Clinic nursing workflow redesign for colorectal surgery education

The purpose of this Doctorate of Nursing Practice (DNP) project is to create a nursing workflow redesign for education of patients scheduled for colorectal surgery at a Midwest integrated health system with a goal of improving patient outcomes and confidence in post-surgical self-care. The process will incorporate the use of the "Teach-Back" model for patient education, follow-up telephone calls, standardized workflow, standardized electronic health record (EHR) documentation, and the use of Krame's On Demand (KOD) educational materials. The project used an inter-professional General Surgery Clinic (GSC) team including certified medical assistants (CMAs), registered nurses (RNs), surgery schedulers, information technology (IT) staff, surgeons, and management to implement this innovative plan. Twelve patients were educated using the new clinic nursing workflow; however, two patients were removed from the project due to a cancelled surgery and a move to a different level of care. Using the new workflow, 100% of patients seen in the GSC were educated during normal business hours from May 2013 through August 2013. The RNs completed 100% of education documentation and collected 100% of the preoperative Self Efficacy surveys (SES). The challenges of the new workflow were noted in the post-education and post-discharge telephone calls, related documentation, and the collected of postoperative survey collection. The project team expressed that a reminder within the EHR about the telephone calls would have been helpful and would have resulted in completing this task.