You can make changes to a client's care plan by adding new items or editing existing items from the care plan tab on the mobile app.
Important note: diagnoses, goals, and interventions are the default names in AlayaCare for the three types of care plan items. Your organization may use different naming conventions for care plan items or only use one or two of the care plan item types.
Permissions
Field workers must have the manage care plan entry ACL in order to make changes to a client's care plan.
Adding new items to a client's care plan
You can create new diagnoses, goals, and interventions in the client's care plan by selecting the + button in the bottom right corner.
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Next, select diagnosis, goal, or intervention depending on the type of care plan item you wish to add.
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Complete the required fields for the new care plan item you wish to add. The fields available to complete will depend on the type of item you have selected. For information about the specific fields available for each item type, select one of the following:
Adding a diagnosis
When add a new goal to the client's care plan, complete the fields you require and select submit to add it to the client's care plan. You must complete all fields marked with an asterisk (*) in order to select submit (found at the top of the page on iOS devices and at the bottom of the page on Android devices).
1. Enter a name and description for the diagnosis.
2. Tap to select a start date for the diagnosis. If you know the expected end date, you can enter this date as well.
3. Tap the tag field to select one or more tags to link to the diagnosis. Any care plan tags configured by your organization will be available to select.
4. Tap the department field to select a department to link to the diagnosis.
5. Tap the service field to choose one or more of the client's active services to link the diagnosis to. If you have selected a department, you will only be able to select services that are tied to that department.
6. If necessary, use the toggle at the bottom of the screen to mark this diagnosis as the primary diagnosis on the care plan.
Adding a goal
When add a new goal to the client's care plan, complete the fields you require and select submit to add it to the client's care plan. You must complete all fields marked with an asterisk (*) in order to select submit (found at the top of the page on iOS devices and at the bottom of the page on Android devices).
1. Enter a name and description for the goal. The description field is optional.
2. Tap to select a start date for the goal. If you know the expected end date for the goal, you can enter this date as well.
3. Select a type from the list of goal types set by your organization. Standard goal types include nursing, physiotherapy, occupational therapy, speech therapy, personal care, and client.
4. Tap the tag field to select one or more tags to link to the goal. Any care plan tags enabled by your organization will be available to select.
5. Use the related diagnoses field to link this goal to any diagnoses on the client's care plan that it is related to.
6. Tap the department field to select a department to link to the diagnosis.
5. Tap the service field to choose one or more of the client's active services to link the goal to. If you have selected a department, you will only be able to select services that are tied to that department.
7. Select a progress tracking method. The available options are none, percentage, and per visit with comments.
- None: you will not have the option to track the client's progress on the goal from visit to visit, but you can still mark the goal as complete in the client's service tasks.
- Percentage: you will have the option to enter a percentage that represents the client's progress toward the goal in the client's service tasks during visits (for example, the client might be 40% of the way toward achieving the goal).
- Per visit with comments: you will be prompted to either mark the goal as complete or leave a comment in the client's service tasks after each visit.
8. If necessary, use the toggle at the bottom of the screen to mark this diagnosis as the primary goal on the care plan.
Adding an intervention
When adding a new intervention to a client's care plan, complete the fields you require and select submit to add it to the client's care plan. You must complete all fields marked with an asterisk (*) in order to select submit (found at the top of the page on iOS devices and at the bottom of the page on Android devices).
1. Enter a name and description for the intervention. The description field is optional.
2. Tap to select a start date for the intervention. If you know the expected end date, you can enter this date as well.
3. Select a type from the list of intervention types set by your organization. Standard intervention types include personal care, nursing, therapy, support, dietary/nutrition, education, mobility, equipment/supplies, household management, medication, wound care, and Infusion.
4. Tap the tag field to select one or more tags to link to the intervention. Any care plan tags enabled by your organization will be available to select.
5. Tap the related goals field to select any goals from the client's care plan that you wish to link to this intervention.
6. Tap the department field to select a department to link to the intervention.
7. Tap the service field to choose one or more of the client's active services to link to the intervention. If you select a service, the intervention will only appear in service tasks for visits scheduled for that service. If no service is selected for the intervention, it will appear in the client's service tasks for visits of any service. Note that if you have selected a department, you will only be able to select services that are tied to that department.
8. Tap to enable the required for visit completion setting if you are required to either complete this intervention or leave a comment explaining why it was not completed before clocking out of the visit.
9. Tap to enable the capture time spent on intervention setting if you wish to prompt caregivers to enter the time it took to complete the intervention during visits when completing the intervention in service tasks.
10. Applicable to U.S. agencies only: tap to enable the include in 485 setting if this intervention should be included on the client's 485 forms.
11. Use the external link field if you wish to add a hyperlink to an external website to help with completing the intervention. Enter a label for the link as well as the URL.
12. Tap the link to AlayaCare module field if you wish to link the intervention with another module in AlayaCare, such as forms, vitals, medication, or infusion. If you select forms, you must select which form you wish to link the intervention to. If you select vitals, medication, or infusion, you then must select either all or single item. If you select single item, you then need to specify which vital/medication/infusion you wish to link the intervention to.
13.. Enter the start date on which the intervention will be considered active. Once active, an intervention is active, it will be visible on scheduled visits for the client. If known, you can also enter an end date.
14. Tap next to proceed to the next screen to finish completing fields for the intervention and select submit.
15. In the next screen, select the frequency you wish to set for the intervention. You can select per request, per visit, daily, weekly, or monthly. Per request means that the intervention will not appear in the client's service tasks but can be added if necessary. Per visit means that the intervention will always appear in the client's service tasks.
If you select daily, weekly, or monthly, you will need to enter a count and an interval. The count is the number of times that the intervention should occur over a set interval of days, weeks, or months (depending on whether you have selected daily, weekly, or monthly). For example, if the frequency is daily, the count is 2, and the interval is 3, then the intervention will will be scheduled to be completed 2 times every 3 days.
You can enter a time window during which the intervention should be administered. If the time of day does not matter, tap the any time of the day setting.
For weekly interventions, you can select which days of the week the intervention should occur, or tap to enable the any day of the week setting.
For monthly interventions, you can select which days of the week the intervention should occur, or tap to enable the any day of the month setting.
Adding items from a care plan library
If your organization uses care plan libraries, you can also add diagnoses, goals, and interventions to a client's care plan from a care plan library. To learn how to add items from care plan libraries on mobile, see How do I add items to a client's care plan from a care plan library on mobile?
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Editing items in a client's care plan
To edit a diagnosis, goal, or intervention on a client care plan, tap the three dots (iOS: 
, Android: 
) next to the item you wish to edit and then select the edit option.
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Android
You can then make your changes to the fields on the diagnosis, goal, or intervention.
When you have finished editing, tap submit to save your changes.
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