practice Pearls

Encourage employees to increase flu shot numbers

In 2005, our flu shot data was inadequate due to poor documentation by our entire staff. Last year, to address the problem, we began the "Flutucky Derby." We originally planned to give a gift card to reward the nurse who administered and correctly documented the most flu shots and to the medical assistant or office employee who influenced the most patients to receive a shot. In the end, we rewarded each employee with a gift card to show our appreciation for their dedication to improvement.

We used the nurses' documentation to track the number of shots they administered. The medical assistants and office staff kept their own lists on the honor system. For example, if a medical assistant recommended a flu shot to a patient and the patient followed through and received one, the medical assistant would include that patient in his or her list. We tracked these numbers each week and posted the results in a high-traffic area. The competition was fierce, the flu shot rush was fun, and we increased the number of shots we documented by more than 40 percent.

Kristy Cowherd, MD
Heber Springs, Ark.

Start a farmer's market at your office

Our practice invites local fruit and vegetable vendors to display and sell their produce at our building. The vendors set up their stands one day each week at the front of the building. Patients can purchase produce when they come in for their appointments. This has been a successful way to promote healthy living and proper nutrition to our patients.

Hien Nguyen, MD
Fairfax, Va.

Prepare for patient visits with a "cheat sheet"

My practice uses a form we call our "chart prep/nursing sheet" (see below) that has improved our workflow and reduced the amount of time we spend looking for records and test results. Patients complete the form when they check in, and nurses review it as they room patients. Our nurses feel more prepared for each visit, and patient feedback has been positive. (A Microsoft Word version of the form below is available here.)

Ku-Lang Chang, MD, FAAFP
Gainesville, Fla.

Chart Prep/Nursing Sheet

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NURSING STAFF:

• If the patient completed a physical or other form, please stamp it, review it and perform the tests required.

• If the patient has diabetes, has an A1C test been done within the last three months? If not, please complete one.

• If the patient has diabetes, has a microalbumin test been done within the last six months? If not, please complete one.

• If the patient is new, verify that paperwork was given and all pages were completed.

• Check to make sure there is an Rx sheet in the chart.

• Check all four vital signs.

Use birthdays for preventive services reminders

It is especially challenging to provide preventive services for two groups of patients: those who don't visit our clinic often and those who have multiple medical problems that must be addressed at problem-focused visits. To manage this problem, we started sending patients a letter on their birthday wishing them well and listing the age-appropriate preventive services they have received and those that are still needed. The letter encourages them to schedule an appointment for the needed services. The response has been positive, and many patients are now up-to-date on their preventive services.

Nate Hitzeman, MD
Sacramento, Calif.

Store high-risk medication samples in red boxes

Keeping high-risk or high-alert medication samples in red storage boxes that distinguish them from other medications can help reduce the chances that they will be administered mistakenly. The Agency for Healthcare Research and Quality defines high-risk or high-alert medications as medications that are involved in a high percentage of medication errors or that carry a high risk for abuse or adverse outcomes. For example, psychotherapeutic medications, medications whose names look or sound alike, and medications not approved or recently approved by the FDA are good candidates to be stored in red boxes.

Source: U.S. Department of Health and Human Services. Mistake-proofing the
design of health care processes. Available at: http://www.ahrq.gov/qual/
mistakeproof/mistakeproofing.pdf. Accessed July 20, 2007.

Help your patients organize multiple medications

My father takes 29 pills each day, which is too many for a normal pill organizer box, so my parents developed a creative and useful way of keeping track of his medications. Each day's pills are sorted into four 2-by-2-inch plastic storage bags (available at craft stores) that are labeled according to the time of administration (e.g., 8 a.m., noon, 6 p.m. and 10 p.m.). These are placed in a larger bag labeled with the day of the week. Each morning, after he takes his 8 a.m. pills, he puts that day's bag in his pocket so he has his medications at hand even if he's not at home.

When it's time to refill the bags, they start with index cards labeled with each dose required in a day (e.g., HCTZ 25 mg) and sort them into envelopes labeled with the time of administration. The envelopes guide them as they fill the medication bags, which takes one to two hours every two weeks.

Jennifer J. Donohue, MD
Lake Oswego, Ore.