Is your work Flowing?

Is Your Work Flowing?

            Workflows are the steps taken in order to complete a task. Steps should be taken to reduce repetitive workflows and make the workflows more automated and user friendly (Amorosano, 2014). One opportunity that I helped to identify in our organization was that of correct Medical Orders for Life-Sustaining Treatment (MOLST) forms and code status. When this was brought to light, unfortunately I learned of past incidents where the Electronic medical records (EMR) did not have the correct code status. So long story short, we resuscitated patients when it was not their wish. I felt very passionately about this and did not want another patient to suffer from our process flaw. Working with our performance improvement, we gathered a group of clinicians to formulate a process map of our current state. From this process map, we identified areas of the workflow that were a point for possible error. We are working to collaborate with our physician group as they are the group to order code status which therefore populates the status in the EMR. We did find some nursing opportunities also and are looking into standardization and what we call “Best Practice Advisories” or “BPA’s” that will pop up in the MAR if a step is missed or if information is conflicting. A clinical decision support system is also being evaluated as it helps to combine clinical knowledge with patient specific data to help guide the practitioner (Nelson & Staggers, 2014). Another new initiative that is emerging is the E-MOLST which is an electronic MOLST form where patients would E-sign and the MOLST would automatically be in the EMR rather than depending on a paper copy that needs to be scanned in (Aultman, 2014). Our organization does not use this technology just yet.

This infographic illustrates a simplified work flow. The patient arrives in the Emergency department, The MD gathers his information by asking questions and doing an assessment as illustrated by the clipboard. The provider then enters that information into the EMR and orders treatment. Part of the orders must include a code status. My next step proposal is a hardstop (represented as the magnifying glass) that would make the provider do a deeper dive and be able to answer questions regarding the patients wishes and if they have discussed them or if the patient has current MOLST scanned into their chart to ensure that the wishes matches the order.

References

Amorosano, D. (2014). Document management gets personal. Streamline your healthcare workflow. Health Management Technology, 35(6), 12-15.

Nelson, R. & Staggers, N.(2014). Health Informatics

Aultman, J. (2010). Ethics of translation: MOLST and electronic advance directives... Medical Order of Life Saving Treatment. American Journal Of Bioethics, 10(4), 30-32. doi:10.1080/15265161003633003