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Learning outcome: The audience will be able to discuss the benefits of a centralized model compared to a decentralized model for prescription renewal management, understand the components required for a prescription renewal program, evaluate best practices with prescription renewal management, and leave with tips on how to begin within their practice environment.
In the post-pandemic resource-scarce environment, nursing leaders and healthcare executives must find innovative and scalable approaches to provide patients with safe and quality care. In many ambulatory care practice environments, a proportion of the work of ambulatory care nurses involves prescription renewal management per protocol. In addition to being a key driver for patients' timely access to care, managing prescription renewal requests in a timely manner also has other benefits such as decreasing physician and provider workload and decreasing repeat calls.
In 2020, the primary care department within a large multi-site ambulatory care medical practice group recognized the need to develop a new model to manage the large volume of incoming prescription renewal requests. Three years later, what started as a pilot involving 4 primary care practices has evolved into a successful and rapidly growing centralized nursing prescription renewal team that now supports 56% of the eligible primary care practices within the group.
Significant changes were necessary to successfully develop and operationalize the prescription renewal team including the development of new standard work, pool (in-basket) management process development, the development of a pool (in-basket) report that allows for data collection and analysis, the development of a staffing model, the development of new effective communication channels, and the implementation of a quality assurance process.
Since 2020, 14 of the 25 eligible primary care practices have merged into the centralized prescription renewal team and the primary care department has benefited from a greater than 25% reduction in prescription message handle time and a decrease in the turnaround time as the centralized team addresses 85% of renewal messages within 24 hours.
Overall findings from this work indicate that a centralized model for prescription renewal management is more efficient than a decentralized model. Additional benefits of centralizing include strong nurse engagement and retention, a standardized hybrid staffing model, and decreased workload for physicians and providers.
Nursing leaders should advocate for centralized, standardized care delivery models when appropriate. Due to the success of this model, the organization chose to fund a pilot to embed prescription renewal technology into the electronic medical record. The pilot begins in the fall of 2023. At the conclusion of the EMR embedded renewal pilot, we expect to see a further decrease in prescription message handle time which in theory should allow the remaining eligible practices within the department to join the centralized prescription renewal team without adding additional nursing staff.
Jennifer Wall discloses that she is employed by FTI Consulting, Inc. as a nurse.
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Purpose: The purpose of this evidence-based practice project is to share lessons learned and outcomes from a pilot ambulatory care nurse residency program (NRP). Estimates show a gap of 450,000 registered nurses (RNs) by 2025. Increased retention will build more robust pipelines for new RNs, especially in the ambulatory care setting where the workforce is traditionally older. Learning outcome for attendees include ambulatory care NRPs can be successful with ambulatory care-specific curriculum in collaboration with a systemwide NRP structure.
Description: In the current times of high RN turnover, many organizations use NRPs to support transition to practice of newly licensed RNs. In the United States, RN first-year employment retention is currently 67%. NRPs are proven to reduce turnover and sustain the RN workforce. Many organizations have not yet implemented NRPs in ambulatory care settings due to financial and operational challenges. Fiscally, each percent change in turnover costs healthcare organizations $380,600 annually. Organizations must focus on retaining early career RNs who are often the most likely to leave.
In 2021, a large health system in the northeast implemented a pilot NRP for 7 newly licensed RNs. As a healthcare system, the organization has had proven success implementing an in-patient NRP for over 20 years. However, until 2021, never implemented an ambulatory care NRP. This abstract depicts the top 5 lessons learned from the pilot ambulatory care NRP: 1) Established systemwide NRP curriculum is applicable to ambulatory care clinics. 2) Supplementary curriculum, including role of the ambulatory care nurse, population health, care coordination, preventative care, scope of practice, social determinants of health, and telehealth nursing is critical. 3) Autonomous role of an ambulatory care RN necessitates greater need for cohorted ambulatory care NRP model; all newly licensed RNs need to start together and have many opportunities for interaction considering geographical spread and limited number of RNs per practice. 4) Pre-scheduling NRP curriculum is necessary to facilitate attendance due to the autonomous nature and staffing challenges in ambulatory care clinics. 5) Established academic practice partnerships and increased clinical rotations in ambulatory care settings will feed a new to practice ambulatory care pipeline.
Evaluation/outcomes: 7 newly licensed RNs completed the ambulatory care NRP with a 100% retention rate. Nursing leadership is currently evaluating next steps of the pilot. In conclusion, implementing a program that takes nurses away from clinics may seem counterproductive while facing the workforce challenges. However, by proactive planning, ambulatory care clinics can offer this vital resource to first-year RNs.
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