A charting system designed to provide an ongoing plan of care. It begins with the nursing assessment; some hospitals add checklists and flow sheets. A separate care plan is not written; instead, interventions are recorded in the nursing notes. After initial assessment, the nurse identifies actual problems or nursing diagnoses that arise during the shift. Problems and diagnoses are listed and numbered consecutively on a problem list during each 24-hour period. In the narrative nursing notes, problems, interventions, and evaluations (PIE) are described, with reference to each problem by number. Problems are evaluated at least once every 8 hours, and after 24 hours the problem list is rewritten, with resolved problems dropped and new ones added. The system was developed in 1984 at Craven County Hospital in New Bern, North Carolina.