title: Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices.
abstract: Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework-the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP's efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse's educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.
authors.affiliation: Hahn School of Nursing and Health Sciences, University of San Diego, San Diego, CA 92110, USA. mary.dellefield@va.gov.|VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. mary.dellefield@va.gov.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Dellefield
authors.affiliation: School of Nursing, Duke University, Durham, NC 27708, USA. Kirsten.corazzini@duke.edu.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Corazzini
keywords: comprehensive care plan; minimum data set coordinator; nursing; nursing home; quality improvement; registered nurse; resident assessment instrument; skilled nursing facility