Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Dr. Nicole Harpold, DNP, RN, AGPCNP-BC

Second Advisor

Dr. Robert Johnson, MD

Third Advisor

Dr. Morgan Kochajda-Watkins, DNP, RN, AGNP-C

Academic Year



Background: Community-based palliative (CBPC) care teams strive to optimize the quality of life of patients living with serious illness while also providing value-based care. An acuity tool was previously implemented at a CBPC site to promote resource allocation and improve follow-up care. Initial implementation failed, and re-implementation was undertaken.

Objective: Address barriers to acuity tool uptake and provide education on correct acuity tool documentation to improve the number of patients that receive prescribed follow-up care.

Setting/Subjects: An urban CBPC service in the Midwestern United States with a patient panel of 443 patients. Subjects include nurses, social workers, providers, and patients.

Design: Quantitative design utilized pre- and post-education chart audits to compare Electronic Health Record (EHR) documentation and prescribed follow-up care.

Measurement: Chi-squared paired proportions and confidence intervals pre- and post-education on correct acuity score documentation and correctly prescribed follow-up care.

Results: Post-education chart audits revealed that 73% of patients had the acuity score documented incorrectly and only 50% of patients were receiving prescribed follow-up care (n=100). Over 25% of low acuity patients had too many visits scheduled while almost 75% of high acuity patients had too few visits scheduled.

Conclusions: Lack of education was identified as a barrier to successful uptake of the acuity tool during a previous implementation. However, re-education did not improve acuity score documentation or the likelihood of patients receiving prescribed follow-up care.

Implications: A clear and efficient access to a standardized process must exist to sustain correct documentation of an acuity score. The EHR should have a single location for acuity score documentation.