Better Together: Desk Staff and RN Partnership Benefits Practice and Patient Care

Purpose: Enrollment into the anticoagulation program is a complex transition of care. Nurses work as vigilant guardians managing warfarin dosing and teachers assuring patients have the knowledge to reach and safely maintain therapeutic range. Recognizing the importance of resource stewardship, RNs sought to utilize the skills and abilities of desk operation staff (DOS) colleagues in the enrollment process while not compromising the RN role of guardians and teachers. The aims were 1) decrease steps of the new patient enrollment process completed by RNs but not needing RN licensure by 90% without adversely impacting patient safely and 2) increase the number of patients taking the warfarin education class by 25%.

Description: An RN team worked to standardize processes and define gaps for completing enrollments. CNS and RNs collaborated to transition experienced nurse's knowledge into a workflow allowing non-licensed staff and RNs to partner with onboarding new patients. DOS use a comprehensive resource to complete a chart review. RNs use information to determine eligibility for program and plan of care. DOS welcomes patient, reviews program information, sends educational materials, assures HIPPA documentation is completed, and schedules educational class and first RN visit. The RN focuses on chronic care management (CCM) processes allowing for billing, patient specific education, and warfarin management.

Evaluation/outcome: 26 of 28 tasks not needing RN licensure were transitioned to DOS accomplishing the aim. Three potential privacy concerns were eliminated. Patient education class numbers nearly doubled. RN FTE decreased from 2.0 to 1.3 FTE per day. The number of patients enrolled in CCM significantly increased. Feedback from RNs revealed patients are better prepared to receive patient education with scheduled appointments. The warfarin class prepared patients to engage with RNs about lifestyle modifications that directly affect their TTR. Despite initial concerns, partnering with DOS to complete enrollments has proven beneficial to the practice and the patients.