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Veterans Health Administration

Daily Plan Keeps VA Patients in the Loop

A patient and doctor hold a brochure

Let’s Talk — The Daily Plan is essentially a road map that lets patients see what’s going to happen to them on a particular day of their hospitalization.

The 55-year-old Veteran was distraught, as anyone would be, upon hearing his diagnosis was cancer.

“We started telling him what medications he’d need, what tests we’d be ordering, what side effects the medications might have, things like that,” said Doreen Albee, a nurse manager at the Department of Veterans Affairs Western New York Healthcare System in Buffalo.

“It was difficult for him to deal with the diagnosis much less absorb all the new information he was being told hour by hour…it was simply too much. He was ready to leave the hospital without getting his diagnostic tests or treatment.

The Daily Plan enhances and promotes communication with our patients. Involving patients and families in the health care experience can serve as a safeguard, preventing unintended mistakes.

— Beth King, VA nurse

“But before he left,” Albee continued, “our nurse approached him with a copy of The Daily Plan. It was two pages of information specific to him. It listed all of his medications as well as the tests he was scheduled for the next day. He asked to keep it so he could look at it later. We told him, ‘Of course you can keep it! The Daily Plan is yours!’

“He was able to gain a good understanding of what was going to happen to him by talking with his nurse and reading his Daily Plan,” Albee said.

The patient’s fear began to fade, as did his sense of being overwhelmed. Feeling somewhat more in control of his situation, he decided to stay at the hospital and participate in his treatment.

“The Daily Plan is essentially a road map that lets patients see, in black and white, what’s going to happen to them on a particular day of their hospitalization,” explained Beth King, a program manager at VA’s National Center for Patient Safety in Ann Arbor, Mich. “The plan includes items such as scheduled procedures, medications, laboratory tests, any allergies the patient may have, and even diet.”

She added: “The Daily Plan increases patient safety by engaging patients, as well as their families. It encourages them to better understand their care. We want the patient to ask questions if something seems different than planned.”

VA pilot tested its Daily Plan at five VA medical centers in the fall of 2007 and winter of 2008. During this initial pilot testing, VA carefully measured patient reaction to the Daily Plan. About 70 percent of them felt good about it. They reported that having a written plan made it easier for them to ask questions, and provided them with information that helped improve their care.

“We feel the Daily Plan enables patients to become members of their health care team and be actively involved in their care,” said Cheryl Mitchell, a nurse coordinator with VA’s National Center for Patient Safety. “At VA, we feel patient involvement is imperative.”

Mitchell, who in helping implement Phase Two of the Daily Plan pilot testing, said errors can be prevented when nurses and patients review the Daily Plan together.

In one instance, for example, a patient was allergic to an antibiotic, but noticed this information wasn’t mentioned on his Daily Plan. He alerted his nurse, the matter was looked into, and the patient’s electronic medical record was promptly updated.

Beth King said preventing this kind of avoidable error “is exactly what the Daily Plan is designed to do.”

King said VA continues to make a number of improvements to the Daily Plan, based on feedback from both Veterans and nurses. These improvements include eliminating complex medical terminology, reducing the number of abbreviations, and using larger print.

As of August 2011, 53 VA hospitals are involved in Phase Two testing of the Daily Plan, and are continually providing valuable insights on how the plan can be fine-tuned even more.

“Our data from Phase Two testing is still preliminary,” King said. “But we’re confident that future data will be positive and support further deployment of The Daily Plan.”

Related link:
  National Center for Patient Safety