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Methotrexate standing orders boost nurse autonomy, reduce physician workload
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FORT WORTH, Texas — Rheumatology clinics that introduced methotrexate standing orders for nurses were able to successfully decrease providers’ workload, increase nurse autonomy and improve patient care, according to Carrie Brumbaugh, RN, BSN, CPN, of Children’s Hospital Colorado, Anschutz Medical Campus.
“We as nurses were doing a lot of managing of the physicians, as far as their labs and the medications, but we have many physicians who were all doing things completely differently,” Brumbaugh told Healio Rheumatology, while presenting a poster on her research at the Rheumatology Nurses Society Annual Conference. “That was very confusing, it was delaying care and was causing considerable nursing frustration — so I decided to make a nursing order that all of the doctors agreed to.”
To determine if the development of nurse-driven methotrexate standing orders could improve efficiency, Brumbaugh conducted a literature review of best practices and nursing guidelines. After determining that nurse-driven orders do in fact improve quality of care, Brumbaugh brought this research to the clinic’s physicians, who agreed to begin following a uniform procedure for how they order and follow up on patients’ safety labs. The physicians also agreed to the same frequency and prescription refilling procedure.
“We order the labs with this frequency 6 weeks after they start, 6 weeks after we change anything in terms of increases or changing it to subcutaneous, and then if everything is normal we stay every 3 months after that,” Brumbaugh said. “Then, if they are normal, we call the family and report that the labs are normal. If there are labs outside of this, the physician still has to review those; however, if the patient just has juvenile idiopathic arthritis, and they are on methotrexate, we can just call them and say, ‘Your labs are normal, you can continue with your medication, we have refilled it,’ and then tell them when their next office visit is scheduled.”
According to Brumbaugh, within 2 months of implementing the standing orders, nurses were able to accomplish 87.5% of encounters, and after 4 months they had taken on close to 100% of encounters. In addition, nurses and providers reported satisfaction with the implementation process and outcomes, Brumbaugh added.
“I interviewed all of the nurses and doctors after the standing orders were implemented — the nurses thought that this made them feel like they were doing what they were before, but it was safely within our scope and under our license because the doctors had signed off on it, instead of just flying by the seat of our pants,” Brumbaugh said. “The take-home message here is that if doctors want to decrease their workload and nurses want to work at the top of their scope, this is the way to go.” – by Jason Laday
Reference:
Brumbaugh C. Rheumatology nurse autonomy improves clinic efficiency. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure : Brumbaugh reports no relevant financial disclosures.