Weir Brett S, Vordtriede Caitrin, Lee Jerry E, Metter E Jeffrey, Talbot Laura A
Nursing Operations, Pharmacy Department, Carl R. Darnall Army Medical Center, Fort Hood, TX 76544, USA.
US Army Garrison, Fort Hood, TX 76544, USA.
Mil Med. 2021 Dec 24. doi: 10.1093/milmed/usab526.
The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication.
The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05.
With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001).
The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.
本质量改进项目的目的是开发并评估电子用药申请仪表盘的使用情况，以减少用药处理所需时间，并减少患者出院期间工作流程中断所造成的时间损失。延迟出院与医疗保健成本增加和不良患者结局相关。出院时的用药申请处理导致了这些延迟，并给项目现场的护理和药房工作人员的工作流程带来了中断。电子仪表盘已在多个医疗环境中成功实施，以简化患者处理流程并加强沟通。
卡尔·R·达纳尔陆军医疗中心（德克萨斯州胡德堡）的人类保护办公室对该项目进行了审查，并以非人体研究的判定结果批准了该项目。成立了一个由护理、药房和健康信息技术（HIT）代表组成的多学科工作组来开发仪表盘。基于所需沟通的逻辑流程图，HIT使用SharePoint和Nintex工作流程创建了用药申请表和状态仪表盘。该仪表盘在一个拥有25张床位的内科/外科护理单元进行了为期30天的试点实施。在实施前后，测量了用药处理所需时间、从出院医嘱到患者出院的时间、护理和药房之间的电话数量以及用药申请流程的可用性。结果采用描述性统计进行分析，并以P值≤0.05评估统计显著性。
随着仪表盘的实施，平均用药处理时间从125分钟降至48分钟（P < 0.0001），平均患者出院时间从137分钟降至117分钟（P = 0.002）。护理人员对用药申请流程的可用性评分从40分提高到87分（P < 0.0001），药房人员的评分从62分提高到85分（P = 0.003）。护理和药房之间的语音通话总数从1115次降至434次，而语音通话总时长从33小时50分钟降至13小时19分钟（P < 0.0001）。
电子仪表盘是一种有效的方法，可在患者出院期间加强跨学科沟通，并显著减少用药处理时间。然而，尽管用药处理时间减少了一个多小时，但出院时间仅减少了20分钟。需要进一步调查以评估导致延迟出院的其他因素。本研究的一个关键限制是在单个单元进行的为期30天的试点中使用了便利抽样。此后，该流程已被整个医院采用，进一步的分析可能会更好地揭示对组织的影响。这种沟通系统具有很高的可用性，并减少了护理和药房工作人员的电话干扰。此外，这项技术可以很容易地应用于军事医学中的其他沟通途径或申请流程。
