Real world examples of the benefits of doing work flow analysis and process redesign

[rninformatics, DNP, RN]

Can anyone share their real world stories about what happens when work flow analysis and process redesign are NOT done before implementing new systems?

I'm not interested in the text book rational for the use of this best practice but more intereted in hearing from you who are actually out there in the trenchs doing the implementations, the training, the testing related to putting new systems in place.

What stories can you tell about what happens if work flow analysis and process redesign are not done (or done badly) PRIOR To implementing a new bar code medication administration system, a CPOE system, a new clincial documentation system or any other system?

Please share your experiences by posting here.

[nungum]

I remember when we went live with our bar code medication administration in the PACU, it was definitely a challenge. When we receive a patient right out of surgery, we require meds ASAP. We couldn't wait to have the orders scanned/faxed to pharmacy and then be able to access it in the accudose. On top of that, the EMAR scanning page was in a separate area so we had to get completely out of our assessments menu and into the EMAR so that was more time consuming. We were told that as long as our orders had a STAT sticker on it, then pharmacy staff would know to get those processed first. I don't think they were quite ready for the volume of orders that we were sending them because it was a constant hurdle between scanning, waiting, checking accudose for meds, not seeing it, calling pharmacy, waiting, checking accudose, still not seeing meds, waiting etc etc. Some meds we were able to just override and get out right away but we were discouraged to do that as much as possible. When you're giving multiple meds every 5 min while stabilizing a patient just out of surgery, it's nearly impossible to go to the EMAR page every time, scan the patient, then the med, then get a message saying meds need to be verified, then repeat the whole process again after verifying the meds, then finally able to give the meds. We pretty much had to just give the meds and write down the time and what we gave and go back later when we had a chance to document. That pretty much defeats the purpose of the EMAR. Overall it was a more time consuming task to do but of course like with anything else, all the bugs and frustrations were minimized over time and everyone got used to the flow of it. There were some things that couldn't be changed but we all just learned to accept and deal with it.