McGonigle and Mastrian (2018) define workflow as the visualized sequences of activities group into work processes, and the set of resources and people needed to complete a task. To achieve optimal workflow, healthcare organizations need to analyze the flow of work, in what McGonigle and Mastrian (2018) describe as process analysis. Workflow analysis involves identifying, prioritizing, and ordering the tasks and information required to achieve the clinical process’ desired result. Shahriar et al. (2019) posit that workflow analysis through flowchart helps identify areas for improvements, such as bottlenecks, redundant tasks/processes, lack of efficiency, and conformity with best practices. This paper aims to create and describe a flowchart for the medication process in the neonatal intensive care unit. Each step describes the task involved in detail, the person responsible for executing the task, policies under consideration, and information needed to move to the next step. Moreover, the paper describes the metric used and the expected areas of improvement.
Explanation of Flowchart
In the neonatal intensive care unit (NICU), there is a growing concern among healthcare professionals regarding pain management for newborns (Querido et al., 2018). Nurses use several pain management methods and routine procedures in the care of newborns hospitalized in the NICU, who undergo multiple painful procedures. Van Wielder et al. (2016) argue that little research has been done to determine EPMA’s impact in streamlining medical administration workflow activities, timeliness of medication administration, and interruptions. Despite increased awareness of analgesic use, neonatologists continue to experience challenges related to workflow activities and routine procedures when undertaking the pain management process.
At NICU, the pain management process begins when the nurse charge uses the Neonatal-Infant Pain (NIPS) scale, a behavioral assessment tool of pain for pre- and full-term neonates. According to Querido et al. (2018), nurses use the NIPS scale to assess behaviors described as indicative of distress or pain in infants. The indicative behaviors the nurse charge assess and puts a score in each are crying, facial expression, arms, legs, state of arousal, and breathing pattern. If the infant scores more than 2 points on the indicative behaviors, the nurse charge takes the assessment report to the NICU nurse-in-charge, who then enters the details in the computer and sends them to the physician. The physician attempts to identify the source of pain using examination and observation techniques, such as induced crying, analgesic positions, avoidance, and postoperative assessment. After diagnosing the source and cause of pain, the physician decides whether a procedure is to perform neonatal pain relief measures and measures. The prescription is recorded on the prescription paper and given to the nurse assistant, who takes it to the pharmacy department. Pharmacists then record the prescription in the computer and give the nurse assistant necessary medication. As soon as the nurse assistant gives the infant the medication, the nurse-in-charge then electronically documents the prescription activity in the infant’s official medical records. After 15 minutes of intervention, the nurse assistant repeats the pain assessment procedures using the NIPS scale and document the final scores.
The Metric
McGonigle and Mastrian (2018) define the metric as a tool used to evaluate the workflow process’s performance. The current pain management process allows newborns to undergo tedious, long, and painful pain management procedures. The list and the number of healthcare practitioners needed to complete the pain management process are quite long. Equally significant is that the large part of the workflow processes is manual. Nurses and physicians move between patient beds, medication lockers to the medication trolley, and back and forth to the treatment room to prepare and retrieve medication. Thus, nurses have to walk long distances to collect necessary tools for diagnosing, prescribing, and administering medication to infants. Also, the pain management procedures and tools are prone to transcription errors, in-appropriate ordering, untimely transfer of orders from the pharmacy to the words, illegible handwriting on charts and prescriptions, and errors in calculating specific medicine doses.
Areas of Improvement
Mekhail et al. (2019) posit that the healthcare industry continues to rely on the electronic prescribing and medication administration (EPMA) system to improve patient care and safety by eradicating medication errors and simplifying prescribers’ identification. The NICU management needs to install the EPMA system, which supports electronic medication administration and management in clinical practices. After the physician prescribes medication needed for pain intervention, s/he should record the prescription electronically and transmit it to the pharmacy department’s system. The electronic system will process the prescription dispensation and send a short message (SMS) to the nurse-in-charge to take it to the ward and administer it to the infant. The ePrescribing system will electronically record the entire pain management process. After using the “spaghetti diagram tool to assess the medication administration, workflow, and activities, Van Wielder et al. (2016) recommends that installing an EPMA system that integrates existing trust systems, such as PAS, pharmacy, and finance, and electronically discharge notifications to relevant healthcare practitioners. The EPMA system will significantly reduce drug round duration, interruptions, and improve timeliness and efficiency in medication administration activities and workflow processes.
Summary
Workflow analysis plays a vital role in improving patient care and safety. The analysis, through the “spaghetti” diagram, gggidentifies the bottlenecks in the workflow process and procedures that hamper effective and efficient pain assessment and treatment of hospitalized newborns. Ideally, the workflow analysis depicts NICU as a “beehive” of activities, as nurses and physicians spend most of the time walking around to look for tools needed to actualize the pain management process. However, installing the EPMA will significantly reduce assessment and medication workflow and activities and drug round duration at NICU. The EPMA systems are designed to reduce risks associated with conventional methods of administering and prescribing medicines.