Individualized Care Planning
Colleen Villamin BSN, RN, OCN, Lourine Davis BSN, RN, OCN, Roxanne Blackburn BSN, RN, OCN,
Buenagracia de la Cruz BSN, MBA, RN, OCN, Nancy Tomczak BSN, RN, OCN
UT MD Anderson Cancer Center
Houston, TX
Email: cvillamin@mdanderson.org
Background Information:
The inpatient stem cell transplant units at an NCI-designated Cancer Center in the Southwest
United States have undergone enormous changes in bed capacity and leadership over the past
year. New challenges have emerged with a fifty percent increase in patient beds and the need to
train thirty new graduate and travel nurses. Tasked with improving customer service, the unit
patient satisfaction committee devised and implemented the Individualized Care Planning
Initiative.
Aim:
Review of the Press Ganey Patient Satisfaction scores revealed that patients wanted more
consistency in care, improved communication, and increased involvement in their treatment plan.
The call to provide individualized, patient-centered was answered by nurses collaboratively
creating individualized care plans with patients and caregivers that customize care for each
patient's unique needs to increase consistency of care, improve communication among nurses
and patients, and raise patient satisfaction.
Programs:
The unit-based Patient Satisfaction Committee called for nurse volunteers to become
Individualized Care Planners (ICP's). The ICP's are assigned to one of the six "pods" each time
they work to provide continuity for patients and to increase the nurses' knowledge of patient
concerns and status. Due to rotations throughout the 6-pod SCT inpatient service, nurses may be
unfamiliar with the patients on a pod because of frequent rotation and assignment changes.
Furthermore, patients complained of always having a different nurse. The nurse ICP's provide
improvement in continuity of care by identifying patients who needed care plans because of
extended length of stay, frequent re-admissions, complex nursing care requirements, or a history
of dissatisfaction. In addition the ICPs may work to develop core teams of consistent nurses to
take care of these patients routinely, thereby addressing concerns with frequent changes in care
providers. Once identified, care plans are developed to address patient concerns, psychosocial
factors, physical needs, daily routine, activity, nutrition, abnormal assessment findings, nursing
interventions, discharge planning, short and long term goals. Copies of the care plan are given to
the patient and placed with the nursing documentation to improve communication. Concurrently,
monthly ICP meetings are conducted with nurse ICPs to identify patients who need care plans,
address challenges faced, and discuss literature that supports the need for providing patientcentered care.
Outcome Data:
Each patient with an individualized care plan is given a Likert-type survey with five questions to
determine their satisfaction with nurse communication, responsiveness, shared decision-making,
care, and the individualized care plan. Surveys began in June 1, 2012 and will continue through
December 31, 2012. Quarterly analysis includes evaluation of ICP survey scores. Of the 49
patients who received care plans from March 2012 through September 2012, 13 completed the
Individualized Care Plan Survey. Preliminary results of the survey indicate that 30% of patients
suggest that nurses always keep them informed, 57% report that nurses are always responsive to
their needs, 46% always feel included in the decisions related to their care, 46% are always
satisfied with the care they receive, and 38% believe their experience always improves with the
individualized care plan. In addition to the unit-based surveys, quarterly Press-Ganey Patient
Satisfaction Reports are examined to trend changes in overall patient satisfaction on the SCT
unit. The overall mean score of patient satisfaction for the stem cell transplant unit improved
from the second to third quarters of 2012 from 87.0 (pre-ICP initiation) to 88.5 (post ICP
initiation). To capture the aim of the individualized care plans, three Press-Ganey questions
were analyzed: 1) Nurses keep me informed, 2) Attention to special/personal needs, and 3) Staff
includes me in decisions related to treatment. Scores for each of these questions improved
following the implementation of the ICPs and will be review in detail.
Conclusion:
The target population for Individualized Care Planning includes patients who endure prolonged
length of stay with complications related to stem cell transplantation. This special population
faces extraordinary challenges physically, emotionally, spiritually, and socio-economically.
There is great need for nurses provide the highest quality, compassionate, patient centered care
for these individuals who endure such prolonged acute stress. It is understood that many of these
patients are dis-satisfied with their situation and changing their perception of nursing care will
require great effort. While preliminary data from unit-based surveys suggests that only 38% of
patients believe that their experience always improves with the individualized care plan, overall
patient satisfaction on the SCT units improved as measured by the Press-Ganey Patient
Satisfaction Report following the implementation of ICPs. Continued process improvement will
focus on administering more surveys to increase the number of patient responses and improving
nurse awareness and adherence to the care plan. Future outcomes for consideration include the
effect of care planning on length of stay, falls, central line associated blood stream infections,
pressure ulcers, and medication errors. In addition, nursing staff and leadership perception of
program success, benefits, and areas for improvement will be collected via surveys.