Decisions From East Cluster 1/28/2009

Regarding flow nursing outreach responsibilities in the East Cluster, at today's meeting we decided on the following points:

The one page sheet that summarizes the flow nurses' outreach responsibilities lists a variety of quality indicators that can be organized as to how the nurses will approach outreach.

Immunizations for Children. There is a statewide electronic database (Child Profile) that tracks completion of immunization rates for Washington's children. Becky is presently arranging for several nurses to get access to this database. If this is successful, our first effort at updating immunization rates will involve flow nurses looking up patients listed as behind on immunizations and making sure in the database that they have not already received the immunizations outside of Group Health. For now, this will be the main outreach effort in this category.

Tests (includes A1C, LDL measurement, microalbuminuria testing). Flow nurses will put in standing orders for these tests to be done on all patients who are due for testing. The flow nurses will do two things: 1) pending standing orders; 2) using the update and file feature on a chronic care medication that will likely be filled soon, they will use a dot phrase in the notes section of the pharmacy ordering field to ask the pharmacist at the time of medication pick up to ask patient to get appropriate tests.

Cancer Screening. We will draft a dot phrase letter that alerts patients of the need for mammography, cervical cancer screening, and colorectal cancer screening. Flow nurses will send these letters out to patients in need, deleting the sections that do not apply to them. Our outreach efforts for cancer screening will be limited to these letters.

Of note, in none of the above outreach efforts, are our flow nurses doing cold calls on patients.