F-DAR Charting – Flashcards

• Most Commonly Used • Focus on a specific patient, problem, concern, or event • Advantages: saves Nurse's time, decreases duplicate charting, easier to read, clear & concise, & efficient for Nurses with many patients!

F = Focus • Subject, Purpose of Role • Nursing Diagnosis • Event: Admission, Transfer, Procedure, Teaching, Patient Concern: (vomiting, nausea)

D: Data • Written in narrative • Contains only subjective & objective data

A: Action • Contains action words aka "verbs" • This is what Nurses performed... Nursing interventions • Ex. Giving PRN medications, Calling MD, Repositioning Patient

R: Response • Write how Patient responded to your action • Many times Nurses will not chart this until later

Date & Time: 10/27/2015, 1100 Focus: Pain D: Patient called via call light requesting pain medication. Arrived to room & found patient grimacing while holding left arm. Patient rates pain 9 on a 1-10 scale in left arm. A: Morphine 1 mg IV administered in 18 gauge Right AC. Repositioned patient on to left side. Date & Time: 10/27/2015, 1145 R: Patient rated pain 2 on 1-10 scale & states "I fell much better."

Date & Time: 10/27/2015, 1100 Focus: Health Teaching R: Patient demonstrated effectively how to use the incentive spirometer. The patient states "I feel like I can breathe better since I'm using this thing regularly."

Date & Time: 10/27/2015, 1100 Focus: Transfer Post Procedure D: Received patient back from special procedures status post thoracentesis. Dressing dry & intact on left lower back. Vital Signs: 98.6, 120/80, 85, 98% on 2LPM NC. Patient drowsy but oriented x 3. Patient lying on unaffected side with call light in reach.

Date & Time: 10/27/2015, 1100 Focus: Medication Education A: Demonstrated to patient how to administer Lovenox correctly. Instructed patient about side effects & safety precautions. Provided patient with additional printed education. Date & Time: 10/27/2015, 1600 R: Patient demonstrated how to administer Lovenox LLQ. Patient verbalized correctly side effects & safety precautions.