Primary care workflow process mapping of medication-related activities performed by non-provider staff: A pilot project's approach.

BACKGROUND: A workflow process mapping approach was previously developed to understand the impact of primary care medication use processes on medication safety. The workflow process mapping approach was applied to a pilot project in one primary care practice.

OBJECTIVES: The objective of this article is to: (1) exemplify how workflow process mapping was implemented in one primary care practice to characterize medication safety issues (i.e., critical workflow gaps/deviations), (2) discuss the identified critical medication safety workflow gaps and deviations, and (3) summarize the pragmatic, practice-level recommendations developed to enhance practice-level medication safety.

METHODS: Four medication-related activities were directly observed, including: (1) medication reconciliation, (2) warfarin medication management, (3) vaccination administration, and (4) medication renewal requests. Observations occurred with registered nurses, medical assistants, and telephone operators. An ideal-state and observed workflow process map was created for each medication-related activity and was compared to identify critical medication safety workflow gaps and deviations. Practice-level recommendations were developed to enhance workflow and medication safety across all medication-related activities.

RESULTS: 111 medication-related observations were recorded over 6-weeks across all 4 workflows (100 observation hours). A total of 17 critical workflow safety gaps, 9 critical workflow step deviations, and 9 workflow sequence deviations were identified. Seventy-six percent of total workflow gaps resulted from inappropriate medication verification. Most workflow step deviations (33%) were due to inappropriate documentation, whereas most sequence deviations (44%) stemmed from inadequate medication verification. Practice-level recommendations to enhance warfarin medication safety were prioritized and implemented prior to the completion of the pilot project.

CONCLUSION: The results of this workflow mapping pilot project exemplify the need to enhance primary care medication safety for workflows conducted by non-provider staff members in primary care practices. Additionally, this approach can be used to identify opportunities for primary care pharmacist integration, particularly for practices with little or no prior pharmacist involvement.