A flow chart for use in treating patients with kidney disease. A more accurate method of getting medical information from patients in the emergency room. These are evidence-based, quality-improvement research projects that can help transform healthcare delivery.
They’re the work of two WSU College of Nursing doctoral students who undertook the research as their final step in the Doctor of Nursing Practice (DNP) degree – a clinically focused doctoral program that often leads to a career as a nurse practitioner. The students presented the results of their research at the College of Nursing recently.
Improving medication reconciliation in the ER
Megan Weese sought to improve the accuracy of information about patients’ medications in the emergency department by including students from the WSU College of Pharmacy in the process.
Nurses in the ER need to get lists of medications that patients are taking, including drug name, dosage, frequency, and route, but nearly all of those lists are incomplete or inaccurate, she said. Sometimes that’s because the patient, or his or her family or friends, don’t know the information, but sometimes it’s because the ER nurse is dealing with many patients at once and frequent interruptions. The most common inaccuracy is not including all medications in the list.
When that list is inaccurate, it’s a patient safety risk because of potential adverse drug events, she said. Getting an accurate list, called medication reconciliation, often takes detective work down the line.
Weese developed a pilot project that placed senior pharmacy students in a hospital emergency department for a month to complete medication reconciliations. The pharmacy students had 40 percent fewer discrepancies than the nurses in that task, she said.
A larger study could show that having a pharmacy technician or student in the ER regularly could improve the accuracy of medication lists, increase patient safety, and reduce healthcare costs, Weese said. She noted that the pilot was considered so successful, WSU College of Pharmacy students are still working in the hospital ER on medication reconciliation a year after her project ended.
Creating a kidney-care decision making tool for primary care clinicians
Robert Playo developed a decision-making tool to guide care of patients with kidney disease.
Playo, who’s been working in the field of nephrology for five years, wanted to address inconsistencies of care provided to patients before referral to a nephrologist, as well as inconsistencies in when they were referred to a specialist.
Though the National Kidney Foundation publishes clinical-practice guidelines addressing those issues, the document runs more than 350 pages and many primary care providers don’t have ready access to its contents, Playo said. The tool he created covers about 80 percent of the recommendations from those guidelines, in a one-page, flow-chart format. It was tested in a small internal-medicine practice, and Playo said the physicians there found it useful.
“They said that it made care of renal patients a little less intimidating,” he said.
Playo noted that chronic kidney disease is reaching epidemic status in the U.S., and with the aging of the population, that number is likely to grow. “If we can get referrals to be more appropriate, it would utilize the time of nephrologists more effectively” and save money in the healthcare system, he said.
— Story by Addy Hatch