Expansion of Nurse Care Protocols in Primary Care PCMH Clinics

Patient-centered medical home model of care was developed in an effort to serve more people and improve chronic disease care. Using interdisciplinary team-based care, PCMH uses a system-based approach to improve access and quality of care in the primary care environment. Increased demand for primary care services can be traced to the passage of the Patient Protection and Affordable Care Act.
As the patient centered medical home (PCMH) care model continues to evolve at Nebraska Medicine, the role of registered nurses (RNs), the largest healthcare workforce, is seen as a valuable asset in providing patient education and prevention strategies. In addition to chronic conditions like diabetes, hypertension, and hyperlipidemia, Nebraska Medicine developed clinical protocols for acute symptom management and healthcare screenings. An interdisciplinary committee developed these protocols using nationally recognized evidence-based guidelines for the following conditions: group a streptococcal pharyngitis (GAS) care screening, urinary tract infection (UTI) care screening, breast cancer screening, colorectal cancer, and nonpregnant adult diabetes in ambulatory care.
The nurse care coordinators (NCC) are registered nurses hired specifically to coordinate care, address care gaps, and invite patients to be full participants in their care. Using care registries and between patient visit outreaches, these protocols enable nurses practicing at the top of their license and skill set to enter orders on behalf of the PCMH medical providers. These protocols can expedite diagnostic test results and facilitate the implementation of therapeutic strategies. Following RN education, this work rolled out to 15 PCMH clinics in May of 2024.
Nebraska Medicine PCMH teams continue to work together to use clinical best practices, technology tools, and provider skills sets to promote strategies to improve patient care. Ambulatory care nurses find their ability to provide quality patient care rewarding and a source of pride.
This session will share the five protocols, review the workflows needed to achieve organizational approval and staff acceptance, and outline next steps to evaluate effectiveness and satisfaction.