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Purpose: The purpose of this initiative is to improve the quality of care for patients with hypertension by enhancing clinical staff knowledge of blood pressure measurement technique, increasing awareness of the quality metric for hypertension, and implementing a standardized protocol for repeat measurements including post-visit follow-up on a system-wide scale in ambulatory care clinics. Background: While blood pressure measurement techniques are taught in nursing and medical assistant schools, these methods are rarely reinforced in clinical practice. A review of the organization’s quality metric data demonstrated the need for a standardized process for blood pressure measurement. Methods: We searched PubMed for current best practices in “blood pressure determination” and refined the results to 34 articles to answer our question: In adult patients with a hypertension diagnosis aged 18-85 years in an ambulatory care setting who have a most recent blood pressure greater than 139/89, does system-wide online caregiver education and implementation of a standardized protocol improve the number of patients with a most recent blood pressure under control? The research confirmed the importance of ongoing education and the use of standardized procedures for blood pressure measurement technique. Interventions were developed to improve blood pressure measurement technique, including a micro-learning educational pathway and standardized protocol. To encourage participation and improvement, our team has created a competition-based approach, measuring percentage of improvement, where the winning clinic in each region will receive a celebratory event for their efforts and a spotlight article in our communications channel. Results: Each participant will complete both a pre-test and a post-test that will assess their knowledge of blood pressure measurement skills, the hypertension quality metric, and perceived barriers or enablers to accurately measuring blood pressure in the clinic setting. A baseline data assessment will be performed, measuring performance during a 3-month period prior to implementation, and intermittent progress data will be completed during the competition period. At the completion of the competition, our goal is to see an overall improvement in blood pressure measurement technique, an increased number of repeat blood pressure measurements when a patient is not at goal, an increased number of follow-up blood pressure check appointments if indicated, and an overall increase of patients whose most recent in clinic blood pressure is under control. Conclusions/implications: This initiative has not yet been implemented. We anticipate the first cycle of this implementation will be completed prior to the conference, with post-data available for success measures at that time. |
Background: Due to a lack of financial clearance, patients needed to be rescheduled for neurological infusions causing a delay in treatments. 25% had to either be rescheduled or given a free dose paid for by the hospital. Duplication of efforts within nursing and pharmacy occurred in attempts to align infusion coverage with date of service (DOS). White bagging is an arrangement between payers and selected pharmacies to ship a patient’s medications directly to the site of care to achieve cost savings. Free meds are manufacturer-dependent; white-bagging has preferred sites and needs prior authorization. Buy-and-bill methodology uses a pharmacy’s own supply and can be implemented interchangeably at any of the hospitals’ sites. PICO: For patients prescribed specialty medication infusions for chronic conditions, does interprofessional involvement in tracking opportunities for implementation of white bagging, free med, or buy & bill promote less appointment rescheduling due to lack of financial clearance? Literature review: Specialty medications are life-changing for patients by helping to achieve lower disease activity, improved quality of life, or remission (Zuckerman et al., 2019). There has been a rapid rise in specialty medication utilization with challenges to high-cost management to healthcare systems (Zuckerman et al., 2019). The 340B drug pricing program increases access to outpatient medications for uninsured/low-income patients allowing hospitals to purchase, dispense, and administer outpatient medications at discounted prices with full reimbursement from public and private insurers (Thomas and Shulman, 2020). Comprehensive management of specialty medications includes complex processes for payer approval, financial assistance, handling, delivery, and storage (Zuckerman et al., 2019). Effective team communication with clearly defined roles are essential and fundamental for effective collaboration among nurses, physicians, and pharmacists to deliver high-quality care and to meet patient needs (De Baetselier et al, 2021). Methodology: Continuous tracking and strategic initiatives were implemented for white bagging, free med, or buy & bill to assure timely patient adherence to prescribed treatment. Weekly interprofessional (nursing, pharmacists, and administration) meetings for sharing of the status of medication availability for upcoming appointments began on September 23, 2020. Outcomes/conclusions: Interprofessional collaboration is effective in decreasing delays in specialty medication infusions. Sharing professional expertise for the management of specialty medication infusions is beneficial to patient experience with decreased rescheduling. Converting specialty infusions to buy & bill is cost-saving and supports organizational fiscal responsibility. References: 1) De Baetselier, E., Dilles, T., Batalha, L. M., Dijkstra, N. E., Fernandes, M. I., Filov, I., ... & Van Rompaey, B. (2021). Perspectives of nurses’ role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses. PloS one, 16(5), e0251982. 2) Thomas, S., & Schulman, K. (2020). The unintended consequences of the 340B safety‐net drug discount program. Health services research, 55(2), 153. 3) Zuckerman, A. D., Carver, A., Cooper, K., Markley, B., Mitchell, A., Reynolds, V. W., ... & Kelley, T. (2019). An integrated health-system specialty pharmacy model for coordinating transitions of care: specialty medication challenges and specialty pharmacist opportunities. Pharmacy, 7(4), 163. |