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.
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.
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.
Click below to download the form.
|Please answer the following questions by circling Y (yes) or N (no). Thank you.|
|Y||N||Have you had any X-rays, CTs, mammograms, MRIs or other types of tests done recently? If yes, when and at which facility?|
|Y||N||Have you had any lab work performed recently? If yes, when and at which facility?|
|Y||N||Have you been seen at an emergency department/urgent care center/hospital recently? If yes, what is the name of the facility?|
|Y||N||Has another physician seen you recently? If yes, which physician and when?|
|If you answered yes to any of the questions above, you may need to complete a release of information form. Please check with our front office staff.|
|Y||N||Do you have forms that need to be completed? If so, please complete your portions and then give the forms to the nurse.|
|Y||N||Are you here for a physical or Pap smear? If yes, ask the front desk for a physical form, and complete both sides.|
|Note: It is rare for insurance companies to reimburse for a physical and treatment of a health problem at the same visit. If you are here for a physical and need medication refills or have a health problem that requires treatment, we suggest that these issues be addressed in two separate visits.|
|Y||N||Did you bring a blood pressure, blood glucose, headache or pain diary?|
|Y||N||Did you bring medical records? If yes, please give them to the nurse to copy.|
|Y||N||Do you need a work/school absence note?|
|Y||N||Do you need medication refills? If yes, for which medications?|
If the patient completed a physical or other form, please stamp it, review it and perform the 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.
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.
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.
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