4. Establish a Process for Delivering Preventive Services
Select Figure 4.1 for steps you can take (15 KB).
Now that you have developed a preventive care protocol, you will need a process to help you implement it. Although each setting has unique needs and the process may vary from one setting to another, your process should include the following steps:
Obtain Staff and Administrative Support
Support from staff and the administration is needed to successfully implement a process for delivering clinical preventive services. Support includes not only the cheerleading role but also the authorization for staff to expend time and resources. Although key staff, representing different areas of your setting, should be involved in the development and ongoing evaluation of your preventive services delivery system, an internal change agent or program champion should have primary responsibility for the program.
The ideal program champion will know the organization's history, personalities, abilities, authority figures, and decision-making process. This person will also have a wide social network within the organization and will be trusted and respected by both superiors and colleagues. This implies that the program champion should have excellent communication skills, especially listening skills.
Every system needs a program champion.
Consider Using Consultants to Provide Technical Assistance
Consultants can assist with the nuts and bolts of implementation. They add perspective, teach staff how to collect data and assess the organization, assist staff in overcoming organizational barriers, and facilitate planning and implementation efforts as needed by each practice. In facilitating implementation, consultants work closely with a person within the organization, such as a program champion.
Define Staff Roles
When you begin to incorporate a system for delivering clinical preventive services into your setting, you will be ready to divide responsibility for the delivery of these services among staff. The functions required to implement Put Prevention Into Practice (PPIP) can be shared in many creative ways. There is no "one way" to implement PPIP.
The worksheet (PDF File, 17 KB; PDF Help) lists several of the functions needed to implement PPIP. Have each staff member complete this worksheet and bring it to a staff meeting for discussion and decisionmaking.
Determine the Flow of Information and Materials
Based on your assessment exercises and review of the Worksheet for Delegating PPIP Functions Among Staff, complete the Revised Clinical Flow for PPIP to guide you in implementing PPIP. Completing this flow sheet will enable you to:
- Illustrate how the patient will move through the PPIP system.
- Note opportunities for patient interaction.
- Note when services will be delivered and documented.
- Determine appointment scheduling changes needed as a result of the new system flow.
- Follow the flow of a chart through the new PPIP system.
As you are completing the Revised Clinical Flow, note that when a procedure or protocol is changed in one department or work group, you will need to consider how this will affect other departments or work groups. For example, at one site, ordering more off-site screening created several additional tasks for staff members, such as following up to make sure patients went for tests, scheduling patients for appointments to receive their results, and confirming that the results were received before the patient's next office appointment.
See the following Sample PPIP Clinical Flow before completing the Revised Clinical Flow for PPIP.
Sample PPIP Clinical Flow
Patient Enters the Clinic for an Appointment
- The receptionist greets the patient, provides the patient with personal/medical history/insurance information forms, and introduces patients new to PPIP to the appropriate health guides and health education materials while they are waiting to see their provider. Returning patients are asked if they brought their health guides and if they have been using them. (See Chapter 6 for more information about PPIP health guides and other health education materials.)
- The nurse/health educator/medical assistant takes the patient into a private
area (e.g., office or exam room) to complete/review the health risk profile
(HRP) and starts the preventive care flow sheet and the appropriate risk-specific
education/counseling. Risks and counseling are documented on the flow sheet.
(Go to Chapter 6 for
more information about the HRP and preventive care flow sheet.)
- The nurse/medical assistant takes the patient into the treatment room and takes height, weight, and vital signs. The patient and staff discuss the results of the health risk assessment and the identified health risks.
- A reminder note is completed to alert the clinician to any areas needing to be addressed with the patient.
Patient Sees the Clinician
- The clinician/nurse/medical assistant/health educator reviews the health guide with the patient.
- The clinician sees the patient and addresses the areas checked on the reminder note. All recommendations and procedures (immunizations, screening, and education) performed are documented on the flow sheet/progress notes.
- The clinician writes referrals for off-site preventive services if needed.
- The clinician/nurse/health educator provides counseling on one or more identified health issues/behaviors and documents services provided on the flow sheet.
Patient Exits the Clinic
- The patient views educational posters and available materials when walking through the clinic.
- The receptionist/clerk receives pertinent followup information from the visit, distributes educational materials, and reminds the patient to use the health guide.
- The receptionist/clerk, while scheduling the new appointment, removes the tickler card from the chart and places it in the tickler file to mail at a later date.
- The receptionist/clerk schedules a return appointment for followup if the patient is scheduled for off-site testing or exams.
Ongoing Activities in the Clinic
- Clinic staff conduct periodic chart audits to assess delivery of preventive services and documentation. Results are shared with staff and used in performance evaluations.
- Regular meetings are scheduled for staff to reflect on implementation of preventive services.
- Staff functions are reviewed for effectiveness, and job descriptions are revised to include preventive care activities.
- Staff and patient feedback is routinely invited and reviewed.
- Successes are acknowledged and celebrated.
Use the information from the sample PPIP clinical flow to design your clinical flow. Use the following boxes to record each step of the clinical flow.
Revised PPIP Clinical Flow
Patient Enters the Clinic for an Appointment
Answer the following questions to help you complete the box above:
- How and when does your clinic identify which screening activities are up-to-date and which preventive services are indicated for your patients?
- Which staff members greet patients?
- Who guides patients through the clinical setting?
- Where do patients go and with whom do they interact?
- Whom do patients see before seeing the clinician? What information is collected or discussed at this time?
Patient Sees the Clinician
Answer the following questions to help you complete the box above:
- How does the clinician use the patient appointment to reinforce, educate, and counsel the patient on preventive care and positive health behaviors?
- How is the patient's preventive care monitored over time?
- What services are documented? How and where are services documented?
Patient Exits the Clinic
Answer the following questions to help you complete the box above:
- How does the staff obtain patients' feedback on their experiences in the setting?
- How does the staff demonstrate their interest in the patients' progress toward healthier lifestyles?
- How can the staff reinforce patients' positive behavior changes?
- What kind of monitoring system is in place to follow up with off-site screenings?
- What kind of reminder system is in place to follow up with needed screenings or counseling?
With collaboration and thorough planning, implementation is nothing more than taking those first steps toward achieving your goals.
As the experience of your staff members increases, your ability to respond to changes in the environment (such as managed care and population aging) will improve. Through changes in your delivery system and the empowerment of your patients and your staff, you will stand out as a competitive, healthy, and successful health care organization.
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