Evaluation of a person‐centered electronic health record care plan for hospitalized patients with dementia

Abstract

AbstractBackgroundHealth care for people with dementia (PWD) has been characterized as inconsistent in quality and fraught with potentially preventable encounters to hospitals (Petty et al., 2019; Phelan et al., 2012). Person‐centered care (PCC) is the preferred model of dementia care because it improves the quality of care and quality of life, yet acute hospital settings struggle to provide care that values personhood (Clissett et al., 2013).ObjectiveThis DNP scholarly project evaluated the effectiveness of the recently expanded, EHR‐embedded, Patient‐specific Dementia Information (PSDI) care plan and aimed to understand its interaction on nurse perception of dementia care, nurse knowledge of PSDI, and patient‐level outcomes guided by the Donabedian Model to measure its impact on enhancing dementia care delivery at a quaternary medical center.MethodNonexperimental, systematic program evaluation design. Pre‐ and post‐implementation survey measured the general attitudes of acute hospital nurses in providing care to persons with dementia, the extent to which they perceived their clinical practice as being person‐centered, and their general knowledge of the EHR tool. Weekly rounding assessed facilitators and barriers to individualizing patient care based on information extracted from the dementia care plan tool. EHR chart examined primary patient‐level outcome of dementia care quality in the acute care setting (length of stay, restraint use, constant observation, fall occurrence, and superimposed delirium). ResultsThe findings illustrated reduction in fall occurrence, restraint use, and an increase in positive Confusion Assessment Method delirium screening. Though results from nurse survey demonstrated high level of perceived confidence in dementia care, thematic analysis revealed poor confidence in evaluating psychosocial needs. Thematic analysis and survey responses elucidated bedside coaching as in effective strategy to promote staff awareness and learning of the PSDI and PCC practices.ImplicationsIncorporation of PCC by hospital nurses through an EHR‐based care plan improves outcomes for hospitalized adults with dementia and reduce clinical complications. Further advancement can be made by utilizing the PSDI tool during care transition, offering robust education on dementia care, tailored bedside coaching techniques to teach concrete PCC intervention, promoting interdisciplinary involvement in PSDI workflow and future QI initiatives to improve care quality for PWD.