Introduction
McGonigle & Mastrian (2012) define a flowchart as a blueprint of all the steps involved in a process, which are arranged in a sequential order with the inclusion of the units and persons participating in the task. It is a visual representation of activity from the beginning to the end. Process charts are useful in standardizing activities, exposing redundancies, and getting rid of wastes (Huser, Rasmusen, Oberg, & Starren, 2011). They are also helpful in identifying areas that need modification and providing effective communication of the steps to relevant staff, which enhances safety and care in the delivery of services.
In my unit, the issue of disposing of unused controlled drugs has been an area of concern. Although staff members have been educated on State and Federal regulations and the number of incident reports has increased, discrepancies are still seen in the weekly reports in the pharmacy. A workflow analysis is, therefore, necessary to enhance the understanding of the current practice of disposing of unused controlled substances and reveal areas that need improvement. The aim of this paper is to create a flowchart illustrating the steps and professionals involved in the disposal of controlled drugs, create metrics that will be helpful in evaluating the effectiveness of the current process, as well reveal areas that need improvement.
Creating a Flowchart
They are several key aspects and tools that are critical in generating a sequence chart. In flow analysis, it is essential to make a checklist of the steps, staff, and technology involved in the task to avoid leaving out some details (U.S Department of Health and Human Services, n.d). It is imperative to list all the steps in a clear and concise manner that is easy to read and understand. The diagrammatic presentation of the process should utilize a variety of symbols to represent different steps or actions. For Instance, the flowchart below makes use of an oval shape to represent the start or end point of the activity, a box to stand for a single step, a diamond shape to indicate a decision point, and flow lines to connect input and output from the beginning to the end. Conducting interviews of the individuals involved in the process provides useful information, insights into the issue, and suggestions on improving the workflow (U. S Department of Health and Human Services, n.d).
The Disposal of Controlled Substances
Step 1: Obtaining the Controlled Substance from the Dispenser
The process begins when a registered nurse (RN) acquisitions a controlled drug from the dispensing station (Pyxis). The nurse should check to see if the full dose is to be given or not. In cases, where the full dose is to be administered there is no need for a witness.
Step 2: Is the Container sealed or Open?
In case the patient is unable or refuses to take the drug, the nurse together with an RN witness should return the medicine to the return bin at the Pyxis station. When administering part of the obtained dose, a witness is required at the point of care. At this stage, policy requires the nurse to give the accurate dosage (in pills or milliliters) to the patient, and the rest should be disposed of properly in the presence of an RN witness. When the controlled substance is an injectable drug, the nurse should draw the correct volume in a syringe and dispose of the vial and the remaining liquid in a sharps container. Patches should be folded twice and discarded properly. Suppositories should be flushed down the toilet. An RN should perform all these activities with another RN witness in tow to act as a witness.
Step 3: Documentation
All disposals of controlled substances must be documented electronically at the Pyxis station. The RN witness should be indicated in the documentation.
Performance Metrics and Improvement Areas
Metrics are powerful tools when used correctly. They are useful in tracking performance and providing insight into process function. They are also helpful in reducing uncertainty and the implementation of the right decisions. Cycle time and organizational performance are appropriate metrics to measure and evaluate the process of disposing of unused controlled drugs.
According to McGonigle & Mastrian (2012), using the cycle time variable is an effective way of assessing the process function. The time duration from the moment a nurse acquires a drug to when he or she finds a colleague to dispose of the unused substance is a critical factor in evaluating the effectiveness of the flow. For efficiency purposes, it is necessary to synchronize this process with the nurses’ workflow.
Organizational performance is a critical metrics in assessing this activity. A falling trend in the number of incident reports is indicative of proper functioning of the workflow. In addition, benchmarking the hospital against a sister facility is useful in providing potential solutions and improving quality (U. S Department of Health & Human Services, n.d).
The current procedure of obtaining and discarding unused narcotics is in need of a few improvements. There is a need to synchronize the whole task with the nurses’ workflow that involves the use of bar-coding technology in matching drugs to patients. This will assist in reducing the cycle time. Real-time resolution of discrepancies is helpful in improving the process. In preference to waiting for the daily report, the outgoing and incoming nursing supervisor should check narcotics discrepancies at every shift change with an aim of resolving them before the departure of nurses from the unit.
The complexity of the healthcare environment and the rapid evolution of health information technology (HIT) warrants a continuous workflow analysis and modification. The awareness of the process sequence of any task allows for optimal staff and organization performance, decreases cost, and it improves the safety as well as the quality of care services (McGonigle & Mastrian, 2012). The exercise of evaluating and redesigning the workflow should involve all the stakeholders.
Summary
Effective HIT implementation must include workflow analysis, given the significant effects that the adoption of technology has in routine clinical practices. The step-by-step assessment of a task is essential in improving efficiency and performance. It allows practitioners to understand the process and identify its shortcomings. Consequently, preparation plans and goals to improve the procedure can be set.
Creating a workflow makes it easy for the relevant personnel to visualize and understand the process. It helps in minimizing wastages and optimizing resource utilization. Essentially, workflow charts assist in the identification and elimination of steps that do not add value as well as the enhancement of the critical components of the task (McGonigle & Mastrian, 2012).
References
Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11(1), 43–61.doi:10.1186/1471-2288-11-43
Lewis, A. (2011). Clinical workflow analysis and process redesign. Retrieved Jul. 21, 2016, from http://community.advanceweb.com/blogs/nurses_18/archive/2011/05/03/clinical-workflow-analysis-process-redesign-part-1.aspx
McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
U.S. Department of Health & Human Services. (n.d). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/w orkflow_assessment_for_health_it_toolkit/27865
