Improving Access to Advance Care Planning: Integrating Nurse-Driven Advance Care Planning Follow-Up for Adult Allogeneic Bone Marrow Transplant Patients

Allogeneic bone marrow transplant patients face significant risks of morbidity and mortality. National guidelines recommend early and frequent advance care planning (ACP) discussions to prepare patients for these risks. At University of North Carolina Medical Center, allogeneic bone marrow transplant patients receive preadmission ACP discussions but lack follow-up during inpatient care, presenting an opportunity for nurse-driven ACP follow-up. This project aimed to improve nurse-driven ACP documentation and confidence, while reducing barriers, through an educational intervention and standardized ACP protocol. Over 3 months, a pre and post intervention quality improvement project used surveys and chart audits to assess the impact of ACP training and a standardized follow-up protocol. Pre and post surveys measured changes in nurse confidence, discussion frequency, and barriers. Chart audits tracked ACP documentation. Ten registered nurses completed 3 surveys, demonstrating significant improvements in nurse confidence (P = .002), frequency of ACP discussions (P = .022), and documentation (P < .001). Reported barriers decreased significantly. Chart audits confirmed improved ACP documentation, with 100% of eligible admissions receiving ACP follow-up. Educational interventions and standardized protocols may enhance nurse involvement in ACP discussions and help reduce barriers. These findings suggest that nurse-led ACP is a promising strategy, though further research is needed to optimize workflows and assess long-term sustainability.