A Quality Improvement Initiative To Remodel Medication Refill Processes In A Pediatric Cystic Fibrosis Clinic
BACKGROUND: For CF patients, poor medication adherence contributes to health exacerbations and hospitalization. Both patient and healthcare provider factors impact medication adherence. According to a January 2018 survey, our patients reported receiving timely refills 57% of the time.
PURPOSE: A quality improvement study assessed the healthcare provider factors that may contribute to the slowness of refill requests.
MATERIALS AND METHODS: Using fishbone modeling and flowcharts, current medication refill processes were documented. Fishbone modeling identified the people, environments, and equipment/materials involved in the process. Flowcharts documented the refill processes when received via telephone and at appointment. Surveys were completed by the CF team regarding time spent refilling medications, level of work stress and morale/attitude.
RESULTS: Multiple team members were involved in the processing of medication refill requests. Our 0.33 FTE nurse spends 3.3 hours of designated 13.2 CF work hours addressing refill requests. Other providers spend approximately 30 minutes per week addressing refills. Our team believes our inefficiency contributes to our work stress and morale/attitude. Seventy-five percent of our team stated work as "very stressful" or "somewhat stressful". More than 80% of our team identified work morale/attitude as "fair" or "poor".
DISCUSSION: Due to inefficiencies of our refill process, multiple individuals were involved during a single refill request. Additionally each individual was not consistently available due to scheduling to track an individual request over time. A standardized protocol will be implemented with one team member addressing all requests. Pharmacies will be called to verify refill needs.