b'END OF SHIFT PLAN OF CARE: Better Communication for Better CareDana BissonRN, MSNI CLINICAL IMPROVEMENT SPECIALIST PROFESSIONAL PRACTICE AND DEVELOPMENT Erin CollinsRN, BSNI VP OF NURSING AND PROFESSIONAL PRACTICE AND DEVELOPMENTNURSING IMPROVEMENT GROUP - CONCORD HOSPITALSince adopting Cerner as our electronic health record in In Cerner, the nursing plan of care was documented in the form December 2017, inpatient nurses have learned new ways ofof an interdisciplinary plan of care (iPOC). The iPOC was designed charting, and adapted to the intricacies of the system.Asas a way for nurses and other clinical disciplines to document the time passed, however, and we moved from the implementationpatients goals and interventions at the end of shift, with evidence-stage to the optimization stage of Cerner projects, Informaticsbased interventions linked to the patients condition and goals. The nurses repeatedly heard the message from inpatient nursing: Cantinformation was supposed to be jointly documented and shared we make this better? Nurses reported innumerable clicks to doamong all the patients caregivers. Although this was the intent,routine documentation, and the time that took, particularly withthe reality did not produce the value-added vision. Despite the best more acute patients who needed more frequent assessments, wasefforts of nursing and informatics staff, the iPOC tool lackeddraining on staff. Time spent on documentation was detractingflexibility and often wasnt able to reflect the fluidity of a patients from direct patient care, and nurses questioned if what they werecondition. Perhaps more importantly, the information in the iPOC documenting was useful to either the patient or to the care team. remained siloed, and wasnt easily accessible to providers and other clinicians, which was frustrating for the entire care team.In2019, the first major change to nursing documentationwas achieved, with the adoption of no change since lastInDecember 2021, a second major change to nursingassessment charting.For routine nursing assessments, nursesdocumentation workflow and policy was implemented, were able to turn multiple charting elements into one click whenresulting in a shift from the iPOC to the End of Shift-Planthere was no change in the patients status to report. Many minutesof Care Note.Under the new workflow, nurses document a were saved in charting, leaving the nurse more time for directcomplete patient assessment at the beginning of every shift in the patient care.Cerner iView tab as usual. Throughout the rest of the shift, while physical assessments and their frequency remain unchanged, only This was a huge win, but as the pressures of COVID-19 and changes or updates to the initial assessment or to the patients staffing issues came to bear, it became clear that there was stillorders or plan of care are documented in real time in Cerner iView. room for improvement in inpatient nursing documentation. One At the end of the shift, the nurse completes a narrative note that of the biggest concerns from both nurses and other clinical staff, summarizes the patients active problems, interventions, andincluding attending providers, was that the time spent on progress over the course of the shift, along with any education documentationparticularly the Centers for Medicare and provided to the patient. A similar narrative note is created when a Medicaid Services required nursing plan of carewas extensivepatient is transferred or discharged, or a mid-shift handoff of care and did not necessarily lead to useful information for the rest of from one nurse to another occurs.the care team. P E O P L E | I N T E G R A T I O N | T R A N S F O R M A T I O N34'