Add ward MAR board plus nursing notes and SBAR handovers.

Nurses can chart given/held/refused doses from active prescriptions on placed patients, and document chronologic notes and unit shift handovers. Co-authored-by: Cursor <cursoragent@cursor.com>
2026-07-20 10:15:58 +00:00
parent 45a1a95142
commit cb6e59e5ed
20 changed files with 2021 additions and 1 deletions
@@ -0,0 +1,165 @@
+<?php
+
+namespace App\Services\Care;
+
+use App\Models\CareUnit;
+use App\Models\NursingNote;
+use App\Models\Visit;
+use App\Models\WardHandover;
+use Illuminate\Support\Collection;
+
+class NursingDocumentationService
+{
+    public function addNote(
+        Visit $visit,
+        string $ownerRef,
+        ?string $actorRef,
+        string $body,
+        string $noteType = 'progress',
+        ?string $shiftCode = null,
+        ?int $careUnitId = null,
+    ): NursingNote {
+        $note = NursingNote::create([
+            'owner_ref' => $ownerRef,
+            'organization_id' => $visit->organization_id,
+            'visit_id' => $visit->id,
+            'patient_id' => $visit->patient_id,
+            'care_unit_id' => $careUnitId ?? $visit->care_unit_id,
+            'note_type' => $noteType,
+            'shift_code' => $shiftCode,
+            'body' => $body,
+            'recorded_by' => $actorRef,
+            'recorded_at' => now(),
+        ]);
+
+        AuditLogger::record(
+            $ownerRef,
+            'nursing_note.created',
+            $visit->organization_id,
+            $actorRef,
+            NursingNote::class,
+            $note->id,
+        );
+
+        return $note;
+    }
+
+    /**
+     * @return Collection<int, NursingNote>
+     */
+    public function notesForUnit(CareUnit $unit, string $ownerRef, int $limit = 50): Collection
+    {
+        return NursingNote::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->with(['patient', 'visit'])
+            ->orderByDesc('recorded_at')
+            ->limit($limit)
+            ->get();
+    }
+
+    /**
+     * @return Collection<int, NursingNote>
+     */
+    public function notesForVisit(Visit $visit, string $ownerRef, int $limit = 50): Collection
+    {
+        return NursingNote::owned($ownerRef)
+            ->where('visit_id', $visit->id)
+            ->orderByDesc('recorded_at')
+            ->limit($limit)
+            ->get();
+    }
+
+    /**
+     * @param  array<string, mixed>  $data
+     */
+    public function createHandover(
+        CareUnit $unit,
+        string $ownerRef,
+        ?string $actorRef,
+        array $data,
+        bool $complete = false,
+    ): WardHandover {
+        $handover = WardHandover::create([
+            'owner_ref' => $ownerRef,
+            'organization_id' => $unit->organization_id,
+            'care_unit_id' => $unit->id,
+            'from_shift' => $data['from_shift'] ?? null,
+            'to_shift' => $data['to_shift'] ?? null,
+            'handed_over_at' => $complete ? now() : ($data['handed_over_at'] ?? null),
+            'handed_over_by' => $actorRef,
+            'received_by' => $data['received_by'] ?? null,
+            'situation' => $data['situation'] ?? null,
+            'background' => $data['background'] ?? null,
+            'assessment' => $data['assessment'] ?? null,
+            'recommendation' => $data['recommendation'] ?? null,
+            'patient_summaries' => $data['patient_summaries'] ?? $this->defaultPatientSummaries($unit, $ownerRef),
+            'status' => $complete ? WardHandover::STATUS_COMPLETED : WardHandover::STATUS_DRAFT,
+        ]);
+
+        AuditLogger::record(
+            $ownerRef,
+            $complete ? 'ward_handover.completed' : 'ward_handover.created',
+            $unit->organization_id,
+            $actorRef,
+            WardHandover::class,
+            $handover->id,
+        );
+
+        return $handover;
+    }
+
+    /**
+     * @param  array<string, mixed>  $data
+     */
+    public function completeHandover(
+        WardHandover $handover,
+        string $ownerRef,
+        ?string $actorRef,
+        array $data = [],
+    ): WardHandover {
+        $handover->update([
+            'from_shift' => $data['from_shift'] ?? $handover->from_shift,
+            'to_shift' => $data['to_shift'] ?? $handover->to_shift,
+            'received_by' => $data['received_by'] ?? $handover->received_by,
+            'situation' => $data['situation'] ?? $handover->situation,
+            'background' => $data['background'] ?? $handover->background,
+            'assessment' => $data['assessment'] ?? $handover->assessment,
+            'recommendation' => $data['recommendation'] ?? $handover->recommendation,
+            'patient_summaries' => $data['patient_summaries'] ?? $handover->patient_summaries,
+            'handed_over_at' => now(),
+            'handed_over_by' => $actorRef ?? $handover->handed_over_by,
+            'status' => WardHandover::STATUS_COMPLETED,
+        ]);
+
+        AuditLogger::record(
+            $ownerRef,
+            'ward_handover.completed',
+            $handover->organization_id,
+            $actorRef,
+            WardHandover::class,
+            $handover->id,
+        );
+
+        return $handover->fresh();
+    }
+
+    /**
+     * @return list<array{visit_id: int, patient_name: string, bed: ?string, note: string}>
+     */
+    public function defaultPatientSummaries(CareUnit $unit, string $ownerRef): array
+    {
+        $visits = Visit::owned($ownerRef)
+            ->where('care_unit_id', $unit->id)
+            ->whereIn('status', [Visit::STATUS_OPEN, Visit::STATUS_IN_PROGRESS])
+            ->with(['patient', 'bed'])
+            ->orderBy('placed_at')
+            ->get();
+
+        return $visits->map(fn (Visit $visit) => [
+            'visit_id' => $visit->id,
+            'patient_name' => $visit->patient?->fullName() ?? 'Unknown',
+            'bed' => $visit->bed?->label,
+            'note' => '',
+        ])->all();
+    }
+}