Date of Award
Projects: SPU Access Only
Doctor of Nursing Practice (DNP)
Background: Patients with inflammatory bowel disease (IBD) can benefit from Patient-centered Medical Home (PCMH) model adaptation (Regueiro et al., 2017). In order to become the PCMH organizations need to create a collaborative care team with clear role delineation and access to evidence-based clinical decision support (National Committee for Quality Assurance [NCQA], 2019). The registered nurse (RN) role is central to effective, team-based, patient-centered care. Empowering RNs to make clinical decisions and coordinate patient care while utilizing standardized tools can revolutionize the care delivered to the IBD patient population (American Academy of Ambulatory Care Nursing [AAACN], 2017; Bodenheimer et al., 2015).
Purpose: To present a feasible and sustainable quality-improvement process for the expansion of RN roles, which will lead to decrease in time needed to resolve incoming urgent telephone encounters by at least 50% by the end of the project implementation in April 2020.
Methodology: The study utilized the Institute for Healthcare Improvement (IHI) Model for Quality Improvement (QI) to implement standardized protocols for IBD patient care for RNs. The protocols were created with the collaboration of participating physicians and included standing orders for common urgent IBD-related issues. Using the protocols, RNs were able to make clinical decisions during telephone encounters with IBD patients experiencing an exacerbation of symptoms. Project implementation and data collection lasted two months. Data was collected from patient’s electronic medical records as well as anonymous on-line surveys.
Results: The length of time needed to resolve incoming telephone encounters, as compared to the pre-implementation period, decreased from the mean of 18 hours pre-implementation to the mean of 2.22 hours post-implementation. The decrease of time exceeded 50%, meeting the goal of this project. The analysis of the Likert scale responses regarding the confidence in RNs adopting the new protocol showed 'high confidence' within 80% RNs’ responses and "mostly confident" within 100% providers’ responses.
Conclusion: The implementation of the IBD RN protocol led to positive consequences such as improved timeliness in care, and enhanced clinic workflow. However, more research is needed to fully illuminate how implementing standardized protocols contributes to the care delivered to the IBD patient population.
Millar, Agata, "Empowering Registered Nurse Clinical Decision-Making in a Patient-Centered Medical Home Using Inflammatory Bowel Disease Protocols and Standing Orders" (2021). Doctor of Nursing Practice (DNP) Scholarly Projects. 13.