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UPDATED ASD Lab Orders LEAN Project Charter

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1. What metrics, other than those listed, could be used to determine the success of the new workflow?

2. Consider you are a consultant brought in to analyze a workflow in your facility's nursing department.  How will you ensure buy-in from the team members of your proposed solutions, when you are not yourself a member of the team?

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What resources, people, and departments are required?
Resources: Examples of previously approved protocols, knowledge of existing workflows

People: Katherine Kolson, BSN, RN & Monique Walker, BSN, RN (Project Leads), Drs. Tatum, Feyissa, Ritaccio (Epileptologists), Cammi Velichko, MSN, RN, CNRN, NE-BC (Nurse Administrator), Neurology Department Physician Leadership, Site-wide Physician Leadership

Departments: Neurology Nursing, Neurology Physicians, Nursing Administration, Site-wide Physician Leadership, possibly Legal

Testing of new workflows:
Once the protocol for ordering the labs is approved, a small pilot of the new workflow will be performed to test it out in practice.  One of the two epilepsy nurses will use the new workflow for a month, while the other epilepsy nurse will continue with the old workflow.  This will allow for a trial of the process before full implementation occurs.  The trial can be evaluated, and changes made before full implementation.

Training of individuals on new workflows:
Currently there are two epilepsy nurses who will be affected by this new workflow.  One of the nurses serves as one of the project leads, and will not require training.  A training session will be used to illustrate the new workflow to the other epilepsy nurse and will include the workflow maps for visualization.  A brief team huddle will be used to convey the new workflow to the rest of the neurology department nurses.  They will not be expected to utilize the new process unless providing coverage for an absence in the epilepsy division.

Description of "Go Live" with new workflows:
"Go live" will take place once the small pilot has been completed and the workflow revised as needed.  Both epilepsy nurses will begin using the new workflow to order antiseizure drug level labs for eligible patients.  Expected volume is approximately ten patients per month.  The epileptologists will be sent a courtesy email to alert them the new workflow is now in place, and they will only need to cosign the orders after completion.  A second email communication will be sent to the neurology nursing department to alert the nurses of the change in workflow should they need to fill in for one of the epilepsy nurses.

Analysis and refinement of workflows:
Analysis will be ongoing during the pilot and after implementation.  The fact that the workflow will only mainly affect two nurses will aid in the process of discovering any workflow issues, as well as implementing refinements.  The previously stated metrics of time, cost, and number of unnecessary labs ordered will be tracked and tallied monthly for six months.  After six months a project success report will be generated to report on metric specifics pre- and post-implementation.

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A key to successful implementation of health information technology (health IT) is to recognize its impact on both clinical and administrative workflow. Once implemented, health IT can provide information to help you reorganize and improve your workflow. This toolkit is designed for people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care.

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Workflow Assessment for Health IT Toolkit

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A key to successful implementation of health information technology (health IT) is to recognize its impact on both clinical and administrative workflow. Once implemented, health IT can provide information to help you reorganize and improve your workflow. This toolkit is designed for people and organizations interested or involved in the planning, design, implementation, and use of health IT in ambulatory care.

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Simplify and Transform Clinical Workflow

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What practical problem will be resolved?
Each state has their own guidelines for allowing persons with epilepsy to operate a motor vehicle.  In Florida, patients must be seizure-free for 6 months.  After patients have been 6 months seizure-free, they must have Department of Motor Vehicles (DMV) paperwork filled out by their physician, presenting relevant information which allows the DMV to determine appropriateness of license reinstatement.  Part of the paperwork is submission of antiseizure drug levels within the last 6 weeks.  Patients do not usually have these, and therefore they must be ordered.  The nurse currently must propose the labs to the physician for approval/signature.  This delays patient care, as oftentimes orders are signed once per day.

What is the project’s purpose?
The purpose of this project is to develop a leadership-approved protocol that the nurse can follow to place lab orders to be acted upon immediately, without needing the physician to sign off on them first.

Scope of Practice Considerations
It is not within a nurse’s scope of practice to place orders without physician approval.  Verbal orders are also discouraged by The Joint Commission, and should not be used for workflow efficiency when not an urgent/emergent situation.  Currently in Florida nurse-driven protocols are not allowed.  The leadership team and legal department at Mayo Clinic have determined that physician-approved protocols may be used by nurses if approved at the highest levels of leadership.

What process steps will be considered in this project?
·       Patient-initiated contact requesting DMV paperwork completion
·       RN determines if labs are needed, and places orders
·       Physician signature of lab orders
·       Patient obtains requested lab work

What is the first step and what is the last step?
·       First step: Patient-initiated contact requesting DMV paperwork completion
·       Last step: Either labs scheduled at Mayo Clinic OR outside lab prescription sent/given to patient

Included in scope:
·       All means of patient contact initiating paperwork request
·       RN current and future workflow of processing request from receipt of request to ordering of labs
·       Physician signature of lab orders

Excluded from scope:
·       Process continuation after receipt of lab results

Justification for this project: why is it important?
This project is important because the guiding principal at Mayo Clinic is The needs of the patient come first.  Persons with epilepsy often experience decreased quality of life related to lifestyle modifications they must endure.  One of these modifications is the inability to drive until they are 6 months seizure-free.  Once patients become eligible for reinstatement of their driving privileges, they want the process to move along as quickly as possible.  They have a need for as much independence as possible, and as their treating epilepsy team, we have a responsibility to meet their needs as efficiently as possible.

Why is it critical to business success?
Developing this leadership-approved protocol is critical to business success because it reduces workflow inefficiencies (which can lead to errors and delays), and improves patient satisfaction.  In healthcare today patient satisfaction is paramount to business success, so improvements in workflow which increase patient satisfaction support success in business.

How will internal and external customers benefit from this project?
Internal customers (nurses and physicians involved in the process) will benefit from this workflow change.  Nurses will be able to act immediately upon the paperwork request, without the delay of sending the lab orders to the physician for approval.  This prevents one instance in the workflow where the nurse is jumping in and out of a particular encounter, streamlining the process.

The physician will now not be bothered with an in basket message with a pended order that he has to sign before the process can be continued.  The decision to order labs does not have to be evaluated by the physician for each patient, as the protocol will define exactly who is appropriate for application of the protocol.  The physician will only get a message to co-sign the order after it has already been placed by the nurse.  There is no decision-making required for the physician at that juncture.

External customers (the patient and the DMV) will benefit also from this workflow improvement.  Patient satisfaction is projected to increase due to a reduction in time from their request to when they can have their labs drawn.  The DMV will benefit as they only allow a certain timeframe for paperwork to be totally completed (lab results included).  A reduction in the time it takes to order the labs is projected to lead to a reduction in paperwork delays and extensions requested from patients.

How does improvement in the metrics that you have selected help them improve their performance?
A reduction in business days from RN review of paperwork to lab order placement will result in improved efficiency, better coordination of care, and faster turn-around times.  Improvement in processing time will result in reduced cost of RN time.  Having a defined protocol to follow will result in fewer unnecessary labs ordered for patients who are ineligible for reinstatement, saving time and money both.

Names and roles of team members:
Katherine Kolson, BSN, RN & Monique Walker, BSN, RN: Project Leads, workflow analysis and redesign, protocol drafting

Epileptologists: Workflow analysis support, First approval step

Nurse Administrator: Approval of project charter, protocol drafting/compliance support, connection to leadership approval

Neurology Department Physician Leadership: Second approval step

Site-wide Physician Leadership: Final approval step

Project costs:
Project costs will be absorbed by the outpatient neurology clinic, with the project leads being given sufficient time to dedicate to the workflow redesign project.  Supplemental staff will be brought in as needed to backfill their positions.  It is expected that over time initial costs will be recouped via the cost savings incurred by the workflow redesign

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Performance Improvement Methods to Optimize Clinical Workflow_A Practical Approach

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Epilepsy and Driver's License Requirements

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Epilepsy and Driver's License Requirements

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CURE: Citizens United For Research In Epilepsy

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CURE: Citizens United For Research In Epilepsy

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Win a VIP Chicago Hamilton Experience with the My Shot Raffle!

Don't throw away your shot to receive two tickets to the FINAL Hamilton performance in Chicago, along with other fantastic prizes during Epilepsy Awareness Month.

Major Milestones

1998

CURE is founded by Susan Axelrod.

2000

CURE co-sponsors the National Institutes of Health Conference - the first of its kind to focus on a cure for epilepsy.

2002

CURE establishes the first Sudden Unexpected Death in Epilepsy (SUDEP)-targeted research program.

2007

CURE establishes the first-ever Prevention of Epilepsy After Traumatic Brain Injury Award.

2010

CURE takes up another unprecedented initiative by publishing its State of Research in Epilepsies Report.

2012

CURE launches the Infantile Spasms (IS) Research Initiative to accelerate the understanding of IS and adaption of innovative therapy into the clinic.

2015

CURE launches a new signature program, the Epilepsy Genetics Initiative (EGI) creating a culture of personalized medicine for people with epilepsy.

Research will lead us to a Cure

Our mission is to find a cure for epilepsy, by promoting and funding patient-focused research. We identify and fund cutting-edge research, challenging scientists worldwide to collaborate and innovate in pursuit of a cure for epilepsy.

Since being founded in 1998, CURE has been at the forefront of epilepsy research, raising more than $60 million to fund research and other initiatives.

The answers are out there, and we're determined to find them.

We are Citizens United for Research in Epilepsy (CURE) - the leading nongovernmental agency fully committed to funding research in epilepsy.

Our organization was founded by Susan Axelrod and mothers of children with epilepsy who joined forces to spearhead the search for a cure.

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CURE Epilepsy | Citizens United for Research In Epilepsy

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Win a VIP Chicago Hamilton Experience with the My Shot Raffle! Don't throw away your shot to receive two tickets to the FINAL Hamilton performance in Chicago, along with other fantastic prizes during Epilepsy Awareness Month. 1998 CURE is founded by Susan Axelrod.

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Epilepsy with Eyelid Myoclonia (Jeavons Syndrome)

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Driving a car is so critical to employment, socialization, and self-esteem that people with epilepsy list it as one of he main concerns. Physicians, patients, and regulators share the responsibility of protecting the public, while still providing reasonable opportunity for individuals with seizures to drive a car.