Flow Nurse Chronic Condition Testing Outreach Responsibilities

Flow Nurse Chronic Condition Testing Outreach Responsibilities
East Cluster, Burien Medical Center

For a given patient overdue for hemoglobin A1C, LDL, or microalbuminuria testing, the flow nurse will do the following:

• Open an orders encounter and pend standing orders for all three tests if the patient is diabetic or LDL alone if the patient has heart disease but not diabetes. Choose different intervals depending on the test: Hemoglobin A1C = 12 weeks; LDL & microalbuminuria testing = 26 weeks.

• Create a smart phrase in your personal smart phrase folder that says the following: “.m .lname is due for the following tests: ***. Standing orders already exist for these tests at the lab. Tell patient that .he must go to the lab in order to refill .his medications. .He does need to be fasting.”

Note: there was some discussion about the ability to create standing orders for longer than a year, but according to CIS: "the Office of Inspector General (OIG), Model Compliance Plan requires that the plan of care be reviewed every year," and thus prohibits standing orders beyond one year.

• Locate a chronic condition drug for the patient that corresponds to the kind of test that is overdue. Identify a drug that is most likely to be filled next by looking at the date of the last fill. For example, if a patient is overdue for hemoglobin A1C or microalbumin (tests related to diabetes), you would ideally pick a diabetes drug like metformin or glyburide that will be filled soon. If a patient is overdue for LDL testing, you would ideally pick the statin drug. If there is not an appropriate drug, simply pick a drug that is going to be filled soon.

• Within the orders encounter, re-order the drug (or drugs) that you have identified and label them as “update and file.” When you clicked on the drug itself in order to label it “update and file,” you opened a comments field in the middle of your screen.

• In the comments section, insert the smart phrase listed above, listing the drugs that will need to be completed in the ***. This comments section is always seen first by pharmacy staff when filling a prescription and it will prompt them to notify the patient of the need to get testing done.