Restructuring Prescription Refill Process Elevates Patient Experience and Nursing Practice

Patients need their healthcare team to provide timely access to care. An influencing factor of a patient’s perception of timely access to care is how their prescription refills are managed. What sounds like a relatively simple task can be burdensome for many reasons within busy ambulatory care practices, and chief among the challenges is overwhelming volume. In 2019, the primary care offices within a large multi-site ambulatory care practice group received over 500,000 prescription refill requests. Knowing that patient access was a top priority for the organization, the primary care team embarked on a journey to innovate and design a new way of work for prescription refill management, a staple, but ever-evolving patient need.

Strides have been made toward a team-based care model in the ambulatory care setting where each member of the patient care team works at the top of their scope and education level to ensure that patients receive high-quality and timely care. For this reason, the nurse plays an integral role in ambulatory care. By empowering these highly skilled clinicians to care for patients using approved prescription refill protocols, a significant volume of work was removed from physicians, and advanced practice providers and efficiencies were gained in the process. The increase in efficiency resulted in quicker turnaround for patients, fewer repeat calls by patients inquiring about their refill, and improved nurse confidence. As a result of this work, we expect to see additional improvements with patient education, patient satisfaction, and population health measures such as hypertension.

This presentation will focus on how a large multi-site ambulatory care practice group used the momentum of a reinvigorated patient access strategy and a newly hired director of ambulatory care nursing practice to empower front-line ambulatory care nurses in the redesign of the prescription refill process, not for their clinic, but a group of clinics, providing examples of:
• how the team approached the evaluation of current roles, responsibilities, and workflows of the four pilot practices
•    the standardized workflow for prescription refill management utilizing the size and scale of the practice group; and
•    the training and education plan developed by the nurses to ensure a smooth process across refill pools and provides a foundation for additional centralization efforts.

As a result of this pilot, the standardized process allowed for seamless floating between refill pools, a 20% reduction in the time a nurse spent on each message, allowing the nurse to complete more messages each day, less than 24-hour turnaround time for nurse responses to messages. Ultimately, efficiencies were found in the number of FTEs required to complete the work as well as the manner in which this work is completed. Amid a global pandemic, this was a win for our team members, and the invaluable lessons we have learned will change how we practice and lead well into the future.