The Ultimate Guide to Finishing Progress Notes on Time
If you are here, you are probably like me and struggle to do progress notes. I have spent the last couple of years redefining my relationship with progress notes for the better. Progress notes are an essential part of therapeutic practice and your clients deserve a therapist who does them well.
Here is a collection of my greatest progress notes completion tips.
Have a format
Formatting your progress notes helps to get them done consistently and completely. When I do not have a format for my progress notes, I end up leaving some crucial detail out of my note. While you do not have to be too particular about the kind of format, I do recommend some general guidelines.
In Chronicler, I broke down a progress note into around ten steps. That number is not necessary, but I recommend going with something more than just a soap note because those note structures are intentionally ambiguous as it can be applied to many different disciplines.
Right now, Chronicler has these steps: telehealth, presentation, symptoms, diagnoses, disruption, safety, general topics, administration (billing issues), treatment stage, interventions, response, strengths, progress, and tasks. Breaking a session down into these steps helps me to move through a progress note quickly and accurately.
I recommend developing questions from these and to have them in front of you while you are completing progress notes. Even just having the steps listed helps to keep me moving through them without getting lost.
Set yourself up for success
Make it a point to give yourself the optimal environment for progress notetaking. I like to provide myself with a computer desktop that is just dedicated for progress notes. I keep everything else on a separate desktop on Microsoft Windows by pressing the control + windows button + left or right arrow keys or by pressing windows + tab key. I believe that Mac computers have something similar. This helps me avoid becoming distracted by some other source while I am working on a progress note.
Giving myself dedicated progress note music is helpful as well. I like to choose music at the beginning of my day; it helps me to be motivated and quick. This is as easy as searching YouTube for “upbeat study music.”
Ideally, complete your progress notes process after each therapy session. Following these steps, I can finish within five minutes which gives me enough time to prep for my next session, use the restroom, or have some brief exercise.
Use a pomodoro timer such as pomofocus to guide your progress notes if you are trying to catch up on a few. This system gives you 25-minute blocks with 5 minutes for breaks. This is also great for any focused work you want to get done.
Make use of timers to speed up your progress notes.
Fun fact: pomodoro is Italian for tomato. The designer of the technique had a tomato shaped timer.
The actual process of writing a progress note is simple but it helps to do it religiously. First, sit down (or stand) and start your progress notes writing music and, potentially, your timer.
Start writing by just blurting out whatever comes to mind after that session onto your notes from that session. This should take around 20 to 30 seconds and is helpful to start the writing process. You will not save this in your progress notes, this is simply so you do not forget that important detail you have been thinking about during the session. You might want this in your process notes and can borrow from it for your progress notes.
Next focus on your progress notes. Go through your progress note steps one by one. Ask yourself the relevant questions with your progress notes such as “what symptoms did my client report today?”
Finally, remind yourself of the truth.
At least for me, I know when I leave work with progress notes still to be done, despite how much I wanted to do them at home, I will not. I will tell myself that I will, I will make promises, but all the while I know that I will not. Reminding myself of this helps to break down the distorted thoughts that perpetuate procrastination for me. I know that if I want my progress notes to be done, I must do them right now.
“Reminding myself of this helps to break down the distorted thoughts that perpetuate procrastination for me. “
Progress notes can be a distasteful part of the therapeutic experience, but you can optimize your process. Have a format for your progress notes and set yourself up for success by creating a pro progress notes environment. Make certain to time yourself to focus on your task. Lastly, remind yourself that if you do not get your progress done now, you will not do them.
If you still find yourself struggling or want help with some of these steps, you can always use Chronicler to help you flow through steps easily. Chronicler speeds progress notes up by providing prewritten statements so that you can just click and search your way through a progress note. With Chronicler, you can create high quality progress notes in less than 3 minutes.
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