patient’s clinical goal. They had originally
been constructed with good intentions, but
because they were part of the transition
from paper to electronic medical records
(EMRs), some of the effectiveness was
lost due to the differences in workflows
between paper and EMRs.
Traditional nursing plans of care included any and all conditions that the patient
had, whether or not the condition was preventing the patient from transitioning to
the next level of care. For example, the care
plan for a compliant diabetic patient who
came into the hospital for a hip replacement
would include diabetes as a problem even
through the patient’s glucose levels were
under control. This added to the list of tasks
that nurses needed to document while contributing insignificantly to the overall goal
for the patient’s hospital care.
A second issue was that the plans of
care were not evidence-based. Often they
included tasks that bore little relevance
to the patient’s specific condition or the
medical treatment plan developed by the
physician; this left a feeling that the plans
were there as a matter of protocol or “just
because.” Even where evidence had been
used in creating the plan of care it did not
necessarily reflect the latest knowledge
about that condition.
As a consequence of the generic nature
of the plans of care, a chart review in 2012
showed only a 60 percent level of compliance by nurses. Bypassing the plans of
care led to non-standardized patient care,
which meant outcomes could vary greatly
while opening the door to potential patient
safety (and liability) issues. With its focus
on quality of care, White Plains Hospital
determined that it needed to replace the old
guidelines with new plans of care that were
evidence-based and patient-specific.
Concurrently, White Plains Hospital
came to the realization that it needed to
expand those plans of care beyond the nurs-
ing staff. Many other disciplines within the
hospital contribute to the goal of moving
patients to the next level of care, such as
physical and respiratory therapists, social
workers, specialty counselors, dieticians
and community services liaisons. Build-
ing plans of care that include these other
disciplines would give all involved with a
patient’s care a single resource to moni-
tor progress and facilitate communication
between them, creating a more holistic
approach to care.
Finally, these issues were occurring
at the same time White Plains Hospital
was restructuring its care management
resources. As part of the process, the hos-
pital was mapping out its Length of Stay
(LoS) parameters for each condition. It
became apparent not only that patients
were remaining in the hospital longer than
White Plains Hospital utilized current evidence-based best practices to develop 60 customized interdisciplinary
plans of care across all specialties.
