STANDARDIZING ADVANCE CARE PLANNING WORKFLOW: A QUALITY IMPROVEMENT PROJECT IN ADULT BONE MARROW TRANSPLANT

Advance care planning (ACP) is an essential component of patient-centered care, particularly for individuals with complex and life-limiting conditions; however, documentation of ACP in inpatient settings remains inconsistent, leading to missed opportunities for timely discussions and alignment of care with patient preferences. On an adult bone marrow transplant (ABMT) unit, variability in nursing workflows and limited clarity regarding ACP processes contributed to inconsistent documentation of healthcare power of attorney (HCPOA). This quality improvement project implemented a standardized ACP workflow, supported by targeted, role-specific nurse education, to improve documentation consistency and enhance nurse knowledge and comfort with ACP processes. Guided by the Iowa Evidence-Based Practice Model and evaluated using the Kirkpatrick Model, the intervention included a unit-specific ACP workflow, a concise ACP Quick Guide, and brief, on-unit educational sessions focused on ACP terminology, nursing roles, electronic health record (EHR) documentation, and referral processes. Evaluation included pre- and post-intervention nurse surveys and retrospective EHR audits conducted at the admission level to account for duplicate documentation. Following implementation, nurses reported improved knowledge of ACP processes and referral pathways, with 92.8% indicating confidence in making ACP referrals, and 80% of paired respondents (n = 10) reporting increased comfort initiating ACP discussions. EHR audit findings demonstrated an increase in documented HCPOA status and a reduction in duplicate and conflicting entries, reflecting improved documentation consistency. These findings suggest that integrating a standardized workflow within existing processes, combined with accessible resources and targeted education, can enhance ACP practices and support more consistent, nurse-driven engagement in patient-centered care.