Improving plan-of-care visit completion.

Abstract

288 Background: Plan of Care Visits (POCV) facilitate communicating daily plan of care among providers, nursing, and patients and their families together at the bedside. This discussion standardizes how patients and caregivers collaboratively develop treatment plans that provide the highest quality of care. Daily Plan of Care Visit Completion is expected to improve patient experience with regards to provider effectiveness and interaction. Improved opportunities for understanding, communication, and patient care planning amongst patients, patient family members, and caregivers are a function of Plan of Care Visits. The documented completion of daily POCV in 2020 on the inpatient solid oncology unit was 42% compared to an expected target of 80%. Methods: Team utilized A3 thinking and tools including process mapping, trips to gemba, brainstorming, 5 Whys and fishbone to determine which Potential Root Causes drove failure to complete POCV. Results: Team identified multiple root causes including: Lack of awareness amongst providers that POCV needs to be completed Lack of provider understanding of how to complete a POCV Inconsistent notification of the nurse and staff of when POCV are occurring. Providers unaware of the results of their POCV documentation completion rate Physician attestation templates do not include an option for proper POCV documentation. By implementing retraining and standard procedures for handoff and setting expectations at the start of each change of provider, the team was able increase POCV completion. The subsequent development of a routine to notify staff of their performance daily (and later weekly), and the integration of the POCV completion documentation option into their attestation enhanced completion from 42% in 2020 to 74% in 2021 to 85% in 2022. Conclusions: Following our QI project, POCV completion exceeded the original enterprise target of 55% and revised target of 80%. Improvement in POCV has been sustained for over a year. POCV completion led to improved communication between physicians and nurses on the inpatient unit. The standardization of the process led to consistent completion and improved interaction with the patient. The interdisciplinary care and team were a large contributor to the success of this process.