Focus Charting (FDAR)
1. Focus Charting
2. Focus charting describes the patient’s perspective and focuses on documenting the patient’s current
status, progress towards goals and response to interventions.
3. Purpose Focus charting brings the focus of care back to the patient and the patients’ 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.
4. The focus might be patient strength, problem, or need. Topics that may appear in the focus column
include patients’ concerns and behaviors; therapies and responses; significant events such as teaching,
consultation, monitoring, manag ement of activities of daily living or assessment of functional health
patterns.
5. The narrative portion of focus charting includes Data, Action and Response (D A R). The principal
advantage of focus charting is in the holistic emphasis on the patient and his/her priorities including
ease in charting.
6. Objectives To easily identify critical patient issues/ concerns in the progress notes. To
facilitate communication among all disciplines. To improve time efficiency with documentation.
To improve concise entries that would not duplicate patient information already provided on flowsheet/
checklist.
7. General Guidelines Focus charting must be Evident at least once every shift. Focus charting
must be patient- oriented not nursing task- oriented. Indicate the date and time of entry on the first
column. Separate the topic words from the body of notes: ° Focus note written on the second
column. ° Data, Action and Response on the third column.
8. Sign name (e.g. M. Aquino, RN) for every time entry. 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 every transfer to/from another unit or discharge.
9. Follow the do’s of documentation. For eight hours shift, use blue or black ink for morning and
afternoon shift, red ink for night shift. For twelve hours shift, use blue or black ink for morning and
red ink for night shift.
10. Specific Guidelines Begin with comprehensive assessment of the patient using inspection,
palpation, percussion, and auscultation (IPPA.) Include in the assessment, collection of information
from the patient, family, existing health records (such as checklist/flow sheets, laboratory results and
other health care providers.
11. Establish a focus of care, to be addressed in the Progress Notes. Document the four elements
of focus charting, as necessary, wherein: ° 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 and
communication.
12. ° Data is the subjective and/or objective information supporting the stated focus or describing the
observation at the time of a significant event. ° Action describes the nursing interventions
(independent, basic and perspective) past, present or future. ° Response describes the patient
outcome/response to interventions or describes how the care plan goals have been attained.
13. Focus note is necessary ° To describe a patient’s problem/ focus/ concern from the care plan -
when the purpose of the notes is to evaluate progress toward the defined patient outcome from the
plan of care. Examples: Self care Skin integrity Activity tolerance
14. ° To identify an exception to the expected outcome - when the significant finding or an outcome is
not expected (the exception). Examples: Wheezes left base Nausea
15. ° To document a new finding - when the purpose of the note is to document a new sign or
symptom or a new behavior which is the current focus of care. (These may be “temporary foci” which do
not need to be incorporated on the plan of care because they can quickly be resolved. Even if you are
uncertain whether the sign or symptom is important, it is valuable to communicate the information to
the health care team.)
16. ° To document an acute change in patient’s condition - when there has been an event of new
patient condition. Examples: Respiratory distress Seizure Code blue
17. ° To document a significant event or unusual episode in patient care - when (a) responsibility for
patient care changes from one department to another (b) a significant treatment. Intervention took
place. Examples: Admission Pre-(specify procedure) assessment Post-(specify procedure) assessment
Pre-transfer assessment Discharge planning Discharge status Transfusion RBC Begin thrombolytic
therapy PRN medication required
18. ° To document an activity or treatment that was not carried out - when treatment or activity in the
flow sheet was not provided to the patient or was different from the standard of care. ° To describe all
specific patient/ family teaching - this is in compliance with a standard of care.
19. ° To identify the discipline making the entry as well as the topic of the note - when all members of
the patient care team use on patient programs record. Examples: Social service/ financial assistance
Dietitian. Instruct low fat diet Physical therapy/ crutchwalking
20. ° To best describe patient’s condition in relation to medical diagnosis - when the patient’s focus is
the pathophysiology rather than pataient’s response to the problem. This happens most frequently in
highly technical areas such as critical care.
21. Data statements contain objective and/or subjective information. Action statement contains
only nursing interventions (basic, perspective, independent) past, present or future. Patient outcome
are evident in the response statements.
22. Data, Action, Response only contain information related to the focus, none of the information is
extraneous (e.g.: asleep, watching TV, visited by family). Response statements are documented after
PRN medications are administered.
23. Information from all these categories (Data, Action, and Response) should be used only as they
are relevant or available. However all appropriate information should be included to ensure complete
documentation. ° DATA and ACTION are responded at one hour and RESPONSE is not added until later,
when the patient outcome is evident.
24. Examples of Focus Charting: DATE/TIME FOCUS DATA, ACTION and RESPONSE 03/08/08 Chest D:
“Sumasakit ang dibdib ko.” Midclavicular line pain of 4 on scale 10 am Pain of 5 A: Medicated with Isordil
5mg. SL. S: Lampe, RN 12:00 am Chest Pain R: resting in bed. “nabawasan na sakit ng dibdib ko. Rating of
2.” S: Lampe, RN
25. ° Response is used alone to indicate a care of plan goal has been accomplished. Example:
DATE/TIME FOCUS DATA, ACTION and RESPONSE 03/15/08 Health R: Patient demonstrates 1 pm
Teaching: he is able to change his Dressing own abdominal dressing Change using aseptic technique S:
Lampe, RN
26. DATA is used when the purpose of the note is to document assessment finding and there is no flow
sheet/ checklist for that purpose. Example: DATE/TIME FOCUS DATA, ACTION and RESPONSE 03/18/09
Post D: Received from the RR via stretcher, awake and alert, vital 2:20 pm transfer signs stable, IV right
forearm Assess- patent, foley catheter in place with clear yellow urine, dressing on ment RLQ is clean
and dry, moving all extremities voluntarily. “Minimal incisional pain at this time rating of 3.” S: Lampe,
RN
27. ° ACTION and RESPONSE are repeated without additional data to show the sequence of decision
making based on evaluating patient response to the initial intervention. Example: DATE/TIME FOCUS
DATA, ACTION and RESPONSE 03/22/08 Nausea D: “I feel like my stomach is filling up with pressure
again and I’m 10:00pm nauseated.” Abdomen round and soft, gastrostomy bag at body level. Rare
bowel sounds. A: Gastrostomy bag lowered. R: “I feel like better now.” Approximately 200 cc golden
fluid returned as much flatus
28. Cont. DATE/TIME FOCUS DATA, ACTION and RESPONSE 03/22/08 Nausea A: Keep gastrostomy bag at
body level. 10:00pm Monitor abdominal status. Monitor how long bag is tolerated at body level.
Document any discomfort. Patient instructed to call nurse when he is uncomfortable. R: “I understand
plan.” S. Lampe, RN
29. °Begin the note with ACTION when the patient’s interaction begins with intervention or when
including date would be unnecessary repetition. Example: DATE/TIME FOCUS DATA, ACTION and
RESPONSE 03/01/08 Health A: Patient instructed on the actions and side effects of digoxin. Given 2:20
pm Teaching digoxin information card. Discusses when he would call the physician Digoxin about the
medicine. R: Return demonstration of radial pulse. “I understand the purpose of medication.” S Lampe,
RN
30. Documentation DO’s and DONT’s DO’s DON’T’s DO read what other DON’T begin charting until
providers have written you check the name and before providing care and identifying number on the
before charting patient’s chart on each page. DO time and date all DON’T chart procedures or
entries. chart in advance. DO use flow sheet/ DON’T clutter notes with checklist. Keep information
repetitive or frequently on flow sheet/ checklist changing data already current. DO chart as you charted
on the flow sheet/ make observations. checklist.
31. DO’s DON’T’s DO write your own DON’T make or sign an observations and sign over entry for
someone else. printed name. Sign and DON’T change an entry initial every entry. because someone tell
you to. DO describe patient’s DON’T label a patient or behavior. show bias. DO use direct patient
DON’T try to cover up a quotes when appropriate. mistake or accident by DO be factual and inaccuracy
or omission. complete. Record exactly DON’T “white out” or erase what happens to patient and an
error. care given. DON’T throw away notes with an error on them.
32. DO’s DON’T’s DO draw a single line thru an DON’T squeeze in a issed entry error mark this entry
as “ERROR” or “leave space” for someone else and sign your name. who forgot to chart. DON’T write
DO use next available line to in the margin. chart. DON’T use meaningless words DO document
patient’s current and phrases, such as “good day” or status and response to medical “no complaints.”
care and treatments. DON’T use notebook, paper or DO write legibly. DO use pencil standard chart
forms. DO use only approved abbreviations.
