Swim Lane Workflow Process Flowcharts (Current and Future)

Swim Lane Workflow Process Flowcharts (Current and Future): Prescription to Drug Administration

The advent of the Electronic Health Record (EHR) has seen a reduction in human errors that have cost the lives of thousands of patients over the decades (Palatnik, 2016). The EHR is a digital record of every patient’s interaction with the healthcare system. It contains what initially was written physically by hand in a patient’s paper file and includes the medical/ surgical history, physical examination findings, radiological and laboratory tests and investigations, prescriptions and treatment. By reducing human error, the EHR has therefore improved the quality of care. It has also facilitated the ease of access to patient data as well as reduced healthcare delivery costs for providers (McGonigle & Mastrian, 2017; Ozair et al., 2015). The use of EHRs by providers has its origins in the enactment of several pieces of healthcare legislation, the most important of which are the American Recovery and Reinvestment Act (ARRA) and the Health Information and Technology for Economic Clinical Health Act (HITECH). These legislative policies go as far as spelling out financial incentives for providers who use EHRs to improve their services (Sweeney, 2017; McGonigle & Mastrian, 2017). This paper is about the improvement in the workflow process in a hospital unit from physician prescription of medications to administration of the same to the patient by the registered nurse. The paper is a narrative description of the accompanying swimlane workflow process flowcharts before (figure 1) and after improvement through the installation of an EHR system (figure 2).   Swim Lane Workflow Process Flowcharts (Current and Future)

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The Current Workflow (Figure 1)

At present, without the benefit of an EHR, the physician has to physically be in the unit to write down the prescription to a patient using pen and paper. The registered nurse (RN) in the unit has to then make sure that they can actually read and have understood the physician’s prescription. They then have to send the certified nurse assistant (CNA) to the pharmacy to physically go and fetch the prescribed medications. The NA waits for the dispensation and then physically brings the drugs to the unit for the RN to administer to the patient.Swim Lane Workflow Process Flowcharts (Current and Future)

A Description of the Problem to be Addressed with Information Technology

Looking at the current swimlane workflow process flowchart (figure 1), it is evident that the physician needs to be physically present at the unit to ensure that their prescription is clear and has been understood by the RNs. This is time spent (wasted) that could have been used to reduce waiting time for other patients that need the services of the physician. The more a patient waits, the longer the hospital stay and the higher the hospitalization costs. This is a dent in the quality of healthcare. Another observation is that the NA has to waste time physically taking the prescription to the pharmacy and then wait for the dispensation to bring back the drugs to the unit. The implementation of novel information technological innovation through an EHR is therefore aimed at freeing the physician to attend to more patients faster within the same time. It is also aimed at freeing the CNA to help more patients within the same time with activities of daily living or ADLs. Improvement in these two areas will improve the quality of care in terms of efficiency, timeliness, patient-centeredness, and cost (Alotaibi & Federico, 2017).   Swim Lane Workflow Process Flowcharts (Current and Future)

The Workflow after the Requested Changes (Adoption of an EHR System)

The swimlane workflow process flowchart after implementation of the EHR system (figure 2) shows that the physician now does not need to be physically in the unit to prescribe medications. He can now do this remotely through the EHR by using the computerized provider order entry or CPOE. This eliminates errors that occur when the RN cannot properly read the physician’s handwriting. The RN in the unit accesses the prescription in the EHR system through the patient data management system or PDMS and posts a request for drug dispensation to the pharmacist (Alotaibi & Federico, 2017). This bypasses the need to send the CNA who is now free to attend to patients who need her services. The pharmacist dispenses the medications as per the prescription in the system (that the physician entered through CPOE), and only then does he notify the nurse to send the CNA to fetch the medications.

Services Needed to Make Changes, Role of Staff in Implementation, & Internal Actors Affected by the Changes

The services that will be needed to effect the changes are those of a nurse informaticist, concept producers, systems developer, and software engineers. Alternatively, it could be the services of an existing systems vendor. In the latter case, an existing EHR system platform is purchased as a product from one of the many commercial vendors. As for the internal customers who will be affected by the changes, these will be the physician, the RN, the CNA, and the patients. Lastly, staff can do the following amongst other things to implement the change process:Swim Lane Workflow Process Flowcharts (Current and Future)

  • Attend in-house training by the nurse informaticist on how to use the EHR system
  • Ask questions when they are having challenges in using the EHR system
  • Request for upskilling seminars to achieve competencies in the use of the novel technological equipment.

References

Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631

McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.

Ozair, F.F., Jamshed, N., Sharma, A. & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in Clinical Research, 6(2), 73–76. http://dx.doi.org/10.4103/2229-3485.153997

Palatnik, A. (2016). To err is human. Nursing Critical Care, 11(5), 4. https://doi.org/10.1097/01.CCN.0000490961.44977.8d

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics (OJNI), 21(1). https://www.himss.org/library/healthcare-informatics

Swim Lane Workflow Process Flowcharts (Current and Future)