FDAR Charting for Dialysis
FDAR charting is intended to make the client and client concerns and strengths the focus of care. It is a method of organizing health information in an individual’s record. It is a systematic approach to documentation. It simply stands for:
F (Focus)
D (Data)
A (Action)
R (Response)
It’s been a while since I did a thorough nurse charting because from my previous workplace, we do checklist, instead. But I won’t deny our long history with SOAPIE charting. That’s when I (as the head nurse) transitioned it to an hourly or in a 15 to 30-min interval monitoring charting.
I figured what’s the use of charting when everything is copied and pasted and the main problem or intervention is not even reflected? When charting is being prioritized than the patient since everyone is all focused in completing the chart early?
Thus, I made the switch to only chart what we intervene or any abnormalities in the patient’s condition followed by its respective intervention. So yeah, we finally bid goodbye to our friendly copy-paste charting or the ever present (-) SOB, (-) DOB, afebrile and what else…
Now that I am in a new workplace, I’m back to FDAR charting. I’ve encountered this one during my hemodialysis training so it’s not entirely a new concept for me. So, as a review, I made this post for my reference and for you.
How to chart FDAR?
F (Focus) is the subject/purpose for the note. This can be a Nursing diagnosis, a sign / symptom, therapies and responses, event (admission, transfer, discharge teaching etc.), an acute change in the condition (code blue, vomiting, coughing).
D (Data) contains subjective cues (what they patient says and things that are not measurable) & objective cues (what you assess/findings, vital signs and things that are measurable). This lays the supporting evidence for why you are writing the note. This then, lets the reader know “this is what the patient is saying and what I’m seeing”.
A (Action) is the “verb” area. In this section, this should correspond to the subjective and objective cures or simply the D (Data) part of the FDAR charting. This includes nursing interventions (calling the doctor, repositioning, administering pain medication etc.)
R (Response) is where to chart how the patient responded to the A (action). Sometimes, this is left open or blank until the treatment is done to thoroughly evaluate and note the patient’s condition post dialysis.
Sample FDAR charting for dialysis
Check out my previous post here about Top 2 Nursing Care Plans for Hemodialysis Patients as guide in doing FDAR charting.
Here’s an actual FDAR charting for dialysis.
For the ideal FDAR charting, here are the following examples for dialysis patients who are (1) stable, (2) with problem access, (3) with special procedure.
- Fluid Volume Excess
9/12/21 10:45 am
2:45 pm
3:15 pm
F > Fluid Volume Excess D > Patient verbalized, “Dako-dako akong kaon atong weekend.”
> Weight gain of 2.5kg from dry weight
> Bipedal edema (2+)
A > Set UF to 2,500mL
> Health teachings imparted on limit fluid intake
> cannulated—hooked to HD machine
> Treatment started
> AP informed
> VS taken and monitored q 30 minutes
> provided comfort and safety
> needs attended
R > Treatment completed
> UF goal met; dry weight achieved
> Bipedal edema (1+)
> VS stable; discharged
Nurse Germz
- Impaired Tissue Integrity
9/12/21 10:45 am
2:45 pm
3:15 pm
F > Impaired Tissue Integrity D > Patient verbalized, “Ayha sya nihubag pag abot sa balay.”
> complaint of pain when venous accessed touched
> swelling noted at venous site
> presence of hematoma
A > Health teachings imparted on proper access care
> applied cold compress on swollen site
> cannulated at new venous site—hooked to HD machine
> Treatment started
> AP informed
> VS taken and monitored q 30 minutes
> provided comfort and safety
> needs attended
R > Treatment completed
> VS stable; discharged
Nurse Germz
- Ineffective Tissue Perfusion
9/12/21 10:45 am
11:00 am
12:45 pm
1:45 pm
2:15 pm
F > Ineffective tissue perfusion D > Patient verbalized, “Di ko makatulog sa gabie ug dali hanguson.”
> Weight gain of 2.5kg from dry weight
> low hgb level – 7.2g/dl
> Bipedal edema (2+)
A > Set UF to 2,500mL
> Health teachings imparted on limit fluid intake
> cannulated—hooked to HD machine
> Treatment started
> pre-BT meds given
> blood transfusion started
> AP informed
> VS taken and monitored q 30 minutes
> provided comfort and safety
> needs attended
R > blood transfusion completed with no untoward reactions
> Treatment completed
> UF goal met; dry weight achieved
> Bipedal edema (1+)
> VS stable; discharged
Nurse Germz
For other examples, you can also check this out.
