of water, you have

to put it down for a while and rest
before holding it again. When we’re
refreshed, we can carry on with the
burden.”
 “So, before you return home
tonight, put the burden of work
down. Don’t carry it home. You
can pick it up tomorrow.
Whatever burdens you’re
carrying now, let them down for
a moment if you can.”

“Relax; pick them up later

after you’ve rested. Life is
short. Enjoy it!”
 Thank for listening!

And Have a stress free Life!