St. Luke’s Hospital, an acute care facility serving the St. Louis, Missouri area, needed a way to make nursing care plans meaningful, interdisciplinary and a tool nurses want to use. At the same time, leadership needed to address compliance challenges with The Joint Commission regulatory requirements. By implementing evidence-based process improvements in their health IT and supporting staff adoption of these changes with a rigorous training plan, St. Luke’s achieved zero care plan citations during the 2017 survey.
“The Joint Commission surveyor noted an exemplary use of information technology in supporting clinical practice and highly commended our care plan,” said Diane Ray, RN, FACHE, senior vice president, network chief nursing officer, and chief operating officer.
In early 2016, St. Luke’s electronic health record (EHR) champion committee challenged RN staff committee members to review the care plan workflow using Cerner’s Interdisciplinary Plan of Care (IPOC) solution, while also identifying compliance, usage and effectiveness across staff. This initiative had leadership’s support from the beginning. Establishing a clear vision and strategy to approach care planning and related documentation helped ensure early buy-in across nursing. The communication plan defined the value of the initiative and set goals for meeting new expectations.
“One of the biggest goals was getting all of our nurses to go to the same place, using a consistent workflow approach in the EHR to get care plans,” said Kristin Garrett, RN, MSN, director of nursing. “We sat down and thought, ‘What is the easiest way to get this documentation?’”
Of course, the nurses knew why patients were in the hospital, what their medications were and their overall treatment plans, but there was room for improvement when it came to documenting information into an interdisciplinary plan of care.
“If we take ourselves back to nursing school, many tasks are taught,” said Ray. “For some, a plan of care had become another task, but we really want our nurses to use the plan of care as a tool to support their critical thinking skills.”
Leveraging Cerner’s IPOCs, St. Luke’s nursing defined a focused approach to interdisciplinary care planning. Four specific care plans were assigned for every inpatient to help address key aspects of care, such as safety. Other plans of care may be assigned based on individual patient needs. By documenting all therapies within IPOCs, all disciplines are expected to contribute to the patient’s care plan which helps support coordination and communication of care delivery.
To more effectively manage and monitor patient outcomes and the patient’s progress towards meeting those outcomes, St. Luke’s incorporated IPOCs target date capability. This supported the nurse’s ability to identify a target date for each patient outcome and keep this information at the forefront so nurses routinely monitor progress or adjust plans to reflect patient care needs. Their ability to adapt technology to accommodate defined processes while providing an individualized approach to care helped meet patient needs and address The Joint Commission requirements.
After developing well-defined policies and processes for nursing documentation and IPOCs, the team then focused on an education plan for more than 600 nurses.
In March 2017, nurse managers used a combination of their learning management system and hands-on training to educate each staff nurse. This helped nurses understand care plan expectations.
“The engagement [nurses] received was invaluable and a big part of helping educate in the moment,” said Michelle Jackson, RN, BSN, manager, nursing informatics. “Nursing leaders and educators were on board to help educate nurses on the value and impact of care plans.”
In April 2017, staff began a large, strategic clinical initiative to prepare for The Joint Commission surveyors. Nurse directors simulated a mock-survey rounding process to ensure nursing was consistently well-prepared to demonstrate their ability to track patient care.
“We conducted daily ‘safety stand-up rounds,’” said Ray. “We had a team, five days per week, that went out and looked at environment of care, infection control, our facility and what our directors of nursing’s goals were. Although we had a zero-citation goal for the survey, the purpose of our journey was advancing high-reliability and readiness of our organization.”
To track and trend adoption progress, nursing directors had pre-planned questions they asked each nurse. Each question was designed to help nurses communicate St. Luke’s standards of excellence to surveyors.
In September 2017, St. Luke’s passed The Joint Commission Survey with zero citations for care plans.
“We were at 75 percent in care plan compliance before this process, but now we’re at more than 83 percent,” said Garrett.1
“I believe our nurses were well-prepared because of this focused initiative,” said Ray. “The Joint Commission survey has come and gone, but we continue doing mock surveys three days per week, in one area per day. We see value in this process that goes beyond the survey. It ensures we’re providing the care our patients expect and that our care delivery processes are individualized, but also standardized. It’s been the best combination of processes, people and technology to achieve excellence. It was such a good process that we continue using it and will keep it for the future.”
1 Comparing April – December 2016 to January – September 2017 (Adult Med/Surg and ICU internal audit data)
For more information about best practices for IPOCs, visit our Model Experience Page.