Creating a Flowchart
The sharing of information, as well as the amount of time spent during the admission process, are essential since they determine the effectiveness of the operations. Use of technology and various metrics to assess the process involved in the admission process can lead to a smooth workflow. Workflow design refers to process and activities that are organized in a particular set up that leads to provision of services to the service users (Cornell, Riordan, & Herrin-Griffith, 2010). The framework indicating the various procedures that are carried out can also be displayed in a flowchart that indicates the procedures involved in the process.
Explanation of the Flowchart.
The flowchart indicates the admission process that forms one of the day-to-day procedures in our psychiatric unit. The process commences with the patient being brought into the psychiatric unit. This is done by the emergency room technician and the security personnel. There is no technology utilized at this stage. The process is guided by the principle of eligibility for admission that is prompted by the assessment in the emergency department. The state of the patient–whether violent, calm, unconscious or restrained determines the manner unto which this stage is carried out.
The following step entails receiving the patient and taking of vital signs in the nurses’ desk outside the nursing station. This is carried out by the admission nurse and the mental health worker. The cardiac monitor is used to measure vital signs. The safety of the patient is also assessed by checking his belongings. This process is carried out to know the status of the patient during the entry period for admission as well as to guide other processes for instance, continuation with other admission processes or interventions in case of urgency in patients’ condition (Townsend & Morgan, 2017).
The patient is taken to the admission room where skin assessment and body checks are done. The patient is briefed on the various procedures and their significance on the care within the unit. The patient is examined, and the outcome of the assessment is recorded on the skin assessment form. This stage is carried out by a nurse or two nurses with the help of a mental health worker. This process is essential to determine any harm the patient might have inflicted on the body that would be evident from injury to the skin (Townsend & Morgan, 2017). The safety of the patient is being monitored continuously by checking on any hidden contrabands. The tool involved at this point is the assessment form with no use of technology.
Within the admission room, the patient is then interviewed. This is carried out by the nurse where history taking, as well as the mental health assessment, is carried out. The technology employed is the electronic health record (Cerner) that is being used to record all the information from the interview.
After the assessment, the patient is briefed about the unit, the expectations, the policies of the unit, expected length of stay and any question might then be addressed. This is carried out by the admission nurse with no use of technology. The following procedure will depend on the previous assessments. In the case that the patient was assessed with signs of active suicidal or with the intention of self-harm, the nurse can recommend one to one observation as well as contacting the doctor using a wireless telephone for further assessment and management. The process ends with the patient being shown the room and being taken around the unit for him or her to be familiar with the environment.
In the unit, various metrics are used to assess the entire process for its effectiveness. The admission error rate is critical in this assessment. The recorded vital signs, information recorded in the skin assessment tool as well as the keyed in information on the electronic health records are assessed on a daily basis to determine the errors that might have been carried out during the process (Cassel et al., 2014). The number of data errors per the number of admissions is usually determined. This enables the determination of bad data that is significant in the disruption of the care quality and safety. This method is effective in determining the situation of the admission process.
Another significant metric is the determination of the average time taken for the admission. With this process, the time each patient takes in the admission process is determined. It constitutes the time from the entry into the unit until the time the patient is allocated room and allowed to the unit for inpatient care. This is however done with consideration of patients’ condition as some may be violent or uncooperative and the normal channel may be modified to meet their situations. This method is, however, less effective in that it is affected by various factors.
Areas of Improvement.
With the introduction of the electronic health records, there is a significant improvement in the recording of patients’ information. However, there is still room for improvement in various areas that would make the workflow efficient. During the taking of vital signs, the electronic health records can be modified to connect to the cardiac monitor to allow direct recording of the patients’ details upon measurement. This will allow the admission nurse to receive the same information directly in the EHR.
In addition to connecting the vital monitor to the EHRS, the skin assessment tool can be incorporated into the electronic health record system to allow entry of data directly into the system instead of using the assessment form. Besides, the tool can be modified to have the expected results from the patients so that during data entry, the nurse assessing the patient will only be tasked with selecting of the relevant data instead of typing the results. This will save the time for documentation as well as having the information which can be shared with other healthcare providers or just within the unit with much ease.
At the same time, the electronic health record system can be equipped with the coding feature whereby in the case of an emergency or suicidal case, the nurse can code the patient red. The system can then give a signal like a pop-up followed by an alarm to the doctor for review. This can reduce the time spent for calling the doctor in the case of such events.
Being aware of the flow of activities is essential as it can form the basis of assessment with an established organization with an effective workflow design hence act as a form of evaluation framework (Huser et al., 2011). The knowledge of the workflow design also allows for better coordination among the players and assessment of areas which can be merged as well as areas that require change or merely being overhauled from the process.
The admission process in the psychiatric unit displays a workflow design that has incorporated the use of various tools such as the wireless devices and electronic health records to enhance its operations. The use of admission error rate and the admission time are vital metrics which has kept this system in check. This can further be improved by modification of the already existing system as well as conducting post-implementation assessment to ensure efficiency in the system.
Cassel, C. K., Conway, P. H., Delbanco, S. F., Jha, A. K., Saunders, R. S., & Lee, T. H. (2014).
Getting more performance from performance measurement. New England Journal of Medicine, 371(23), 2145-2147.
Cornell, P., Riordan, M., & Herrin-Griffith, D. (2010). Transforming nursing workflow, part 2: the impact of technology on nurse activities. Journal of nursing administration, 40(10), 432-439.
Huser, V., Rasmussen, L. V., Oberg, R., &Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC medical research methodology, 11(1), 43.
Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.
U.S. Department of Health & Human Services. (2012). Workflow assessment for health IT toolkit. Retrieved from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865