P008  Improving efficiency with a nurse driven immunomodulator lab monitoring tracking tool
Authors: Shari Frueh , Ashley Grinhaug , Kati Cavanaugh , Patricia Winzenburg , Desiree Tynsky 
Published: July 2019

BACKGROUND:
Immunomodulator medications are commonly used in the care of patients with inflammatory bowel disease (IBD). American College of Gastroenterology's and American Gastroenterology Association's IBD practice guidelines recommend routine lab monitoring during initiation of and ongoing medication therapy to avoid the risk of acute or delayed bone marrow suppression and/or liver toxicity. Within the IBD clinic at a large academic medical center, registered nurses (RNs) routinely monitor lab results of patients enrolled in a lab monitoring program. Lab results were previously monitored using an institutionally created guideline and messaging system within an electronic health record (EHR) that was being discontinued. The messaging tool was suboptimal and limited the RNs ability to view the total volume of patients in the lab monitoring program. Additionally, there was no efficient way to view lab due dates, differentiate internal vs external lab collection expectations, track patient's compliance with lab monitoring requirements, nor efficient tracking of patients requiring more frequent monitoring due to abnormal test results. Subsequently, these inefficiencies made it difficult for nurse leaders to assess the nursing workload associated with the coordination of care for these patients.

AIM:
The primary endpoint was to develop electronic tools specifically designed for immunomodulator lab monitoring, which would assist with RN efficiency in tracking a large volume of patients enrolled in the required lab monitoring.

METHODS:
Input was obtained by benchmarking with similar nursing workflows involving patients requiring close monitoring; and brainstorming with the RN team regarding essential elements to place within the report. Informatics colleagues assisted in the design and development of the electronic tools.

RESULTS:
Development of an immunomodulator-specific electronic tracking tool that is integrated into the new EHR. The closer tracking of patient adherence improves quality and safety for patients taking these medications. The new tool allows convenient access to the following information (was not previously available): Volume of patients enrolled, Due dates for required lab tests (delinquent or next expected result), Quick links to view lab results, At-a-glance way to see which patients are high priority for next lab results, Stratifying options to track patient enrollment by provider, specific drug prescribed, medication start date, internal/external lab location, pending enrollments and more. Additional outcomes included: Written standardized RN workflows, Defined RN training program and written reference guides, Adapting the standardized IBD tool for use within the hepatitis C and Hepatobiliary practices, Quantifiable data available for future analysis related to nursing workload.

CONCLUSION:
Development of a comprehensive EHR-integrated lab monitoring tool allows an IBD practice to more efficiently track patient adherence, which in turn improves quality and safety for patients taking these medications. Additionally, the report tool is an initial step toward better quantification of the nursing workload associated with the ongoing care coordination required with this patient population.