1. Re-engineering the Prescription Refill Process in the Ophthalmology Practice
Participants:
Jean Bruggemeier, RN
Geoffrey Emerick, MD
Marilyn Hauser, MBA
Nancy Quandt, RN
Peggy Squires, LPN

2. Opportunity Statement and Desired Outcome
To decrease patient wait times for prescription (Rx) refill responses to within 24 hours by eliminating the barriers associated with the processes and mechanisms currently in place to refill prescriptions. To improve patient satisfaction scores
Our goal is to maximize patient satisfaction by reducing the wait time for Rx refills.

3. Most Likely Causes for Current Opportunity
Inconsistent communication to patient when call is taken from voice mail
Patient frustration that refill request is not being acknowledged
Multiple phone calls from patient and pharmacy
Multiple inquiries (phone/fax) regarding same refill
Wait time for charts requested from medical records
Lag time in resident review of request

4. Solutions Implemented
1) Developed Ophthalmology specific refill guidelines enabling triage nurse to automatically refill prescriptions meeting certain specific criteria within 24 hours.
2) Improved communication with residents
3) Have on-site attending physician sign refill orders that fall outside of the policy guidelines when there is a resident delay

5. Progress to Date Opthalmology Prescription Refill Turnaround Time
09/03/2003
09/09/2003
09/15/2003
09/22/2003
09/30/2003
10/06/2003
10/13/2003
10/20/2003
10/27/2003
11/07/2003
11/10/2003
11/17/2003
11/24/2003
12/01/2003
12/08/2003
12/15/2003
12/22/2003
12/29/2003
01/05/2004
01/12/2004
02/17/2004
02/23/2004
03/02/2004
03/08/2004 1 2 3 4 5 6 7 8
Mean = 3.11
Mean = 1.36

6. Progress to Date (cont.)
Patient Satisfaction Scores
Return Calls 65 70 75 80 85 90
CY02 Q3 Q4
CY03 Q1 Q2
Score

7. Results and Analysis
Significantly improved patient satisfaction scores
Increased triage nurse’s autonomy in completing refill process in a timely manner
Decreased triage nurse’s time spent processing refill request
Shortened lag times to refill prescriptions

8. Results and Analysis (cont.)
Increased residents’ awareness of issues surrounding prescription refill barriers
Decreased physician and resident time required to review all prescription refills

9. Conclusions
By taking a process, identifying issues, developing a plan, and implementing a protocol, we were able to significantly improve patient satisfaction and decrease time involved in refilling prescriptions.

10. Next Steps Validate process changes and outcomes Continue monitoring
prescription refill turnaround times
patient satisfaction scores for return calls
Implement electronic medical record (EPIC) to eliminate paper chart retrieval lag time
Refine the process for outliers so that all prescriptions are refilled within the 24 hour target