The Evidence-Based Care Plan

Evidence-based practice (EBP), a vital aspect of core measures performance and initiatives rolling out under the Health Information Technology for Economic and Clinical Health (HITECH) Act, has been demonstrated to improve care quality, enhance patient safety and reduce costs related to errors and adverse events.

As a result, a growing number of hospitals and integrated delivery networks (IDNs) have set their sights on tools that can provide physicians and clinicians with the best available evidence at the point of care, including access to scientific methodology, best practices and clinical-decision support.

However, to fully realize the impact that EBP and clinical decision support can have on quality outcomes, organizations must consider the use of these tools for all participants across the continuum of care – nurses and allied health professionals included.

One such tool that has emerged is the evidence-based care plan.

Much like order sets, care plans provide nurses with clinical information and best practices that have the potential to improve outcomes and reduce errors by standardizing care. However, their impact on care outcomes is just one reason that these tools should be moved higher on healthcare organizations’ priority lists.

Also at play is the fact that care plans, which address nursing and other disciplines, are required by both the Joint Commission and Centers for Medicare and Medicaid Services (CMS) for provider certification.

However, complying with these mandates and achieving the potential benefits that care plans can bring is not without its challenges.


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Challenges to Care Plan Use

For years, nurses have used paper-based care plans to identify expected outcomes and strategies for care. These plans are found to increase communication between nursing and other members of the healthcare team and enhance the effectiveness and consistency of care.1

Yet despite their potential to improve the care delivery process, care plans harbor a number of challenges regarding implementation and adoption.

For example, paper-based care plans require a great deal of writing to complete. The cumbersome formatting processes that must be addressed in order to draft an effective, standardized care plan further complicates the process.

Electronic care plans, including those that are scanned and saved as a PDF file or built into the electronic medical record (EMR) system, come with their own set of challenges.

For example, while a few EMR systems include care plan management tools, these systems tend to be inflexible and do not allow users to easily customize the care plans to fit the hospital’s specific needs.2

Nor do the challenges cease once the care plan has been created. Keeping care plans current with the latest evidence is problematic, and as a result, they are rarely updated.

Subsequently, because care plan templates often go years without updating, many nurses do not trust that the content follows current, credible guidelines. Others reject the implementation of care plans simply because they are resistant to change in the care process. Another challenge is the lack of time and resources to adequately maintain lengthy care plans.2

Finally, while many nurses recognize the value of research-based knowledge, they also acknowledge the difficulty with interpreting and applying research findings. Many noted that research is too complicated or too scholarly and has limited or no relevance to practice, while others desire information that is more geared toward guiding and directing their practice.

Care Plan Management Software

A robust care plan management software system that provides advanced authoring and editing tools and access to evidence-based guidelines and best practices is one way organizations can overcome a number of challenges with paper-based and even electronic care plans.

For example, by providing nurses and allied health professionals with a library of templates, these systems streamline the time-consuming process of drafting and customizing care plans in the paper environment.

Links to the latest evidence-based guidelines also provide nurses with clear parameters for effective patient care, while a central web portal that allows for templates to be shared and collaboratively reviewed eliminates the need for large group meetings to review and approve drafted care plans.

These systems can also streamline the process by which care plans are reviewed and updated based on the latest evidence by allowing authors to establish rules for reassessment. Once established, the system alerts authors when it is time to review the care plan, thus mitigating the risk that plans will go years without updating.

Finally, the best solutions provide access to patient education content, as well as to procedures and guidelines for multiple clinical disciplines. Thus, they support an interdisciplinary approach to care plan management, which is an important aspect of complying with the standards required for Joint Commission accreditation.


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EBP Across the Continuum of Care

Be it a result of time or budget constraints, the reality is that care plans are often neglected and outdated as higher priority initiatives take center stage. However, for organizations to truly standardize care and elevate the practice of evidence-based medicine, these efforts must be implemented across the continuum of care.

For hospitals, electronic care plan management systems can provide concise, up-to-date evidence and enable interdisciplinary collaboration. By integrating with EMR technology, these systems also allow nurses and allied health professionals to merge multiple plans, thus eliminating duplicated efforts. And by standardizing care and applying the most current best practices, evidence-based care plans improve patient care and regulatory compliance.

Finally, by providing nursing staff with a database of evidence-based care plans that can be put into the EMR system, these systems allow hospitals to position clinicians across the care continuum to meet the quality expectations of the future.

1. Schultz, JM, Videbeck, SL. Lippincott’s Manual of Psychiatric Nursing Care Plans. China: Wolters Kluwer Health | Lippincott Williams & Wilkins; 2009.
2. Wolters Kluwer Health | ProVation Medical. ProVation care plans: Voice of customer research. PowerPoint presentation presented internally; March 28, 2012.

Anne Tisel, RN-BC, is director of clinical development for care plans at Wolters Kluwer Health Clinical Solutions, Minneapolis.

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