Exceptional Care Planning: Background

Project History: In 2008, The Foundation for Long Term Care received a cost effectiveness grant from the New York State Health Foundation to test the impact of a more effective care planning system, Exceptional Care Planning (ECP). In ECP, interdisciplinary teams write Standards of Care (SOC) for the prevalent issues that they see in their homes, writing out all the steps they would take for any and every person with those certain issues. Each issue gets its own SOC (i.e., there might be one for incontinence, one for weight loss, etc.). Sites keep these SOCs in a central location (on a shared computer drive or in a binder at the nurses’ station) where they are easily accessible to everyone that provides care.

When the Care Team is writing out a care plan for a resident who has weight loss, the first line in the care plan would say “see weight loss SOC,” followed by any plan for care that differs from what is on the Standard, including more personal notes about the resident (such as: “Resident prefers to eat with Mr. Smith at table X”).

Rationale: The idea is for care planning teams to write only the exceptions to standard care in care plans. Nurses and care teams spend an enormous amount of time re-writing the same things in every person’s care plan (basically, re-writing the standards in every person’s care plan). With Exceptional Care Planning, time writing care plans is greatly reduced (about 50% time reduction), and it creates a much more individualized care plan, and thus better care. With Exceptional Care Plans, the information included is easily read and is specific to the resident, which helps the care team provide better, more personalized care.

Outcome: We tested ECP in nine LeadingAge New York member homes and we have found that using ECP has significantly reduced the number of pressure ulcers, falls, and hospitalizations on the units where it was used. It also saved a great deal of nurses' time care planning.