Cerrone, Mary Jane, MSN, RN-BC

Fenstermaker, Katherine

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksNetwork Office of Research and InnovationDevelopment of a Quality Improvement ProcessFollowing Evaluation of Patient Outcomes andNursing DocumentationMary Jane Cerrone MSN, RN-BCLehigh Valley Health Network, Mary_Jane.Cerrone@lvhn.orgKatherine FenstermakerLehigh Valley Health NetworkFollow this and additional works at: http://scholarlyworks.lvhn.org/network-office-research-innovationPart of the Health and Medical Administration CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtCerrone, M. J., & Fenstermaker, K. (2010). Development of a Quality Improvement Process Following Evaluation of PatientOutcomes and Nursing Documentation. LVHN Scholarly Works. Retrieved from http://scholarlyworks.lvhn.org/network-office-research-innovation/3Important Medication Safety InstructionsDate of Visit: ________________ Ordering physician: ______________Your physician gave you a prescription for : ____________________________________This medication is being prescribed for: _______________________________________You should take this medication as follows:_____________________________________General GuidelinesOnly take your medication as prescribed above. You should not change the dose or the number of times you take themedication or stop the medication abruptly unless directed by your pain physician.You must keep your scheduled appointment in order for us to continue to renewyour prescribed medication.Medications will not be replaced if they are lost, left somewhere, get wet or accidentally destroyed.The prescribed medication can be dangerous to others such as children, pets and other family members.We recommend the following to keep you and your loved ones safe:Lock your medications or keep them out of reach of othersKnowwhat prescription medications you have in your home. It is a good idea to do an inventory of what you haveand check it frequently to make sure nothing is missing.Properly dispose of all unused, outdated medications that you have in your houseo Do not flush in toileto Place medications in used coffee grounds, cat liter, or other undesirable garbage in a tied bago Do not share your medications with your friends or other family membersLearn the most commonly abused medications and tell your family & friendsThe most common medication used and abused by teenagers is prescription medication in the homes.Guidelines for Prescription RenewalsFor office or Health Spectrum Pharmacy pick up or Fed Ex of your renewal you must give a 4 to 5 business day noticeby calling 484-884-2992 and pressing the prescription option and following the instructions.I have read the above and understand my responsibility of keeping my medication safe. If I haveany questions orconcerns I will call my pain management physician or office staff.__________________________________ _________________Signature of Patient DateI have reviewed above instructions with the patient.___________________________________ __________________Signature of Staff Date**place a copy in the patient file**It is everyone’s responsibility to keep yourself and others safe from prescription drugmisuse.Phone Follow-UpPatient MR#: ________________Ordering MD: __________________________Actual prescription given to patient: (e.g. percocet 5/325 q 4 hours prn)___________________________________________________Actual date of office visit:_____________Actual date of phone call: _______________( to be completed 5 days after visit)1. Did you get your prescription filled? Yes NoIf no, document why:_____________________________________________________________________________________________________________________________2. Howmany times a day are you taking your medication? _______Is this the way it was prescribed? Yes NoIf no, document why:______________________________________________________________________________________________________________________________. Do you knowwhy this medication was prescribed to you? Yes  NoIf no, explain what you told them_________________________________________________________________________________________________________________________________________________________4. Were the side effects of the medication reviewed with you? Yes NoIf no, explain what you told them_________________________________________________________________________________________________________________________________________________________If they received an opioid- did they receive a copy of the bowel regimen? Yes NoIf no, then tell the patient and mail a copy to the patient ________________________________________________________________________________________________________________________________________5. Did you receive a copy of the prescription refill guidelines? Yes NoIf no, then tell the patient and mail a copy to the patient ________________________________________________________________________________________________________________________________________6. Do you have any questions or concerns about thekeeping your medication safe at this time? Did you receive theMedication Safety Instruction Sheet? Yes NoIf no, please reviewand document:____________________________________________________________________________________________________________________7. Do you have any other questions or concerns about your medications at this time?_____________________________________________________________________________________________________________________________________________________ ______________Signature of Person Calling DateMaryjane Cerrone, MSN, RN-BC; Katherine FenstermakerLehigh Valley Health Network, Allentown, PennsylvaniaDevelopment of a Quality Improvement Process Following Evaluation of Patient Outcomes and Nursing DocumentationAbstractThe release of new opioid treatment guidelines that were published in February 2009 and the implementation of the REMS (Risk Evaluation Mitigation Strategies) have prompted the development of a compliance quality improvement project. Within the practices there are many patient issues that can arise with opioid prescriptions. In order to ensure patient safety and good practice a compliance monitoring program was developed.Many patient phone calls, lost prescriptions, inappropriate use of medication and other concerns were dealt with on a daily basis. A pilot program was developed to review charts for patient teaching and education. The next step was to develop a one page educational sheet and implement a phone follow-up call to the patient after receiving the prescription. The outcomes that were looked at include the number of phone calls from the patient, lost prescriptions, compliance in taking the medication as directed and any other concerns. In conjunction with this, charts were reviewed for documentation of the elements of Universal Precautions for Pain Management.This program focused on both Physician and Nursing compliance.Improvement Plan and Implementation:During January and February 2010, a teaching/medication guideline sheet was developed to include the following elements: Medication purpose, dosing, side effects, renewals, safe storage, and proper disposal. (see Figure 1) This sheet was given to patients when they received any prescriptions at their visit. For patients that called in for renewals, they received the teaching sheet/guideline when they picked up the prescription. In order to capture the education, the nursing note was revised. (see Figure 2) This allowed better documentation of nurse’s patient teaching about the prescribed medication. A follow-up call was made 5 days after the visit to assess any problems with the medication. (see Figure 3)  This process was implemented May 1, 2010. Implemented a plan with our in-house retail pharmacy in which the prescription is sent to the pharmacy by the staff and the patient has the option to pick up the prescription at the pharmacy or the pharmacy would fed-ex the medication to the patient’s home.                           No scripts are sent to the patient homes.Retrospective Chart Review:A retrospective chart review from July to December 2009 of 250 charts was completed for current nursing practice for documentation of teaching when prescriptions were given. This project was completed at Lehigh Valley Hospital-Muhlenberg Center for Pain Management. In addition, we were tracking the number of phone calls made by the patient after receiving a prescription about any problems or concerns with the medication. Out of the 250 charts-100 patients had received prescriptions for opioid medications. 80 charts had no documentation that the patient had any teaching or instructions in regards to the prescribed medication. 20 charts had adequate documentation of teaching about the prescribed medication. In addition, approximately 55 patient phone calls were recorded with problems or concerns about their prescribed medication.Concurrent chart reviews were completed during February, March, May and June- 33 random charts for compliance in obtaining an opioid agreement and the use of Urine Drug Screens. The patients were on an opioid from a few months to 7 years. Out of the 33 charts there were 6 charts that had an opioid agreement-many that were obtained but never updated on an annual basis. Out of the 6 that had an opioid agreement there was only 1 UDS completed. Many of the charts were lacking in documentation of risk assessments, benefit of current treatment and the 4A’s. Concurrently, a Standard Operating Procedure was developed for Opioid Prescribing to include opioid agreements, outline responsibilities of the staff (physician and nursing), and urine drug screen guidelines. This SOP was implemented as of July 6, 2010.Evaluation/Outcome:As of July 15, 2010 approximately 175 patients received the teaching/guideline sheet at each clinic visit. There was an overall improvement in nursing documentation as well as patient compliance with taking the medication as prescribed along with satisfaction with their current treatment.The pharmacy collaboration overall decreased the number of pharmacies that were being used by the patients, the number of lost prescriptions due to no mailing of prescriptions. The pharmacy was able to monitor if patients went to other physicians/pharmacies for additional medications. It also increased patient satisfaction and compliance. As well decrease nursing time spent on writing/mailing/documenting of renewals.The follow up phone call was difficult to complete. Many times patients were not home or did not return our phone calls. In follow- up at the next visit many patients did not report any major issues with their medication. • Revise and update opioid agreements •  Have at least 2 days per month scheduled for UDS days •  Follow-up monitoring of charts to be completed 3 months after implementation of the SOP for the implementation of opioid agreements and the use of UDS in the practice. •  Continue chart reviews for nursing documentation of teaching and patient compliance.Future Processes:Figure 3Phone Follow-UpFigure 2Nursing Progress NoteFigure 1Medication Safety Instructions

Development of a Quality Improvement Process Following Evaluation of Patient Outcomes and Nursing Documentation

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Development of a Quality Improvement Process Following Evaluation of Patient Outcomes and Nursing Documentation

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