Implementing a Transition of Care Policy in a Pediatric Primary Care Setting

Nursing shared governance is a professional practice model empowering nurses to make decisions about patient care, clinical practice standards, policy, professional development and evidenced-based care. The problem: There are close to 6,500 team members in the Department of Nursing who represent over 230 different job roles. To ensure every team member has a voice, we require a model that provides local forums for surfacing problems, ideas, needs, and suggestions at the team level, supported by a governance process to prioritize, resource, and resolve them. Our approach: We adapted a councilor model of shared governance that rests on four governance council types, and four supporting structures.

Implementing a Transition of Care Policy in a Pediatric Primary Care Setting Janie Jensen, BSN, RN; Chelsea Ghena, DNP, APRN; Lisa J. Taylor-Swanson, PhD, MAcOM, LAc Key Take Away . Implementing a transition of care policy and educating pediatric primary care providers about healthcare transition (HCT) guidelines and resources improves provider documentation and discussion of HCT with adolescent patients. Background Provider Documentation of Transition Policy Discussion (n=30) • Transition to adult care is addressed less than 25% of the time in pediatric practices (Davidson et al., 2022) • HCT interventions improve continuity of care, No decrease hospital use, improve health outcomes (Guzman et al., 2021) • University of Utah Pediatric Clinics need a HCT policy as none presently exist Post 0 10 20 30 100 p=0.01 30 01 Purpose p=0.01 40 50 60 70 80 90 100 Percentage 60 Methods Provider Confidence in Discussing Healthcare Transition (n=15) Pre p=0.005 50 Percentage • Provider education on HCT guidelines and clinic policy. Charting templates and resources created for use in patient education • Pre- and post- intervention surveys assessed providers’ understanding of HCT principles and attitudes regarding the policy • Chart review compared pre- and postintervention documentation of HCT discussion Pre 70 Yes • To implement a HCT policy at the South Main Pediatric Clinic to improve provider utilization of CDC transition guidelines and determine feasibility, usability, satisfaction of the policy Results Post 40 30 p=0.005 20 10 0 Very Confident Moderately Confident Neutral Moderately Unconfident Very Unconfident • 50% of providers (n=30) completed both surveys • 30% increase in provider documentation of HCT discussion with ICD-10 code • 5.1% increase in patients with at least one transition discussion documented • 40% of providers stated use of HCT charting templates • Statistically significant increase in provider confidence in discussing HCT (p=0.005) • 93.3% of providers reported policy was easy to use with patients, enjoyable to discuss, and would recommend to other providers. • 100% of providers plan to continue using HCT policy and charting templates in future practice Conclusions • Providing HCT education, policy, resources for providers led to an increase in reported discussion and confidence in HCT • Addressing identified barriers will promote improved HCT documentation and sustainability of provider participation • Future projects implementing additional CDC transition guidelines will further increase provider discussion of HCT @uofunursing @utnurseresearch