Enterprise-Wide, Evidence-Based Interdisciplinary Plan of Care Content Validation: Guiding Principles and Lessons Learned
Hosted by: Zynx Health
Presenters: Mary Swensen, RN, MBA and Naomi Mercier, MSN, RN-BC
I attended this webinar as improving the translation of evidence into practice is one of the overarching themes of my career and is of relevance to the project that I’m working on right now, so I was interested to learn about how others are doing this. I was hoping that they would be talking about how they incorporated evidence into practice, but it turned out that they were focusing on the process they used to engage people in validating their content, as opposed to speaking about the content per se. It was still useful information, even though it wasn’t what I was expecting.
Here are the notes that I took:1
- Partners Healthcare have not yet gone live with their interdisciplinary plans of care (IPOCs), but are explaining their process of how they developed them
- Partners eCare – started in 2011, expected to have implemented Epic electronic health record and administrative system by 2017
- huge process – in terms of scope, number of clients served, all of healthcare coming together to implement one system
- have a history of excellent homegrown systems, but they don’t talk to each other
- working on testing and training (will need to train 18,000 users)
- March 2016 – will go live at 2 hospitals; Q1 in 2017 will go live with their other hospitals
- 10 hospitals, each with different ways of doing plans of care
- chose to go with a vendor solution (rather than home grown) – chose Zynx
- wanted evidence-based IPOCs
- wanted patient-centred, not discipline-centric
- wanted an ongoing process for updates and maintenance
- assembled a nursing leadership council; involved other health professionals early on
- needed to standardize terminology/definitions
- IPOC is considered part of the patients overall care plan=patient’s chart
- defined: “plan of care”, “patient problem”
- guiding principles
- shared, inter-professional
- active, patient and family-centred problems, goals
- discipline-specific only if approach to care is so different that it couldn’t be shared
- simple
- only include problems that are barriers to a transition to a lower level of care or preventing the patient form meeting goals
- no standard of care
- minimal “at risk for”
- active and relevant interventions
- update goals and interventions with changes in patient condition
- patient education documented (not part of plan of care)
- did a Zynx-led content review bootcamp
- 354 SMEs
- 274 tasks in 50 working days
- did a gap analysis of the developed content
- noted that guiding principles were not applied consistently
- variability in plan modifications (for a variety of reasons)
- focus on interdisciplinary workflow slowed down the tailoring process
- lack of style guide resulted in differing terminologies
- post-boot camp, did a cross-walk of all problems created during the bootcamp
- combined multiple versions of same problem into one inclusive of all terms for review
- had everyone review and comment
- developed a style guide to help promote consistency
- lessons learned
- this was a starting point, not an end point
- develop a style guide along with the guiding principles
- cultivate interdisciplinary buy-in early in the process
- “IPOCs templates using Therapies is a nirvana”
- bigger is not better – you should “rightsize” the number of reviewers (sometimes they had too many people to many decisions
- take the time to develop small groups of experts for review and validation
- plan to update the plans every year, looking at the most frequently used IPOCs first
- looking at a project that more actively involves patients in their own plans of care
To view a reply of the webinar, click here.
