Reduce PRINT (Prescription Re print In Missing NCS Prescription · 2018. 8. 28. · Team Leader:...
Transcript of Reduce PRINT (Prescription Re print In Missing NCS Prescription · 2018. 8. 28. · Team Leader:...
Team Leader: SSN Anbukkarasi D/O Sakadevan Naidu, Team Co Leader : Dr Moosa Aminath Shiwaza Team Member: Dr Shera Chaterji, Ms Chua Liwei, Mr Ron Ang Yee Loon, SSN Yeo Chek Cheng, SSN Ng Ah Mui, SSN Lee Yuet Lai.
Reduce PRINT (Prescription Re – print In Nurse Clinician Service TCU appointment)
Aim : The aim of the project is to explore ways to reduce the
occurrence of missing NCS prescriptions and re-printing of these prescriptions again by physicians.
In Singhealth Polyclinics, Nurse Clinician Service(NCS) is an appointment nurse –based service offered to patients with well controlled chronic medical conditions. Trained nurse clinicians attend to these patients and they endorse the prescription that had already been prescribed by the physician at the previous visit. (Workflow as shown in Figure : 1.)
The aim of this project is to explore ways to reduce the occurrence of missing NCS prescriptions and the re-printing of these prescriptions again by physicians. The aim of this project is to explore ways to reduce the occurrence of missing NCS prescriptions and the re-printing of these prescriptions again by physicians. The aim of this project is to explore ways to reduce the occurrence of missing NCS prescriptions and the re-printing of these prescriptions again by physicians.
The team formed consisted of 4 nurses, 2 doctors, 1 administration staff and
1 pharmacist.
With the implementation of the new workflow, the incidence of missing NCS prescriptions have been significantly reduced resulting in time and manpower savings, as well as a reduction in the frequency of interruptions to the physician.
Patient
Patient to see doctor for chronic medical condition(s) and receive prescription. Submit the prescription to pharmacy and arrange appointment at appointment
counter for next visit to see NCS nurse.
Doctor
NCS eligibility checked and prescription issued as per physician's preference for duration of either 24 weeks or 32 weeks. Post consult slip ticked on NCS column and passed to patient to make next appointment.
Pharmacy
To collect the prescription and check on ‘By protocol-supply half first then the rest after review’. To supply the medication to patient and original prescription to place in the NCS slot at pharmacy.
Nurse
Collect the NCS prescription and check the next date and file in the NCS prescription files according to date and month.
MRO
Admin
As per post consult slip next appointment made for NCS review.
Team feedback and brainstorm session
Cause and Effect using Ishikawa Diagram
As shown in Figure. 3: Three main key factors were identified during the feedback session.
1.Pharmacy staff wrongly placed the NCS prescription into
the stack for storage instead of the one to be returned to the NCS room.
2.The NCS prescription was filed wrongly by the nurse at NCS room
3. Patient was given doctor’s appointment instead of NCS due to being wrongly ticked in appointment (post- consult) slip by doctor or mistakenly wrong service given by the appointment staff.
Pharmacy •To separate ‘NCS prescription by protocol’ from the non NCS prescription.
ISHIKAWA DIAGRAM
Missing NCS
Prescription
PATIENT
DOCTOR
PHARMACYSYSTEM
MRO NURSES
Tick wrong TCU date in post consult slip
Did not indicate in the Prescription by "PROTOCOL"
Dr never order NCS review in Clin Doc and advise to remain OLD NCS Appt
Tick wrong service in post consult slip
Font & shape
small
Gap between the check
box too close
inconsistency in Post Consult Slip
Originalprescription given to patient for partial collection
Prescription filedin to the common pool.
Forward NCS appointment given by NCS during NCS visit date
collect partial medication and did not bringoriginal presciption
Nurse unable to locate presciption from NCS folder
prescription
fi led under different service or date
nurse
unaware how to locate the presreption
Nurse return the prescription to phamarcy if no nurse service appointment made
patient did not make
NCS appt
MRO given dr appointment
instead of NCS
appointmentgiven for wrong service
appointmentgiven for wrong date
MRO given
appointment for di fferent service or date
nurse put
prescriptionunder wrong service or date
patient madeappointment via call center/online
Nurses •On the job training {OJT)
to file NCS prescriptions accordingly at
NCS files.
Doctor •Reminded to tick on the correct box for NCS
appointment.
Senior Admin Staff
Conduct training for their staff to enter appointment correctly
Pharmacy Nurse Doctor Senior
admin Staff
•Continuous monitoring
pharmacy staff to place the
NCS prescriptions at NCS
slots for Nurses to collect
every morning.
•- On going
• Continuous OJT to
place the NCS prescription at NCS files according to date and month by nurse after collection
of NCS prescription
every morning from pharmacy
•– On going
•Continuous OJT for ticking the NCS column correctly.
•– on going.
•Continuous reminder to enter appointment correctly and to keep constant info on ‘remarks’ information if patient not keen for NCS appointment.
• – On going
The multi-disciplinary stakeholders analyze the factor contribute and identified the potential cause the problem; a resultant of cause –effect Ishikawa diagram (as shown in Figure 2).
After brainstorming on the main factors identified, team members agreed on 4 interventions as shown in figure 4.
Figure: 4
Figure. 3:
Intangible Benefits Better care and safe care for patient. Manpower saving in time and enhance for more focus on treatment care. Less disruptions in service quality to patient.
We would like to thank :
Adviser : Dr Hwang Siew Wai.( Director Bukit Merah Polyclinic)., NM Tan Joo See .,NC Zuhaidah Amir.
In a two weeks survey performed in June 2017, it was found that, out of an average daily NCS attendance of 22 patients, 18 of the prescriptions were missing, requiring resources of manpower and time to re-print the lost prescription.
Figure:5
49%
45% 47%
49%
45%
0.81% 0.84% 0.51% 0.31% 0.40%
0%
10%
20%
30%
40%
50%
60%
Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18
Percentage reprint NCS prescription
After intervention a three months survey done and the result shown a positive outcome and supported by our stakeholders and core team members.
Intervention Starting point
Figure 2
Final and completion of Intervention
Sustainability period