NURS 6421 Determining Workflow Issues Week 3 Discussion

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Workflow is a term used to describe the interconnected steps and processes that nurses and other health care professionals complete on a day-to-day basis. Many existing workflows contain inefficiencies and areas that could be improved using new technologies or evidence-based practice. Workflow issues are often referred to as “gaps” because they indicate a disparity between the current state and the optimal, future state. Many gaps in health care exist related to the implementation and optimization of electronic health records (EHRs). The Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009 to assist organizations in identifying these gaps and encouraging the “meaningful use” of EHRs. The meaningful use objectives seek to fulfill the IOM six aims of patient care (patient-centered, timely, effective, efficient, equitable, and safe).

In this Discussion, you examine scenarios that feature workflow issues related to the HITECH Act and its meaningful use objectives. You identify specific workflow gaps and consider how you would conduct a gap analysis to gather more information about the gaps. This Discussion allows you to explore workflow gaps and meaningful use objectives to prepare you for completing the Course Project, which is also centered on workflow gaps and their relevance to meaningful use objectives.

Scenario 1:

Stephanie is a nurse practitioner at Central Care Hospital who is often involved in administering prescribed medications for patients in the general care ward. When a physician sees a patient, he or she uses the hospital’s EHR system to document findings and recommendations for treatment, but submits medication and drug orders by faxing prescriptions to the hospital’s pharmacy. Before Stephanie administers the medications from the pharmacy, she must cross-check the medication and dosage with the physician’s notes and patient information in the EHR system. In doing so, Stephanie often identifies problems with the medication the physician prescribed; patients are sometimes prescribed a medication to which they have a known allergy or one that conflicts with another medication they are currently taking. In addition, the pharmacy sometimes sends the wrong medication or the wrong dosage. Furthermore, for patients who have been transferred from other parts of the hospital such as the intensive care unit or the maternity ward, Stephanie often encounters duplicate drug orders or incorrect medications sent from the pharmacy.

Scenario 2:

General Health Hospital is implementing new outreach programs and preventive care support groups for patients with certain conditions or health risks such as diabetes, smoking, and obesity. Philip, a nurse leader, is the manager of a team of nurses who have been asked to organize these programs and groups and to identify patients who would be eligible for and interested in being involved in these opportunities. However, Philip and his team have run into a variety of challenges and problems as they attempt to complete these tasks. In identifying patients to contact about the outreach programs and support groups, Philip’s team has had to browse the hospital’s EHR system. The team has also run across significant holes in the EHR system as they try to contact patients; many patients’ contact information is inaccurate or out of date. Furthermore, Philip’s team has partnered with the hospital’s Appointments Desk personnel in sending reminders about meeting dates and times to patients who express interest. However, the Appointments Desk often either neglects to send out these reminders or sends duplicate reminders to only a few patients because the personnel do not have a way of tracking who should be contacted and when.

Scenario 3:

Robert works in the medical records office at Garden View Hospital. Because the hospital does not have a policy of providing clinical summaries to patients after each visit, Robert frequently receives calls from patients requesting copies of their health information (such as test results, vital statistics, diagnostic information, and medication lists and dosages). For every request, Robert must retrieve the patient information from the hospital’s EHR system, print out hard copies of the records, and then either mail the records or wait for the patient to retrieve them in person. Additionally, Robert’s hospital often receives lab test results for patients from certified third party providers. These results are not automatically transferred from the provider’s EHR system to the hospital’s EHR system, so Robert often must contact the providers before responding to a patient’s request. Robert also finds that he and his colleagues in the office spend a considerable amount of time printing, mailing, and faxing immunization records to patients’ workplaces, schools, and volunteer organizations, which can be disruptive to the office’s other responsibilities.

To prepare:

  • By Day 1 of this week, your Instructor will have assigned you to respond to a specific scenario. Review this week’s Learning Resources on workflow, gap analysis, and meaningful use, and consider how they connect to the scenario you were assigned.
  • Determine the most prominent workflow gap you see in the scenario you were assigned. Where does the gap lie, what factors contribute to the gap, and what are the consequences of the gap?
  • Explore how this gap relates to one meaningful use objective. Refer to the articles in this week’s Learning Resources for more information on meaningful use.
  • If you were involved in the scenario, consider how you would go about conducting a gap analysis to gather more information about the gap you identified, and determine possible strategies for addressing the gap. How would you gather data? Who would you contact, interview, and/or observe? How would you determine strategies for addressing the gap?

Note: Before you submit your initial post, replace the subject line (“RE: Discussion – Week 3) with “Review of Scenario ___.” Fill in the blank with the number of the scenario you reviewed.

By Day 3

Post an explanation of the most prominent workflow gap in the scenario you were assigned, including who is responsible for the gap and the outcomes or consequences. Identify the meaningful use objective to which the gap relates, citing specific points in the Brown article. Explain how you would conduct a gap analysis to gather further information and determine strategies for addressing the gap.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who responded to a different scenario than you did. Provide any additional insights you may have on the main workflow gaps and how you could conduct a gap analysis. Identify additional meaningful use objectives that might also be related to the scenario.

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