(2017-05) Armendariz, Tomas; Chernesky, Shelli; Lin, Christina; De Simone, Nicole; Sarode, Ravi
[ This is a test sample.] PURPOSE: To report the implementation of a concise and easily accessible “apheresis synopsis” report to improve team communication, overall efficiency, patient safety and comfort. With the birth of electronic medical records (EMR), the patient story has been lost. In the past, physicians would review nursing apheresis procedure flowsheets in the paper charts. However, in the EMR used at our institution (EPIC®), physicians did not have access to apheresis display screens due to differing configurations based on provider type. An employed solution was for nurses to write a procedure summary note including final machine data. This documentation was not standardized and did not provide sequential data from previous procedures to make patient specific treatment decisions. Historical and current data drives these decisions. Historical data, such as inlet flow rates, use of calcium to treat citrate reactions, or use of tissue plasminogen activator, drives future treatment. Current data, such as most recent hematocrit or vital signs, are used to adjust procedure run parameters. Further inefficiencies occurred due to having to toggle between tabs in the EMR, such as between prior procedure notes, labs and recent vital signs, to determine parameters for that day’s procedure.
METHODS: Physicians, advanced practice providers, nurses and technologists collaborated on identifying data points needed to assess patients for their apheresis procedures. Nursing worked with the EMR team to develop a well-organized, comprehensive and easily accessible report. All this was developed into the “apheresis synopsis” display screen within the EMR. This ensures that all relevant parameters are automatically displayed at the end of a procedure for ease of viewing. It also allows physicians to view sequential apheresis procedure data to observe for any trends, allowing appropriate adjustments in the apheresis plan.
RESULTS: We now use the synopsis screen to help coordinate and improve patient care in our clinic. The synopsis is a summarized report displayed as a running timeline of procedures, containing information regarding dates, types of apheresis procedures, information of pre- and post-procedure machine parameters, vital signs, types of access, and adverse reactions. If more detailed information is needed, clicking the hyperlinked date opens expanded documentation for that procedure (Image). Providers can now review multiple parameters from multiple procedures without having to open various EMR tabs or encounters, thus making for more efficient and individualized treatment decisions by trending data.
CONCLUSION: The patient story has been recaptured by maximizing the potential of the EMR through use of a synopsis. Communication between nurses and physicians has improved with standardized information available about each procedure leading to less frustration and ultimately, safer care.