Error loading player: No playable sources found

P031

Transforming Order Transmission: Implementing a Pend and Send Workflow for Enhanced Clinical Practice


Electronic health records (EHR) have demonstrated their effectiveness in minimizing medical errors. However, the use of workarounds can introduce significant safety risks. A carveout in the hospital-based clinic (HBC) policy allowed cancer center nursing staff to sign orders under “transcribed/internal” mode. Non-providers use this order mode when entering orders into Epic on behalf of a provider. Orders entered this way are active immediately before the provider signs it and are subject to interpretation and transcription errors. Concerns related to physicians and nurses practicing outside of scope encouraged executive leadership to look at improvement opportunities to ensure patient safety and protect our medical staff by ensuring all were practicing within scope of their licensure.
This initiative aims to provide the safest care possible to our medical oncology patients by eliminating the gap in unsigned orders. The process of pending orders to providers was developed to ensure orders are reviewed for accuracy and signed by the provider before they are executed. Key stakeholders, including cancer center leadership, clinicians, nurse educators, workflow informaticists, and project management, met to develop an individualized, collaborative plan for each disease-oriented team (DOT).
Initially, executive health system leadership met with cancer center leadership, including project management, to assess compliance and patient safety concerns, review data, and partner to develop an action plan. Before each DOT go-live, the project team met to develop an implementation strategy with respective clinic leadership, including physician leaders. Education was then provided to each nursing team which included required Elsevier training to be completed before go-live. An Epic “pend and send” workflow was created allowing nurses to directly pend orders for signature to the provider via an Epic in-basket message.
Genitourinary (GU) medical oncology was the first DOT to go live in April 2024. A phased approach was utilized to implement the workflow in the remaining DOTs, with planned completion by November 2024. Before implementation in April, the cancer center averaged over 3,000 transcribed orders entered weekly. As of the end of September, the cancer center decreased transcribed internal orders by 50%. The partnership between the project team, physician leadership, and clinical team was critical to this project's success. A tailored approach to each DOT while focusing on the patient's safety and care was integral in the rollout of this initiative and helped increase buy-in from clinicians.

Learning Objective

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Speakers

Speaker Image for Brooke Ferguson
Brooke Ferguson, MHA, CLSSGB
Speaker Image for Charlene Stein
Charlene Stein, MHA, RN, OCN

Related Products

Thumbnail for Quantifying Nurse Activities: A Survey of VA Patient-Aligned Care Team Nurses 2022
Quantifying Nurse Activities: A Survey of VA Patient-Aligned Care Team Nurses 2022
Veterans Administration primary care nurses perform activities that are often uncaptured, leading to these nurses not receiving credit for their work. These activities also are difficult to quantify or capture within the electronic health record (EHR)…
Thumbnail for Effects of Remote Patient Monitoring in the Ambulatory Care Setting on Chronic Conditions
Effects of Remote Patient Monitoring in the Ambulatory Care Setting on Chronic Conditions
Remote patient monitoring (RPM) is an opportunity to manage patient care virtually. Although RPM technology is not new, the COVID-19 pandemic provided an opportunity to capitalize on telemedicine, reduce in-person visits, and potentially prevent the transmission of SARS-CoV-2…
Thumbnail for Evolution of Pediatric Suicide Screening in the Ambulatory Care Setting: Maximizing Technology
Evolution of Pediatric Suicide Screening in the Ambulatory Care Setting: Maximizing Technology
The identification of suicide risk in pediatric patients is a growing concern in ambulatory care. According to the CDC in 2022, suicide was the second leading cause of death for ages 10-14…
Thumbnail for The Effect of Intentional Rounding on Patent Satisfaction in Ambulatory Care Clinics
The Effect of Intentional Rounding on Patent Satisfaction in Ambulatory Care Clinics
Learning objective: Evaluate whether the inclusion of intentional rounding by nursing staff affects the satisfaction of patients attending a clinic appointment…
Privacy Policy Update: We value your privacy and want you to understand how your information is being used. To make sure you have current and accurate information about this sites privacy practices please visit the privacy center by clicking here.