Significance/background: In an ambulatory care multiple myeloma clinic covering 10 physicians that sends approximately 4,000 immunomodulatory drugs (IMIDs) refills per year by a team of 8 advanced practice providers (APPs) and 10 registered nurses (RNs), communication alignment for refill requests was challenging due to high medication refill volume and multiple modalities of communication. Original workflow included a RN receiving medication refill notification via EPIC in-basket. The RN would add the refill request to a manually managed shared Excel sheet for APPs to review or send an email to all APPs. Historically, there were 1-3 patient complaints per month regarding missed IMID refills as a result of missed communication.
Purpose: To create a digitized and automated work queue to streamline interdisciplinary communication of IMID refill requests while simultaneously tracking and collecting data for auditing, analysis, administrative, and managerial purposes.
Intervention: After initial process analysis, building rapport and buy-in with end-users, Microsoft Lists (a PHI-secure platform) was used to replicate previous Excel workflow with new automated features. The project was independent of an IT team. Design and implementation of the beta version was achieved in one day. Changes, updates, and full user integration were achieved in one week.
Evaluation: The platform tracks patient identifiers, physician, provider sending refill, medication, dose, quantity, direction, notes, authorization number, pharmacy, date added, date modified, and total medications sent, not approved or pending. Since implementation, data entry has been self-sustained by end users with 100% participation occurring on a daily basis. Patient complaints of missed refills have been at 0% post-implementation. The RNs and APPs using the platform will be surveyed on ease of usability at 6 months. Data captured will be used for administrative and management purposes.
Discussion: This medication refill platform was a no-cost, secure, quick, and effective implementation that improved workflow and streamlined communication between RNs and APPs. The platform tracks and collects data that can be used for additional research and process improvement initiatives. This platform can be replicated in other oncology practices.
Innovation: Innovative use of technology and informatics provided the opportunity for nurses to facilitate communication alignment between RNs and providers and improved coordination of patient care and track metrics for future analysis and process improvement, which can lead to improved patient medication adherence, decreased medication errors, and increased patient satisfaction.