Prairie Lakes Hospital Nursing Division Policy and Procedural Manual

Intervention Title:
Reducing Documentation Time by Eliminating Written Care Plan Reports – Prairie Lakes Healthcare System, Watertown, S.D.

Decrease the amount of time nurses spend on documentation.

Staff developed a patient care planning process that meets regulatory standards but excludes a written report.

Time spent on documentation decreased, while the number of satisfied staff increased.

Prairie Lakes Healthcare System
401 Ninth Avenue, N.W.
Watertown, SD 57201
P: (605) 882-7000

From the C-Suite:
“We have gone to great lengths to carefully think through patient care planning and the most effective way to do it. While we have eliminated an actual report, we now consider care planning to be a process where our nurses are better partners in managing care.”

Jill Fuller, R.N., Ph.D.
Chief Nursing Officer, Prairie Lakes Hospital

Prairie Lakes Healthcare System is an 81-bed hospital serving seven rural counties in northeastern South Dakota.

Clinical areas affected:

  • Medical/surgical units
  • Critical care units,
  • Obstetrics

Staff involved:

  • All staff

The program took four months to design and was fully operational in 2002.

Jill Fuller, R.N., Ph.D.
Chief Nursing Officer
P: (605) 882-7670

Intervention implementation:
Writing up care plan reports had become a time-consuming and burdensome task for nurses at Prairie Lakes Healthcare System. The hospital had recently implemented an electronic record and documentation system that included data entered by an interdisciplinary team that could be leveraged for care planning.

To begin redesigning the care planning process, regulatory requirements for written documentation in care plans had to be understood. Regulations require written goals and evidence of an individualized plan of care. Such evidence already existed in the form of an electronic record, since each patient has unique and personalized documentation. The team then identified four goals for acute-care patients: 1) carry out medical treatment plan; 2) keep patient safe; 3) keep patient comfortable; and 4) educate patient to prepare for discharge. The four goals were hardwired into the electronic documentation system.

Staff was trained on how to plan care in real time using the tools available, including a “Google-like” ability to query the electronic patient record. Care planning policies were rewritten to reflect the new process. Tools for staff on how to talk to surveyors about the process were developed. Care planning tools were also embedded in patient records, such as standard order sets with evidence-based medicine protocols.

The hospital also implemented a daily Interdisciplinary Care Conference that included an interdisciplinary team of a pharmacist, bedside nurse, physical therapist, pastoral caretaker, home health care worker and social worker, all of whom participate in a standard conference on every patient every day. Patient care plans are discussed and incorporated into the electronic record. Care planning is now considered to be planning for transition to the next level of care and discharge, not just a care plan for the day.

Advice and lessons learned:

  1. Take time to design. Consider the different options available through electronic documentation vendors but make sure the applications work to achieve goals.
  2. Empower nurses. Change nursing work from being task oriented to managing patient care.
  3. Change mindset. Work with staff to think of care planning as a process and not a report.

Cost/benefit estimate:
Benefits include decreased time spent in documentation, no adverse clinical outcomes, increased staff satisfaction and two Medicare surveys showing no deficiencies related to care planning.